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How Does It Work?

Insurance Claims

An introduction paragraph about Insurance Claims

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Definition of Claim in insurance: A formal request or demand by an insurance policy holder to have their insurer indemnify them after a loss.

After the large hail storm in Brisbane destroyed her home, Lucy lodged a claim under her insurance policy to take care of the hail damaged roof repairs and replacement of damaged rooftop solar panels.

What is an insurance claim?

When an insurance policy holder (the insured) suffers a sudden and unexpected event that costs money to rebuild, repair or replace, this is considered a loss. In the event of a loss, a policyholder can compel their insurer to compensate them for any loss incurred. This request is what we call an insurance claim.

An insurer’s main objective is to restore the insured back to the financial state they were in before the loss occurred. This process is referred to as indemnification. When the loss is caused by an event covered under the insurance policy, the insurance company is obligated to indemnify by paying for the exact value of the loss in accordance with the cover—no more, no less as long as the insurance claim is within the limits of the insurance policy.

How does an insurance claim work?


Large hail destroyed Tim’s home during the severe hail event in Bribie Island QLD last year. It’s going to cost thousands of dollars to repair his hail damaged roof, fences, and the house’s exterior like his deck, trampoline, barbecue and patio furniture. Luckily, Tim’s home insurance policy covers him against damage caused by hail and other severe weather events. The week after the Bribie Island hail storm, Tim contacts his insurer to lodge an insurance claim. Tim expects the insurer to assess the damaged caused by the large hail and then finance the repair of all the hail damage, so he’ll return to the same financial state he was before the hail storm.

When you suffer an unexpected loss, you will want your insurer to shoulder it. However, insurance coverage can sometimes be limited by what’s included in the insurance policy.

Insurers have the obligation to protect thousands of customers and hence they cannot pay for what is not covered out of kindness.Insurance companies design their coverage with the aim of safeguarding its customers, but not covering to the point of going out of business, or being compelled to charge exorbitant premiums.

When a policyholder like Tim lodges a storm damage insurance claim, the insurer may assign a loss adjuster to handle the individual claim on behalf of the insurance company.


Mary is a loss adjuster working for Tim’s insurance provider. She receives his call in the aftermath of a Brisbane hail storm and records all the details provided by Tim about the destruction from the giant hail in Brisbane that damages metal roofs. She assures Tim that the hail damage caused to his home would be covered, but not the contents of his home. This is because his insurance policy offers comprehensive coverage for the home, but excludes his possessions (contents) from some specified events leading to loss. The policy does not indicate hail damage as one of the perils (catastrophic events) for his contents.

After suffering a substantial loss such as damage caused by a severe storm or fire, ascertaining the true value of coverage can be challenging. Using Tim as an illustration, he wants his insurance company to compensate him for everything that was damaged or destroyed. Yet, the insurance policy he chose clearly states that only his home (excluding the contents in it) is safeguarded from hail storm.

Tim lodged a claim for everything that the giant hail storm damaged in Brisbane home. When the insurance companies loss adjuster came into the picture, she adjusted the claim to include only what was included in the insurance policy; his hail damaged roof, damaged fencing, siding, deck, trampoline, barbecue and patio furniture. With that settled, the insurer takes care of repairing the damage to Tim’s home. Unfortunately he gets stuck trying to replace the home contents destroyed by the hail storm.

Insurance companies adopt different ways when it comes to ascertaining the value attached to a property or asset, depending on the type of insurance policy one chooses. One of the ways used is the replacement cost basis. Replacement cost coverage is where the insurance company pays the total cost of replacing the particular item with a similar but new one.

The other method is the actual cash value basis, where the insurance company compensates for the full cost of the item at the time the loss occurred, putting into consideration its age and current condition. Such bases are included in every policy. It’s the work of the loss adjuster to determine the base applicable to each claim.

On the other hand, liability claims are considered more complex though they are similar in a way. Here, instead of paying to repair or replace a property, the insurance company takes care of compensatory damages and the legal fees.

As the names insinuate, compensatory damages are simply meant to compensate the victim, while punitive damages are designed to punish the offender. Notably, home insurance policies exclude punitive damages.

When it comes to liability claims, the insurer has to still ascertain what’s covered and at what value, however, a legal process exists that guides the process before the true values are known.

Whats is involved in the claim process?

If you have suffered a loss and believe the event is covered in your insurance policy, be sure to commence the claims process as soon as possible. While the claims process can seem daunting to you, four the team at Insurance Claims Group it’s quite straight forward.

Step 1: Let us know about your potential loss as soon as you can.

You can contact us online via the dedicated chat, web form or by calling us. You will be connected with one of our experienced claims professionals who will record the details about your loss to determine what is required to successfully lodge your claim.

Step 2: Our experienced claim handler will book a storm check assessor immediately on behalf of you.

As part of our service, you will access a specialised storm check assessor who will come out to observe the loss and damages, often picking up on items that you may not identify yourself. This exercise is thorough and includes an eighteen point checklist which covers top to toe of your property.

Step 3: A new claim will be lodge with your insurer.

With the information gathered, our experienced claim handler will lodge a claim with your insurer. Once the claim is received and processed, the insurer will arrange a loss adjuster who will be assigned to your claim throughout the process.

Step 4: The insurer palms the claim off to a Loss Adjuster.

When you handle your own claim, you will be expected to provide the loss adjuster with detailed information regarding the loss and damage. So be prepared to put your expert cap on. Understandably, you will likely miss some important details that do fall in your personal interest and this can devalue your loss and minimise a claim. Alternatively, revert back to Step 1 and get in touch with us. After all, it is our job to at all times act in your best interest and when we apply the years of industry experience coupled with the Insurance Claim Group professionally engineered process, naturally you will be accessing what you are entitled to. And for the record-We do not consider this to be maximising your claim, rather meeting exactly what you are entitled to. You can rest assured that the whole process will be simple for you.

Step 5: The loss adjuster will then investigate the claim on behalf of the insurer.

The adjuster might visit the scene of damage or send someone to do so for them. A hail damaged metal roof claim may result in a Loss Adjuster appointing one of their approved licensed builders to report on the damage. Don’t worry, you do not have to pay for this. The insurer typically pays the builder to attend and produce a report for them. If you run the gauntlet on your own, be prepared. It is here where you will likely be called upon to help them identify witnesses or any other party with relevant information. Your adjuster advises what is needed from you to successfully complete the investigation process.

Step 6: Insurance coverage is ascertained.

Armed with required details and information, the loss adjuster will evaluate your insurance policy to check if your loss or the event leading to the loss was full, partial or not covered at all. Most insurance companies will let you know in writing what your policy covers, the total amount and applicable deductions if any.For Insurance Claims Group, this is where we get busy for you. Armed with years of experience and backed by the detailed supporting evidence, our claim handlers will take the brunt of what most claimants consider to be a waring down and daunting process.

Step 7: Repair or replacement

When we can agree on the coverage, the indemnification process will begin. Smaller claims such as a dented letterbox may be as simple as your insurer buying you a new one and that’s it (check next step).The more complex losses may demand the involvement of a licensed contractor. It is here where the assigned loss adjuster may recommend several contractors that you can engage for any repairs or replacements.Insurance Claims Group act on your behalf and share a similar approach to complete the repairs. The difference is that you are not on your own and in most instances, the licensed builder is known to you already and has been working with you throughout the claim process. The builders in our network are not only licensed to complete the repairs, but they are heavily experienced with storm support services, hail that damages metal roofs, rebuild relief and storm damage restoration. Like us, our recommend builders rely heavily on their exceptional workmanship too.

Step 8: Final settlement.

Once the value of the settlement meets the repairs and or replacements set out in the scope of the works, your insurer will settle your claim by paying you the full settlement amount which is equal to the that’s been agreed for the total repair costs. For more complex claims, this step may call for negotiations between the insurer and the insured regarding who should pay and for what. If the insured agrees with the insurer’s offer, then the insurance company will transfer the funds electronically to your nominated bank account before closing out the claim. If the policyholder disagrees with the insurer’s offer, you are within your right to lodge your concerns via the insurers dispute resolution process. Alternatively, call one of our experts who are experience in this area and will take the rains for you.

Will my premium increase after a claim?

Filing a claim can result in increased insurance premiums but this isn’t just for you. If this happens, the premium increment is determined by your insurance company and is likely based on the proximity of the event, weather you lodge a claim or not. As of now, there is no transparent standard method for this.

Why? Insurance premiums are a result of complex calculations that take into consideration many factors.

All policyholder’s claim statuses are just one of the determining factors.

Some insurance companies are known to give discounts to their clients that they consider claim-free; hence filing a claim changes this status, leading to an increase in premium. Some insurers offer a freebie for first claims, as long as it’s insignificant.

The type of insurance claim is another factor to be considered. Damage caused by a lightning strike during a storm may not lead to an increase in premium since it’s an uncommon event that’s unlikely to reoccur.

On the other hand, water damage caused by large hail that’s penetrated the roof, like seen recently in Springfield Lakes is likely to result in increased insurance premiums. Hail penetration could be an early sign of problems with the roof and the structural integrity, and water damage results in mould which causes a larger risk that can potentially lead to health problems for the residents.

Such factors make it risky to insure the home, hence the insurance company is likely to increase their premiums.

Ultimately, we recommend that you speak with one of our experienced claim handlers first. All consults and the storm checks are free. Even if you can afford to repair a fence that fell due to strong winds, it would be wiser to get the experts in. You don’t want any surprises when you don’t expect it. Like when you are selling your house for instance.

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