Indemsure

INDEMSURE
Processes and Procedures Manual

Claims
CONTENTS
Introduction ................................................................................................................................................ 7
Definition of a ‘claim’ ............................................................................................................................................ 7
The objectives of this claims manual .................................................................................................................. 7
Insurance Contracts Act 1984 ........................................................................................................................ 7
Privacy Principles ....................................................................................................................................... 7
Indemsure front-end claims........................................................................................................................ 8
Overview ................................................................................................................................................................ 8
Claims handling procedures ....................................................................................................................... 8
Our mission: .......................................................................................................................................................... 8
Our rules of conduct ............................................................................................................................................. 8
Claims authority limits ................................................................................................................................ 9
Claim types that Claims Handlers do not have authority to manage ................................................................ 9
Simple claims........................................................................................................................................................ 9
Complex and non-routine claims ...................................................................................................................... 11
Claims authority assessment and approval process...................................................................................13
What is the assessment and approval process? ............................................................................................... 13
Does one Claims Handler’s claim authority flow on to their replacement when they leave? ........................ 13
What authority level applies to a Claims Team when a Claims Handler takes annual leave?....................... 13
How often is the claims authority level of a Claims Handler reviewed? ......................................................... 14
What happens when a Claims Handler authorises a claim above their approved authority level? ............... 14
Claims Handlers without claims authority ........................................................................................................ 15
When claims authority may be revoked ............................................................................................................ 15
Indemsure National Claims Teams.............................................................................................................15
Contact Details .................................................................................................................................................... 16
Claim documentation ......................................................................................................................................... 16
General Insurance Code of Practice ...........................................................................................................17
Purpose of the code ............................................................................................................................................ 17
Types of policies governed by the code ............................................................................................................. 17
Performance standards required by the Code .................................................................................................. 17
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Complaints and disputes ............................................................................................................................27
What is a complaint? .......................................................................................................................................... 27
Responding to a complaint ................................................................................................................................. 27
What is a dispute? ............................................................................................................................................... 27
Declining a claim ................................................................................................................................................ 27
Content of the declinature letter ....................................................................................................................... 28
Await a possible challenge from our customer to the declinature ................................................................. 28
Internal Dispute Resolution (IDR) process ........................................................................................................ 28
The Financial Ombudsman Service ................................................................................................................... 28
Key claims practices ..................................................................................................................................28
Two people are needed to process a claim ....................................................................................................... 28
Claims Teams ‘buddy’ system ........................................................................................................................... 29
Indemsure preferred suppliers and repairers .................................................................................................. 29
Adequate product knowledge ............................................................................................................................ 29
Standard letters .................................................................................................................................................. 30
Educate your customer to contact you for claims direction ............................................................................ 30
Ensure all mail is date stamped upon receipt .................................................................................................. 30
Identify paid invoices .......................................................................................................................................... 30
Claim files ........................................................................................................................................................... 30
Registering a new claim .............................................................................................................................31
Claims checklists ................................................................................................................................................ 31
A claim must be lodged promptly ...................................................................................................................... 31
The TeleClaims process .............................................................................................................................32
What is TeleClaims? ........................................................................................................................................... 32
How does TeleClaims work? .............................................................................................................................. 32
Who can use TeleClaims? .................................................................................................................................. 32
Claims management procedures ...............................................................................................................32
What is ‘managing’? ........................................................................................................................................... 32
Managing starts on day one ............................................................................................................................... 33
Communication protocol .................................................................................................................................... 33
Checking premiums are paid in the Claims Workflow System ....................................................................34
Monthly premiums .............................................................................................................................................. 34
Unpaid monthly instalment premiums .............................................................................................................. 34
Unpaid annual premiums ................................................................................................................................... 34
Monthly premiums .............................................................................................................................................. 34
Estimating ..................................................................................................................................................35
Applying the policy excess .........................................................................................................................35
The Claims Workflow Diary ........................................................................................................................36
When is original documentation required?.................................................................................................36
Proof of ownership .....................................................................................................................................36
Authorising a payment ...............................................................................................................................37
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Cheque payments .......................................................................................................................................38
Cancelling a cheque that has been returned to you ......................................................................................... 38
Cancelling a cheque that is not in your possession .......................................................................................... 38
Replace or cash settle? ...................................................................................................................................... 38
Late notification of a claim ................................................................................................................................. 39
File notes on the Claims Workflow System ................................................................................................39
The file must always ‘speak for itself’ ............................................................................................................... 39
Recording phone call discussions ..................................................................................................................... 39
New claim with partial form completed ............................................................................................................ 40
Claim payments..........................................................................................................................................40
Finalising the claim ....................................................................................................................................40
The policy excess .......................................................................................................................................41
What is an excess?.............................................................................................................................................. 41
Collecting the excess .......................................................................................................................................... 41
Paying an excess by cash, credit card or cheque ............................................................................................. 41
GST procedures ..........................................................................................................................................41
What is GST? ....................................................................................................................................................... 41
Input tax credit .................................................................................................................................................... 42
The GST questions we ask our customer .......................................................................................................... 42
Why is the ITC information so important? ......................................................................................................... 43
How does the GST affect our customers? ......................................................................................................... 43
How does the government collect GST? ............................................................................................................ 44
Registering a new claim ..................................................................................................................................... 44
Acquisition or settlement ...........................................................................................................................44
Acquisition ........................................................................................................................................................... 44
Settlement ........................................................................................................................................................... 45
Cash settlement—property total loss ................................................................................................................ 46
Claiming acquisitions payments ........................................................................................................................ 47
Claiming settlements payments ........................................................................................................................ 47
Finalising settlement .................................................................................................................................49
Settlement release ............................................................................................................................................. 49
Settlement payments ......................................................................................................................................... 51
Processing a payment ................................................................................................................................51
Role of the Loss Adjuster ...........................................................................................................................54
Circumstances requiring the appointment of a Loss Adjuster ........................................................................ 54
Appointing the Loss Adjuster ............................................................................................................................. 55
Appointing the Loss Adjuster whilst the claim is being lodged ....................................................................... 55
Appointing the Loss Adjuster after the claim has been lodged ....................................................................... 56
Changing the Loss Adjuster after the claim has been lodged ......................................................................... 56
The role of the Loss Adjuster ............................................................................................................................. 57
Managing the Loss Adjuster............................................................................................................................... 57
Checking the Loss Adjuster’s fee ...................................................................................................................... 58
Loss Adjusters—panel and service standards .................................................................................................. 58
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Management of property claims .................................................................................................................60
Settlement options: replacement value or indemnity value? .......................................................................... 62
Arranging for the item to be repaired ............................................................................................................... 64
Replacement of goods ........................................................................................................................................ 64
Types of claims ..........................................................................................................................................66
Burglary and theft claims ................................................................................................................................... 66
Claims for damage to buildings and contents .................................................................................................. 66
Fusion, machinery breakdown and electronic equipment claims ................................................................... 67
Money claims ...................................................................................................................................................... 67
Glass claims ........................................................................................................................................................ 68
Jewellery claims ................................................................................................................................................. 68
Motor vehicle claims ..................................................................................................................................70
Who will manage the claim? .............................................................................................................................. 70
Motor vehicle claims exceeding the delegated level of authority .................................................................... 71
Indemsure Heavy Motor Assist .......................................................................................................................... 71
Vehicle-to-vehicle collisions—when to apply the excess ................................................................................. 71
When the customer’s vehicle damages their own property ............................................................................. 71
‘Cause’ and ‘At Fault’ fields in the Claims Workflow System .......................................................................... 72
Damage to farm machinery ............................................................................................................................... 72
Vehicle hire costs ................................................................................................................................................ 72
Preferred supplier of rental passenger vehicles .............................................................................................. 73
How to arrange a Pacificar hire vehicle ............................................................................................................ 73
Report-only claims .....................................................................................................................................74
Cash in lieu of repairs settlements.............................................................................................................74
Windscreen claims .....................................................................................................................................74
The importance of local law relating to road rules .......................................................................................... 74
Summary of the windscreen claims procedures .............................................................................................. 74
Total loss claims ........................................................................................................................................76
About Indemsure recommended repairers ...................................................................................................... 76
Who appoints approved IRRs ............................................................................................................................. 76
How does the assessment process begin? ....................................................................................................... 77
Types of assessments ........................................................................................................................................ 77
Desktop assessment .......................................................................................................................................... 77
Digital assessment ............................................................................................................................................. 77
On-site inspection ............................................................................................................................................... 78
Authorising repairs ............................................................................................................................................. 78
Paying the repairer ............................................................................................................................................. 78
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Other claims scenarios ...............................................................................................................................78
When the customer’s claim is denied ............................................................................................................... 78
When additional damage is discovered ............................................................................................................. 78
When additional damage is discovered by the IRR ........................................................................................... 79
When the repairer is not an IRR......................................................................................................................... 79
Flowchart for motor claims ............................................................................................................................... 79
Insurance claim cheque drawing ....................................................................................................................... 80
Incidental salvage ............................................................................................................................................... 80
The Indemsure recovery process (IRP) ............................................................................................................. 81
Claims audits and customer surveys ................................................................................................................ 81
Ex gratia payments ............................................................................................................................................. 81
Claims fraud ...............................................................................................................................................82
The cost of claims fraud ..................................................................................................................................... 82
Indemsure policy on fraud ................................................................................................................................. 82
What is claims fraud? ......................................................................................................................................... 82
Types of claims more likely to be fraudulent .................................................................................................... 83
What is claims non-disclosure? ......................................................................................................................... 83
Parents insuring their children’s vehicles in their own names ....................................................................... 83
How will I know if a claim is fraudulent? ........................................................................................................... 84
Claims that may be fraudulent are to be referred to the Investigations Team ............................................... 84
The importance of carefully examining documents ......................................................................................... 84
Informants ........................................................................................................................................................... 85
What is an informant? ........................................................................................................................................ 85
When you receive a phone call from an informant ........................................................................................... 85
Verbal Report of Loss ......................................................................................................................................... 85
Completing a VRL form ...................................................................................................................................... 86
When you receive a verbal report of a loss that is not covered by the policy .................................................. 86
Fraud Indicator checklists .................................................................................................................................. 86
Front-end motor claims ..................................................................................................................................... 86
Front-end property claims ................................................................................................................................. 88
A catastrophe event ...................................................................................................................................89
What is a catastrophe event ............................................................................................................................... 89
Catastrophe procedures ..................................................................................................................................... 89
Code of Practice catastrophe claims .................................................................................................................. 89
Catastrophe Response Manual............................................................................................................................. 89
Claims reference documents .....................................................................................................................90
Purpose of the library ......................................................................................................................................... 90
Glossary of Terms ......................................................................................................................................91
Page 6 of 95
INTRODUCTION
Definition of a ‘claim’
A claim is a request made by the customer for payment of the benefits provided by the insurance contract.
The objectives of this claims manual

 To document in detail the procedures that apply to the management of front-end claims
 To provide a training tool and reference resource for Indemsure claims staff
 To ensure uniformity in work practices
 To achieve best practice in the management of claims
 To deliver excellent service to our customers
INSURANCE CONTRACTS ACT 1984

It is essential that you understand how the Insurance Contracts Act should be applied to particular claims
situations.
A simple resource has been created to assist claims staff, which you can access via.
PRIVACY PRINCIPLES
The Privacy Act 1988 governs the way in which businesses can obtain and use personal information.
The general insurance industry in has adopted the privacy principles, which apply to Claims Handlers who
act for insurance company.
Refer to the Privacy in Insurance Course for further information on the Privacy Principles.
Page 7 of 95
INDEMSURE FRONT-END CLAIMS
Overview
Most general insurance Claims Teams can manage and settle motor and property claims within their
delegated levels of authority (DLA).
The ability to settle claims at claims lodgement provides Claims Handlers with a unique advantage over
many of our competitors.
Customer service does not end when a policy has been sold or renewed. While this is obviously important,
Indemsure is also judged by the claims service we provide to our customers.
Our decentralised claims processing structure enables Claims Handlers to settle minor claims quickly and
efficiently, without the need to refer them to the various specialist Claims Teams, which include:
 motor
 property (house & contents, jewellery)
 commercial
 statutory claims
 travel, liability and investigations.
The current DLA process enables our Claims Handlers to handle approximately 65 per cent of claims that
come within that level of authority.
Claims that fall outside of the relevant DLA are referred to the specialist teams listed above. Refer to the
‘Claims authority limits’ section of this manual for further information.
CLAIMS HANDLING PROCEDURES

Our mission:
To provide an excellent claims service experience at every opportunity when dealing with our customers.
Our rules of conduct

The following is a list of the principles we follow in our daily activities:
 We approach claims investigations and adjustments with an open and unprejudiced mind.
 We conduct claims handling in a fair, transparent and timely manner.
 Every person we deal with, including our Indemsure colleagues, is our ‘customer’, and is therefore
treated with courtesy and respect.
 We work together as a team—helping each other and thereby using our collective strength to excel.
 We don’t accept mediocrity—‘good enough’ is never good enough!
 We are proactive (not reactive) in our management of claims.
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CLAIMS AUTHORITY LIMITS
Claim types that Claims Handlers do not have authority to manage
While Claims Handlers are granted authority to manage and settle certain insurance claims, the following
types of claims must be referred to specialist Claims Teams for management, regardless of the value of the
claim.
 Any claim where the claimant is the Claims Handler or their family member, or the Claims Handler’s
employee or their family member, as this is a conflict of interest (refer to the Indemsure Conflict of
Interest Internal Policy).
 Any claim received by a Claims Handler where the claim falls outside their DLA.
 Any claim where the Claims Handler is not authorised to offer advice
 Any claim where the Claims Handler has not achieved the minimum level of compliance (e.g. Tier 1 or
Tier 2) to manage the claim for the specific general insurance product.
 Any ex gratia payment under any circumstances.
Simple claims
A Claims Handler can apply for two levels of claims authority for simple claims ($5,000 and $10,000), which
means they have the authority to manage a claim up to that amount. In the instance that the claim estimate
exceeds $5,000, the Claims Handler must refer the claim to a Claims Handler or Claims
Supervisor/Leader/Manager with the appropriate level of claims authority to authorise the settlement.
NOTE: A Claims Handler’s authority limit is related to the settlement of the claim and not to the claims
estimate, as the estimate alters multiple times during the claims process.
Example
If a Claims Handler (or Claims Supervisor/Leader/Manager) is granted $10,000 claims authority, it
means that they have the authority to manage a claim that has an estimated incurred value of $10,000 or
less. In the event that it becomes apparent that the claim will cost more than $10,000, the Claims
Handler file must immediately be transferred to a Claims Handler or Claims
Supervisor/Leader/Manager with the appropriate DLA.
NOTE: ‘Estimated incurred value’ means the total of payments already made plus the estimate for future
payments, inclusive of Loss Adjuster or Motor Vehicle Assessor fees.
Page 9 of 95
The following table explains how claims staff members qualify for a simple claims authority.
Successfully Successfully Work for an Work as an Successfully Have at least 12 Have at least 3
complete claims complete all Indemsure Indemsure Claims complete the months’ years’
training, including available Claims Handler Handler with a Indemsure experience experience
the Indemsure online product for at least signed Claims working full- working full-
online claims training three months Representative Handler time in a claims time in a claims
training module modules Agreement for at induction handling role handling role
least three program
months
Claims Handler
  
must
$5,000
claims
authority Claims
Supervisor/Leader    
must
Claims Handler
   
must
$10,000
claims
authority Claims
Supervisor/Leader     
must
Page 10 of 95
Complex and non-routine claims
As complex and non-routine claims are usually for higher amounts than simple claims, Claims Handlers
require a much higher level of authority to settle claims costs.
The DLA granted to the Claims Handler is comparable to the reserve on the claims they manage. This level
of authority applies only to complex and non-routine claims and is subject to different qualification criteria to
simple claims authority.
All claim payment requests must be authorised by both the Claims Handler whose DLA is equal to, or
greater than the payment, and a Claims Supervisor/Leader/Manager who has an equal or greater DLA.
Example
A fire completely destroys a factory and a claim is submitted for $1,900,000. The damage includes the
building, raw materials, processing lines, forklifts and commercial vehicles used to move around stock
in the factory. There is also commercial insurance cover for business interruption (where product cannot
be sold or orders cannot be filled due to the interruption to production).
The following DLAs apply:
Job level/role DLA
Claims Handler $50,000
Commercial Claims Handler $500,000
Claims Supervisor or Leader $1,000,000
Manager $2,000,000
Settlement payments are requested as follows:
Requested Purpose of payment Who can authorise

payment payment?
First payment: To make the area safe (by securing the area so that no one Commercial Claims Handler
$100,000 can enter it and get injured, ensuring that the remainder of
the building cannot collapse onto anyone and/or removing
or safely containing any asbestos or chemicals).
Second payment: To clean up (by removing debris and rubbish and Commercial Claims Handler
$100,000 addressing water damage caused by the fire brigade when
putting the fire out).
Third payment: To rebuild the factory (building costs). Manager

$1,700,000
Page 11 of 95
The following table explains how claims staff members qualify for a complex and non-routine claims authority.
Successfully Successfully Work for an Work as an Successfully Have at least Have at least Have at least 3 Have at least 3
complete complete all Indemsure Indemsure complete the 12 months’ 12 months’ years’ years’
claims available Claims Claims Handler Indemsure experience experience experience experience
training, online product Handler for with a signed Claims working full- working in a working in a working in a
including the training at least Representative Handler time in a Commercial Commercial Commercial
Indemsure modules three Agreement for induction claims Claims Team Claims Team Claims Team
online claims months at least three program handling role in a claims as a Leader or as a Manager
training months handling role Supervisor
module
$50,000
claims      
authority
$100,000
claims      
authority
To $500,000
qualify claims       
for: authority
$1 million
claims        
authority
$2 million
claims         
authority
Page 12 of 95
CLAIMS AUTHORITY ASSESSMENT AND APPROVAL PROCESS
What is the assessment and approval process?
An integral part of the approval process for claims authorities is the assessment of the Claims Handler and
Claims Supervisor/Leader against the criteria.
To satisfy the above requirement, Claims Handlers and Claims Supervisors/Leaders are required to
complete a Delegated Level of Authority Request form (DLA Request form):
 stating the level of claims authority they wish to have
 attaching evidence supporting the fact that that they meet the minimum requirements applicable to the
desired authority level.
The application forms are forwarded to the Training & Development Officer (TDO) who confirms that all
required training has been completed. The TDO then emails the request to the Claims
Supervisor/Leader/Manager responsible for the applicant.
The Claims Supervisor/Leader/Manager then performs an initial assessment of the application and, where
they are satisfied that the applicant meets the criteria, makes a recommendation to the National Claims
Operations Manager for approval. The National Claims Operations Manager subsequently advises the Claims
Supervisor/Leader/Manager and applicant of the decision, and will arrange the necessary system changes.
IMPORTANT: When a Claims Team has claims authority, the individuals that qualify for claims authority
will each have the Claims Team level of authority. For example, if a Claims Team has $5,000
authority, each qualifying individual will also have $5,000 authority. It is not possible for
individuals within a team or branch to have differing levels of authority, unless approved by
the National Compliance Team.
Does one Claims Handler’s claim authority flow on to their replacement when they
leave?
It is the qualifications of the replacement Claims Handler which dictates the claims authority level for the
Claims Team.
If the replacement Claims Handler does not qualify for any claims authority (i.e. a new Claims Handler who
has been with a Claims Handler for less than three months and has not undertaken claims training), claims
access will be removed from the Claims Team until such time as the Claims Handler has been trained and
qualifies for $5,000 authority, as is the current practice. Alternative arrangements such as using the buddy
system until the replacement Claims Handler qualifies for claims access can be made in conjunction with
the Claims Supervisor/Leader/Manager.
If the Claims Team previously had $10,000 claims authority but the replacement Claims Handler qualifies for
only $5,000 claims authority, the Claims Team’s claims authority will reduce to $5,000 until such time as the
replacement Claims Handler qualifies for the higher level of authority.
What authority level applies to a Claims Team when a Claims Handler takes annual
leave?
When a Claims Handler takes leave, their Leader/Supervisor/Manager will need to apply for another Claims
Handler to inherit their authority during their absence, using the DLA Request form. In this instance, the
claims authority level granted will be that of the stand-in Claims Handler.
You will find details of how to make an application under the ‘Key claims practices’ section of this manual.
Page 13 of 95
It is important to note that once the relevant Claims Handler or Team actions a claim within the Claims
Workflow System and takes annual leave, they are unable to continue managing the claim so it needs to be
escalated to the relevant Claims Leader/Supervisor/Manager. For this reason, it is highly recommended that
when a Claims Handler is intending to take leave, whenever possible, they should identify a ‘buddy’ Claims
Handler who has the same claims authority level that they have to support their office while they are away.
NOTE: The Claims Leader/Supervisor/Manager is personally responsible for the quality of claims handling
within their Claims Team.
How often is the claims authority level of a Claims Handler reviewed?

The claims authority level that is provided to a Claims Handler is reviewed at least annually, taking place at
the same time as the operational audit is conducted on their business. The results of the operational audit
will be considered as part of the review. For example, if the Claims Handler scores a red (serious) rating for
the management of their claim files and the Claims Handler has a $10,000 authority limit, the limit may be
reduced to $5,000 immediately. In some cases authority will be removed completely until improvement is
seen in the next operational audit or retraining has occurred, as is the current practice. Results of all
operational audits conducted on claims managed by a Claims Handler will be communicated to the National
Compliance Team, who will perform the claims authority review.
What happens when a Claims Handler authorises a claim above their approved authority
level?
All Claims Handlers are currently provided with sanctions in the Claims Workflow System that dictate the
amount that they are able to pay on claims. Claims that exceed the Claims Handler’s authority level are
required to be referred to another Claims Handler or Team with the required DLA for management and
finalisation.
When a Claims Handler or Team identifies that a Claims Handler has approved a claim above their authority,
the matter will be referred to the relevant Claims Manager and a breach will be recorded and issued to the
Claims Handler. Corrective action will be taken. Claims Handlers authorising claims above their authority is
a very serious breach and will be treated as such.
NOTE: When a Claims Team receives a new claim that falls outside their authority, or a development
occurs on an existing claim that causes it to exceed their authority, it must immediately be referred
to another Claims Handler or Team for management.
Page 14 of 95
Claims Handlers without claims authority
If your Claims Team does not have claims authority, there is still a requirement to provide assistance to both
the customer and relevant Claims Handler or Claims Team in the management of claims.
All claims are reported to the Claims Team. In the interests of customer service, the following action will be
taken immediately upon receiving notification, verbally or in writing, of a claim report:
1. Register the claim (regardless of your DLA).
2. For a motor vehicle claim where the customer’s vehicle has been damaged or stolen, an Accident Repair
Notification (ARN) is to be completed on the Indemsure Claims Lodgement website. A Motor Vehicle
Assessor must be appointed on a without prejudice basis prior to the appointment of a Motor Vehicle
Repairer from the Indemsure approved repairers panel.
3. When a property claim requires appointment of a Loss Adjuster, an Adjuster from the Indemsure Loss
Adjusters panel will be appointed via the Claims Workflow System on a without prejudice basis. Refer to
the ‘Appointing the Loss Adjuster’ section of this manual for details on when an Adjuster should be
appointed.
4. A copy of all documentation should be sent to the relevant Claims Handler or Claims Team for ongoing
management of the claim.
As the Claims Handler has no claims authority, repair, replacement or settlement must not be authorised.
NOTE: A Claims Handler/Supervisor/Leader/Manager with no claims authority will have limited access to
the Claims Workflow System. They can use it solely for the purpose of registering claims and will
not be able to perform any other claims functions. The Claims
Handler/Supervisor/Leader/Manager must meet the necessary criteria and have been assessed
and approved as qualifying for a claims authority in order for them to have this access.
When claims authority may be revoked

Management has the ability to remove claims authority from any Claims Handler whose standard of claims
management is unacceptable or who fails to adhere to the claims procedures documented in this manual.
INDEMSURE NATIONAL CLAIMS TEAMS

The National Claims Teams are as follows:
 Motor Claims
 Property Claims (house & contents, jewellery)
 Commercial Claims
 Statutory Claims
 Travel, liability and investigations.
Page 15 of 95
Contact Details
Motor Claims Property Claims Commercial Statutory Travel, liability
Claims and investigations
Postal Indemsure Indemsure Indemsure Indemsure Indemsure

Address National Claims National Claims National Claims National Claims National Claims
Dept. Dept. Dept. Dept. Dept.
Motor Claims Property Claims Commercial Commercial Commercial
GPO Box 66 GPO Box 66 Claims Claims Claims
Lurdervale Lurdervale GPO Box 66 GPO Box 66 GPO Box 66
Lurdervale Lurdervale Lurdervale
Internal Indemsure Indemsure Indemsure Indemsure Indemsure

Mail National Claims National Claims National Claims National Claims National Claims
Address Dept. Dept. Dept. Dept. Dept.
Motor Claims Property Claims Commercial Statutory Claims Travel, liability
Claims and investigations
Claims
Email motorclaims@ propertyclaims@I Commercialclaim Statutoryclaims@i TLIclaims@

Indemsure.com.a ndemsure. s@indemsure.com ndemsure. indemsure.com.
u com.au .au com.au au
IMPORTANT: Please specify the claim number and claims consultant’s name, if known, in the
subject line of the email.
Phone 1300 654 321 1300 654 321 1300 654 321 1300 654 321 1300 654 321
Fax 754 9642 4166 754 9642 4166 754 9642 4166 754 9642 4166 754 9642 4166
Claim documentation
Whenever possible, hard copy documents and electronic documents supporting a claim should be attached
to the claim record in the Claims Workflow System and forwarded to the appropriate Claims Team
electronically.
If documents cannot be attached to the Claims Workflow System, they must be submitted to the appropriate
Claims Team, covered with a Claim Documentation Submission form.
The amount of documentation received by Claims Teams every day is very high. It is of course important for
correspondence to be actioned promptly; therefore, Claims Teams are required to promptly distribute
correspondence to the appropriate Claims Handlers.
The Claim Documentation Submission form is designed to ensure that the Claims Team provides all the
pertinent information the Claims Handler will need in order to be able to quickly respond to the
correspondence. It will tell them:
 whether the correspondence relates to a motor, property or liability claim
 contact details of the person sending the documentation
 whether this is a new claim or correspondence regarding a claim previously submitted claim number
and customer’s name
 any special comments the sender may want to make.
IMPORTANT: Before forwarding a claim form to the appropriate Claims Team, please ensure that it has
been signed and that all the relevant questions have been clearly answered, including an
adequate description of the vehicle accident or the event giving rise to the property claim.
Page 16 of 95
GENERAL INSURANCE CODE OF PRACTICE
Purpose of the code
The General Insurance Code of Practice (the Code) is a self-regulatory code developed by the insurance
industry to promote good relationships between insurers and consumers.
The code requires insurers to have fair internal procedures to handle complaints and resolve disputes.
These procedures are referred to as the ‘Internal Dispute Resolution’ (IDR) process.
Learn more about the Code and its complaint handling in our General Insurance Code of Practice Resource.
Types of policies governed by the code

The following types of policies are governed by the code
 Retail general insurance
 Residential strata plan insurance
 Small business insurance
 Medical indemnity insurance
(Indemsure has elected to offer the IDR facility to complainants under all policy types. However, it does not
apply to Third Party claimants, other than motor vehicle accident claimants).
Performance standards required by the Code

The following table gives details of the requirements of the code, and Indemsure procedures to ensure we
comply with them.
Code
Code requirement Indemsure procedures
section
3. INSURANCE CLAIMS
3.1 Within 10 business days of receiving your The appropriate Claims Team/Department claims
claim, we will decide whether to accept or staff, are conversant with the Code performance and
decline it, providing we have received all customer service requirements, and comply with
the necessary information at that time, and them.
no investigation or assessment is required A Code of Practice checklist is completed for every
claim.
Random audits of claim files are conducted by
appropriate Claims Team/Department, Claims Team
Managers, Operational Audit and the Customer
Dispute Resolution Manager, to monitor compliance.
The Claims Workflow System diary system
automatically generates prompts to all claims staff
nationally to ensure compliance targets are met.
3.2 This section stipulates the standards that apply to claims where further information, assessment or
investigation is required
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3.2.1 Within 10 business days of receiving your As above for 3.1

claim, we will:-
a. Notify you of the detailed information
we require to make a decision on your
claim
b. If necessary, appoint an assessor,
adjuster or investigator and
c. Provide an initial estimate of the time
required to make a decision on your
claim
3.2.2 If we decide to appoint an assessor, As above for 3.1

adjuster or Investigator, we will notify you
within 5 business days of appointing them
3.2.3 We will keep you informed of the progress As above for 3.1
of your claim, at least every 20 business
days
3.2.4 We will respond to your routine requests As above for 3.1

for information within 10 business days
3.2.5 When we have all necessary information As above for 3.1

and have completed all investigation that
was required to assess your claim, we will
decide to accept or decline your claim and
notify you of our decision within 10
business days
3.3 If the timeframes set out in 3.2 are not As above for 3.1
practical due, for example, to the complex Our standard letters include reference to the
nature of your claim, we will agree complaints handling procedures
alternative timeframes with you. If we
cannot reach an agreement, you can
access our complaints handling
procedures
3.4 The standards in this section apply to all claims
3.4.1 We will conduct claims handling in a fair, As above for 3.1

transparent and timely manner. Indemsure “Claims Handling Procedures” address
this requirement.
3.4.2 We will only ask for and take into account As above for 3.1
relevant information when deciding on your Indemsure claim forms have recently been revised in
claim. conjunction with correspondence we have had with
the Privacy Commissioner and his comments have
been taken into account in these documents.
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3.4.3 You will have access to information about Indemsure Privacy Statement states that the
you which we have relied on in assessing customer has the right to access information held
your claim and an opportunity to correct about them.
any mistakes or inaccuracies. Indemsure Claims Manuals provide procedures for
In special circumstances or where a claim what to do with regards to privacy enquiries. For
is being or has been investigated, we may privacy-related enquiries the client is referred to a
decline to release information and reports Head Office person responsible for privacy.
but we will not do so unreasonably. In As above
these circumstances, we will give you
reasons and you will have the right to
request a review of our decision through
our complaints handling procedures. We
will provide our reasons in writing upon
request.
3.4.4 Where an error or mistake in dealing with As above

your claim is identified, we will
immediately initiate action to correct it.
3.4.5 If we decline your claim, we will provide: As above for 3.1

 written reasons for our decision to
decline your claim Standard letters address these issues
 information about our complaints
handling procedures and
 on request, other than in the
circumstances referred to in 3.4.3
above, copies of reports from our
service providers which we have relied
on in assessing your claim.
3.5 The standards of section 3 of this Code do As above for 3.1

not apply if you or another person who may
be entitled to benefits under your policy
have commenced any proceedings in any
court, tribunal or under any other dispute
handling process (other than the Financial
Ombudsman Service FOS) in respect of
your claim.
3.6 The following standards apply to the handling of claims by our Employees and our Service Providers
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3.6.1 Our Employees and our Service Providers As above for 3.1
will conduct their services in an honest, Indemsure “Claims Handling Procedures” address
efficient, fair and transparent manner. this requirement.
Service Providers have been advised that they must
comply with the requirements of the Code and
provide exception reporting on any non-compliance
to Indemsure on a monthly basis. We have received
commitment from our Service Providers and
confirmation of their knowledge and adherence to the
Code.
3.6.2 Our Service Providers will notify us of any Service Providers have been advised that they must
complaint they receive against them when comply with the requirements of the Code and
acting on our behalf. provide exception reporting on any non-compliance
Code.
3.6.3 Our Service Providers will inform you of the As per 3.6.2
services they have been asked to provide
and the identity of the Insurer for whom
they are acting.
3.6.4 Our Employees or our Service Providers As above for 3.1

will not perform functions that do not Service Providers have been advised that they must
match their expertise. comply with the requirements of the Code and
provide exception reporting on any non-compliance
Code.
3.6.5 Our Employees and Service Providers will As per 3.6.4

have and maintain:
 current license if required under
legislation and
 membership of a relevant professional
body or sufficient expertise
3.6.6 Our Employees will receive adequate Training Programs have been identified for all
training to carry out their claims handling positions, including within claims.
tasks and functions competently
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3.6.7 Training of our Employees will include: Indemsure’s Training Database reflects these
 principles of general insurance and requirements
any relevant consumer protection law
 what to do in the event of a claim
 product knowledge and
 the requirements of this Code.
3.6.8 We will keep our Employees training We comply with this requirement
records for at least 5 years and on request
shall make those records available for
examination by FOS.
3.6.9 We will: The results of the various monitoring and supervision

 measure the effectiveness of training processes are communicated to the Training
by monitoring the performance of our departments and additional training identified and
employees and conducted where required.
 require additional or remedial training
to address any identified deficiencies.
3.6.10 Our Service Providers will obtain our Service Providers have been advised that they must
approval before subcontracting their comply with the requirements of the Code and
services. provide exception reporting on any non-compliance
Code.
3.6.11 We will handle complaints relating to or We comply with this requirement

received by our Service Providers under
our complaints handling procedures, when
they are acting on our behalf.
3.7 Where you demonstrate to us that you are Our procedures reflect this requirement.
in urgent financial need of the benefits you All staff are aware of this requirement.
are entitled to under your policy as a result
Claims files are subject to review by Claims Team
of the event causing the claim, we will:
Managers, Operational Audit and Customer Dispute
 fast-track the assessment and Resolution.
decision process of your claim and/or
 make an advance payment to assist in
alleviating your immediate hardship
within 5 business days of you
demonstrating your urgent financial
need.
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3.8 We will notify any financial institution that As per 3.7

you have told us has an interest in your
policy.
3.9 If you are unhappy with our decision, we As per 3.7

will inform you of our complaints handling Standard letters include complaints handling
procedures. procedures.
3.10 We and our Service Providers will comply As per 3.7

with the ACCC & ASIC Debt Collection Service Providers have been advised that they must
Guideline for Collectors and Creditors, comply with the requirements of the Code and
which require us to act fairly and in a provide exception reporting on any non-compliance
considerate manner. to Indemsure on a monthly basis. We have received
Code.
3.11 If a person is experiencing difficulty Indemsure’s Approved Panel providers service

repaying a debt due to illness, standard complies with this Code requirement.
unemployment or other reasonable cause, Our providers perform the assessment as to financial
we will work with that person, if he or she hardship and refer to Indemsure if debtor is
cooperates with us, and consider one of the experiencing this. Indemsure will then consider
following options: alternative methods of payment and refer to our
 extending the period of repayment and providers for communication to individual.
reducing the amount of each payment If agreement cannot be reached, the debtor is
due accordingly provided with our complaints procedures and made
 postponing payments for an agreed aware of the availability of the Australian Financial
period or Counsellors and Credit Reform Association.
 extending the period of repayment and
postponing payments for an agreed
period.
3.12 If we are unable to reach an agreement As per 3.11

with the person referred to in Clause 3.11
about the repay of their debt, we will
provide information to them about:
 our complaints handling procedures
and
 the existence of the Australian
Financial Counsellors and Credit
Reform Association (www.afccra.org)
for a referral to a not for profit, free
financial counselling service.
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3.13 Where we have selected and directly Claims and Complaints procedures reflect this
authorised a repairer, we will:-
 accept responsibility for the quality of
workmanship and materials and
 handle any complaint about the quality
or timeliness of the work or conduct of
the repairer as part of our complaints
handling process.
4. RESPONDING TO CATASTROPHES AND DISASTERS
4.1 This section applies to catastrophes and disasters resulting in a large number of claims.
4.2 We will respond to catastrophes and Addressed in Claims Manuals

disasters in a fast, professional and
practical way and in a compassionate
manner.
4.3 Due to the large number of claims we may Indemsure Claims budget allows for extra resources
not be able to meet all standards of this to be employed immediately in the event of a
code following a catastrophe or disaster. catastrophe
4.4 We will establish our own internal Addressed in Catastrophe Response Manuals
processes for responding to catastrophes
and disasters.
4.5 If you have a property claim resulting from When we settle a claim within one month of the
a catastrophe or disaster and we have catastrophe event, we will advise our client in writing
finalised your claim within one month of that they have one further month in which to advise
the catastrophe or disaster, you can us of any additional loss or damage that they may
request a review of your claim if you think discover subsequent to our settlement of their claim.
the assessment of your loss was not We will then review their claim.
complete or accurate, even though you may
have signed a release. We will give you six
months from the finalisation of your claim
to ask for a review of your claim. We will
inform you of:
 this entitlement when we finalise your
claim and
 our complaints handling procedures.
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4.6 We will co-operate and work with the Addressed in Claims Manuals
Insurance Council of Australia in its role of
industry coordination and communications
under the Insurance Council of Australia’s
catastrophe coordination arrangements.
6. COMPLAINTS HANDLING PROCEDURES
6.1 The following standards apply to all complaints handling.
6.1.1 We will conduct complaints handling in a Training that Indemsure representatives receive prior
fair, transparent and timely manner. to being authorised contains complaints handling
requirements.
Indemsure’s Authorised Representative & Standard
Operating Procedures Manuals contain guidance on
complaints handling and also refer to the Indemsure
Customer Dispute Resolution Policy & Procedures.
6.1.2 We will make available information about Standard letters contain access to complaints
our complaints handling procedures. handling information, as does disclosure
documentation (FSGs, PDSs) and the “Have we
worked for you? Code of Practice” brochure.
6.1.3 We will only ask for and take into account All staff receive Privacy training.
relevant information when deciding on your Representatives use only the Claim Forms provided.
complaint.
We have recently had correspondence with the
Privacy Commissioner on a separate issue and his
comments have been taken into account in our Claim
Forms.
6.1.4 You will have access to information about Indemsure Privacy Statement states that the
you that we have relied on in assessing customer has the right to access information held
your complaint and an opportunity to about them.
correct any mistakes or inaccuracies. Indemsure’s Authorised Representative and Claims
In special circumstances or where a claim Manuals provide procedures for what to do with
is being or has been investigated, we may regards to Privacy Enquiries. For Privacy related
decline to release information but we will enquiries the client is referred to a Head Office
not do so unreasonably. In these person responsible for Privacy.
circumstances, we will give you reasons.
We will provide our reasons in writing upon
request.
6.1.5 Where an error or mistake in handling your As above

complaint is identified, we will immediately
initiate action to correct it.
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6.2 We will respond to complaints within 15 Indemsure Customer Dispute Resolution Policy &
business days provided we have all Procedures comply with these requirements.
necessary information and have completed
any investigation required.
6.3 In cases where further information, Indemsure Customer Dispute Resolution Policy &
assessment or investigation is required we Procedures comply with these requirements.
will agree reasonable alternative
timeframes. If we cannot agree, we will
treat your complaint as a dispute and we
will provide information on how you can
have your complaint reviewed by a different
employee who has appropriate experience,
knowledge and authority.
6.4 We will keep you informed of the progress Indemsure Customer Dispute Resolution Policy &
of our response to your complaint. Procedures comply with these requirements.
6.5 When we notify you of our response, we will Indemsure Customer Dispute Resolution Policy &
provide information on how our response Procedures comply with these requirements.
can be reviewed by a different employee
who has appropriate experience,
knowledge and authority.
6.6 If you tell us you want our response Indemsure Customer Dispute Resolution Policy &
reviewed, we will: Procedures comply with these requirements.
 treat it as a dispute
 notify you of the name and contact
details of the employee assigned to
liaise with you in relation to your
dispute and
 respond to your dispute within 15
business days provided we receive all
necessary information and have
completed any investigation required.
6.7 In cases where further information, Indemsure Customer Dispute Resolution Policy &
assessment or investigation is required we Procedures comply with these requirements.
will agree reasonable alternative
timeframes. If we cannot reach agreement
you can report your concerns to FOS.
6.8 We will keep you informed of the progress Indemsure Customer Dispute Resolution Policy &
of our review of your dispute at least every Procedures comply with these requirements.
10 business days.
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6.9 We will respond to your dispute in writing Indemsure Customer Dispute Resolution Policy &
giving: Procedures comply with these requirements.
 reasons for our decision
 information about how to access
available external dispute resolution
schemes and
 notify you of the timeframe within
which you must register your dispute
with the external dispute resolution
scheme.
6.10 Insurers subscribe to the independent Member of FOS

external dispute resolution scheme
administered by FOS.
6.11 The FOS Service is available to customers Yes.

and third parties who fall within the Terms
of Reference of the FOS Service.
6.12 External dispute resolution determinations We advise customers of this.

made by a Panel, Adjudicator or Referee of
the FOS Service are binding upon us in
accordance with the Terms of Reference.
6.13 Where the FOS Terms of Reference do not Inform customers to obtain legal advice
extend to you or your dispute, we will give
you information about other external
dispute resolution options that may be
available to you.
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COMPLAINTS AND DISPUTES
What is a complaint?
A complaint occurs when any person involved in an active claim (that is, a claim we have not yet settled or
rejected) expresses dissatisfaction, either verbally or in writing, about any issue relating to the claim.
Some examples are that a customer complains about:
 the service given to them by the Loss Adjuster.
 our delay in processing a claim.
 a staff member being rude.
 our decision to replace a stolen item, insisting we instead settle in cash.
 the settlement figure the Loss Adjuster proposed.
Responding to a complaint
When a complaint is received, it is given priority treatment and is resolved as quickly as possible.
When you deal with a complaint, all discussions and deliberations must be recorded in detail on the claim
file. It is critical that your file ‘speaks for itself’ because if you are not able to resolve the complaint and it is
subsequently dealt with as a dispute, the adjudication process will rely heavily on file notes.
Most complaints are not complex or serious, and you will be able to quickly resolve them without assistance.
If the person complaining does not accept your response to their complaint, the matter should be referred to
the Claims Supervisor/Leader/Manager for action or advice.
When the Claims Supervisor/Leader/Manager decides that the complaint has no merit, the final decision of
the branch will be conveyed in writing to our customer, using the standard declinature wording.
What is a dispute?
A dispute arises when our customer protests to our Internal Dispute Resolution Panel about:
 your written response to their complaint about an active claim
 a claim you have settled
 a claim you have rejected in writing.
Declining a claim
When we decline a claim it must be confirmed in writing to the customer.
Most claims complaints and disputes arise following our rejection of our customer’s claim.
When declining a claim from our customer, it is important that our declinature letter is correctly worded.
Consequently, all declinature letters require the Claims Handler’s approval and signature.
When declining a claim, the following action is to be taken:
1. The declinature letter is drafted.
2. The Claims Handler or Claims Supervisor/Leader approves the wording and signs the letter. A copy of
the declinature letter must be retained on the file and file notes added to the customer file outlining the
reasons for the declinature, including reference to the relevant PDS and relevant sections.
3. The letter, with the Code of Practice brochure attached, is posted to the customer.
NOTE: Any references to writing and/or posting letters can also be interpreted as writing/sending emails.
There is no material difference and either can be used in all circumstances.
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Content of the declinature letter
The Code requires the declinature letter to explain clearly and adequately our reasons for the declinature.
Whenever possible, the policy exclusion or condition that supports the declinature will be quoted in our
letter.
After we have given our reasons for the declinature, the following paragraph must be placed at the end of
the letter:
Under the terms of the General Insurance Code of Practice, should you wish to dispute our decision you may
ask for your complaint to be considered by our Internal Dispute Resolution Panel. Further details of this
process and how to contact them are outlined in the attached brochure.
Await a possible challenge from our customer to the declinature

After the declinature letter has been sent to our customer, diarise the file for four weeks, awaiting a possible
challenge. The current estimate should be maintained.
If no response has been received after four weeks, the file is to be closed in the Claims Workflow System.
Internal Dispute Resolution (IDR) process

When a customer wants to challenge our declinature they can ask for the matter to be considered by the
Indemsure Internal Dispute Resolution Panel.
The Code requires our IDR Panel to give a response to the customer within 15 business days.
The Financial Ombudsman Service

If our customer does not accept the decision of our IDR Panel, they can ask for the matter to be reviewed by
the Financial Ombudsman Service (FOS).
It is the responsibility of the complainant to make contact with FOS and they must do this within two years of
receiving the decision from our IDR Panel.
The decision of FOS is binding on the insurer and there is no appeal process.
The decision of FOS is not, however, binding on the customer, who is free to pursue the matter against the
insurer through litigation.
KEY CLAIMS PRACTICES

Below are some essential business practices that must be followed to ensure that claims are being
managed appropriately and professionally at the front-end.
Two people are needed to process a claim

You must have two people to process a claim. The Claims Handler will register the claim and process the
payment/s, and the approved Authoriser will authorise the payment/s.
This is an operational audit requirement to reduce the possibility of internal fraudulent activity and errors or
omissions by the initial Claims Handler.
NOTE: The Claims Handler is ultimately responsible and accountable for claims management.
Under no circumstances should you reveal your Indemsure computer system access passwords
to someone else.
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Claims Teams ‘buddy’ system
This is a system whereby two Claims Teams have an informal arrangement to support each other by
providing temporary assistance to process front-end claims. It is preferable, but not essential, that the
buddy Claims Teams have the same level of claims authority.
The Claims Team ‘buddy’ system enables a team or branch to continue providing a claims service when a
specific Claims Handler is absent for a short period of time, for example, because of annual or personal
leave. It allows a Claims Handler from another Claims Team to temporarily manage and process the claims.
When this situation arises, the Claims Team requiring assistance completes the Claims Team Buddy Access
Request (available from the intranet) and submits it to the Training & Development Officer (TDO) for
approval.
IMPORTANT: The Claims Team Buddy Access Request should be submitted at least three weeks in advance
to allow time for the application to be approved and implemented.
The TDO approves the application and emails it to the Agency Support Centre, which will seek final approval
from the National Compliance Team before processing the request.
It is important to remember that if a Claims Handler from another Claims Team (acting as a buddy)
processes a claim, the initial Claims Handler for the policy must still be the one to process the claim
payment.
Refer to the ‘Claims authority limits’ section, which explains the authority levels that apply in various ‘buddy’
scenarios.
Indemsure preferred suppliers and repairers

Indemsure has arrangements in place with various national repairers and suppliers, and you are strongly
encouraged to use these whenever possible. Our preferred repairers and suppliers are businesses we have
identified as:
 providing a high standard of customer service
 charging competitive prices
 doing quality work
 being reliable.
NOTE: You are not permitted to enter into any contractual arrangements with suppliers outside of
Indemsure’s preferred suppliers and repairers without the prior written consent from Indemsure’s
National Manager.
It may at times be necessary for a customer to use someone other than a preferred supplier. This might be
necessary if they are located remotely and the nominated preferred supplier does not have a local provider.
Under these circumstances the customer is required to mitigate the costs.
Example
If the customer is stranded in a remote country town, they will not be compensated for having spare
parts airlifted to that town or for staying at a five-star resort. They will be covered for normal local
expenses.
Adequate product knowledge

You cannot make correct decisions on claims unless you have a thorough knowledge and clear
understanding of policy wordings.
If you are unsure whether a loss or event falls within the cover provided by the policy wording, discuss it with
your colleagues or seek guidance from your Claims Leader/Supervisor/Manager.
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Standard letters
A suite of standard letters is available in the Claims Workflow System. To maintain consistency, use of these
letters is strongly recommended.
The Claims Workflow System allows you to generate pre-populated standard letters, eliminating the need
for manual duplication.
Educate your customer to contact you for claims direction

It is a policy condition that customers contact you before proceeding with repairs or replacement. This is in
the customer’s interest, to ensure they do not jeopardise their claim settlement.
Ensure you educate your customers to do this so you can direct them to our preferred suppliers and
repairers, which helps reduce claims costs.
Ensure all mail is date stamped upon receipt

You must ensure that all hard copy mail is date-stamped on the day of receipt.
This is good business practice and avoids disagreements over when correspondence was received by your
office.
Identify paid invoices

When receiving invoices in hard copy, you must use the ‘Paid’ stamp.
It is also a requirement that a file note be created on the claim in the Claims Workflow System in order to
avoid duplication of claim payments. On the first line, the wording standard is:
PAID – Supplier Name – $Amount (incl/excl GST) – Date payment made.
In the text box, provide further details about the payment, such as the itemised information contained on the
tax invoice and if the excess has been deducted from the payment. The hard copy documents will be retained
or, where possible, scanned and attached to the Claims Workflow System.
If a tax invoice cannot be paid, a file note should be created in the Claims Workflow System. On the first line,
the wording standard is:
UNPAID – Supplier Name – $Amount (incl/excl GST) – Date on invoice
In the text box, provide details as to why the invoice cannot be paid.
Claim files
If hard copy documentation is retained, a claim file needs to be created for each new claim, with all
documentation secured within the file in chronological order, with the most recent on top.
When ALL information is being scanned and attached to the Claims Workflow System, a hard copy file is not
required.
Statutory claim files must never be destroyed. Hard copy claim files must be kept for at least seven (7)
years after they are closed, only after which can they be destroyed.
NOTE: Hard copy claim files are only used as a backup for electronic claim files or as a reference
document when attending a claims meeting or when the claim becomes a litigated matter,
meaning it is going through mediation or court.
It will sometimes be necessary to locate a closed hard copy claim file, perhaps because an unexpected
additional payment needs to be made or the file is required for auditing purposes. To enable documents to
be quickly retrieved, it is recommended that closed hard copy claim files are stored by the month they were
closed in the system.
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REGISTERING A NEW CLAIM
Claims checklists
Before registering a claim, you must conduct an inquiry through the Claims Workflow System to check that
there was a policy in force that covered the reported loss.
You must first identify the policy and check the following:
 Did the loss occur within the policy period?
 Is the situation covered by the policy?
 Is the cause of the loss an insured event?
 Is the vehicle or property claimed for insured by the policy?
As the above details are checked in the Claims Workflow System, you should complete the appropriate
sections of the claims checklist. The completed claims checklist is to be retained with the claim file.
The claims checklist serves the following purposes:
 to check the cover against the loss details
 to provide a snapshot of the claim.
A claim must be lodged promptly

A claim must be lodged in the Claims Workflow System no later than one business day after your branch or
team receives first advice of the loss.
Sometimes, the first notification you have of the loss will be when your office receives a completed claim
form. When this happens, you should carefully check the claim form to make sure you have sufficient
information to register the claim. If not, contact the customer to obtain the missing details so that the claim
can immediately be lodged.
The majority of claims will be reported to you verbally—by telephone, during a visit to your office or during a
meeting away from the office. In this situation, you must ask the customer to provide further details in one of
the below three ways.
1. Provide details of the loss now using the TeleClaims process. The TeleClaims process will capture all the
information required to immediately register the claim.
NOTE: You may elect not to offer this choice, for example, when you are very busy and cannot spare
the time.
2. Request the customer complete the claim form in your presence and check the claim form to make sure
it has been signed and all questions have been clearly and fully answered to enable you to immediately
register the claim.
3. Complete and submit the claim form at a later date. If the customer chooses this option, you will need to
complete a Verbal Report of Loss form and confirm what has been lost, damaged or stolen to enable you
to identify the policy risk number/s. By doing this, you will have sufficient information to immediately
register the claim.
NOTE: A claim form is not required for any claims that qualify for the fast-track process (such as
broken glass at a home premises or broken windscreen). Fast-track claims can be lodged at
the Call Centre by the Claims Consultant by completing the process via the phone for a first call
resolution claims process.
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THE TELECLAIMS PROCESS
What is TeleClaims?
The majority of claims are reported to you verbally—over the phone, during a visit to your office or during an
external meeting with the customer. In these situations, and for most types of claims, you have the option of
using the TeleClaims process to obtain details of the loss.
NOTE: The use of the TeleClaims process is not mandatory. There will be situations where you may elect
not to offer this choice to the customer, for example, when you are very busy and cannot spare the
time. Conversely, your customer may indicate a preference to complete a claim form instead.
How does TeleClaims work?

You obtain details of the claim by asking the customer questions. You follow an online script and type in the
answers given by the customer.
You will find details of the procedures on the intranet under the heading, ‘TeleClaims’.
Who can use TeleClaims?

TeleClaims can only be used by a person who:
 has claims authority
 has received TeleClaims-specific training from their Training & Development Officer.
CLAIMS MANAGEMENT PROCEDURES

What is ‘managing’?
There is a big difference between ‘managing’ a file and just ‘handling’ a file.
You are expected to effectively manage the files under your control, and this means being proactive,
controlling what happens and driving the case to a prompt and successful resolution.
Effective management means you:
 think before you act
 ask probing questions
 obtain all appropriate information and documents
 pay no more than the customer is reasonably entitled to receive under the terms of the policy
 seek to minimise the claim file administrative expenses, such as loss adjusting fees
 use the Diary effectively
 monitor and control the activities of external service providers, such as Loss Adjusters
 record adequate notes so that the claim always ‘speaks for itself’
 be alert to the possibility of fraud
 ensure salvage and subrogation opportunities are referred to the Recoveries Department.
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Managing starts on day one
Your first advice of a claim is usually the most critical event in the life of a claim because it presents you with
a once-only opportunity to control the direction of the case.
IMPORTANT: If the claim is reported verbally, you must record details on a Verbal Report of Loss form.
(For further details, refer to the ‘Claims fraud’ section of this manual.)
When a new claim is reported, it is very important that you make the effort to obtain all the pertinent
information that is available at that time and carefully evaluate it, before you take the next action required.
Taking the trouble and time to gather quality information at the outset will enable you to make value
judgements. If you adopt a proactive approach when the claim is first reported—this means taking all details,
clarifying future requirements (such as the need to forward original documents, not photocopies) and
ensuring all steps are taken to minimise the loss—you will reduce the cost and life of the claim.
Asking the right questions and making the appropriate decisions will enable you to steer the claim in the
right direction from the start. This will usually lead to an earlier settlement of the claim, which will save you
work.
Communication protocol
Indemsure’s preferred method of communication is by phone, because it is:
 relatively inexpensive
 personal
 time-efficient
 instantaneous, and usually achieves an immediate result.
A written communication is sent only when:
 it is considered to be necessary or appropriate
 the customer has indicated on the claim form that their preferred form of contact is fax or email
 the customer’s claim is being denied.
When contact by phone is unsuccessful, because there is no reply and you have no opportunity to leave a
message, two more attempts must be made within the next 24 hours. If still unsuccessful, an email, fax or
letter must immediately be sent.
Whenever possible, the narrative field on the cheque is used to explain the settlement. A covering letter will
only be sent when the settlement calculation is complicated or for some other reason at your discretion.
All written communications are to be worded in a professional and business-like manner.
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CHECKING PREMIUMS ARE PAID IN THE CLAIMS WORKFLOW SYSTEM
The Claims Workflow System displays payments made on instalment payment policies in the ’Instalment
History’ screen. For all other types of policies, such as annual cash paid policies, you will need to run the
Outstanding Items by Customer policy report.
Annual premiums are due and payable on receipt of the renewal invitation and the policy is only ‘current in
force’ when the premium has been paid and receipted against the applicable policy.
EFT monthly instalment policies renew one week prior to their expiry date.
It is important to remember that claims must not be authorised when premiums remain outstanding. If a
claim occurs on an unpaid policy, the customer must be contacted for payment before the claim can
proceed.
Premiums cannot be deducted from claims settlements for annual policies.
Monthly premiums
For policy renewals and new business, monthly instalments are deducted from the customer’s bank account
on the day of the month requested by the insured or the next working day.
It is important to remember that if there are dishonours displaying on the policy, claims must not be paid
unless the loss occurred prior to the dishonours.
Unpaid monthly instalment premiums

The Claims Workflow System will not allow a claim to be lodged if there is an outstanding premium debt on
instalment policies.
Unpaid annual premiums

If premiums remain unpaid for 15 days after processing new business, a policy payment reminder letter is
sent to the customer requesting payment within 10 days. If the policy remains unpaid after 30 days, it will be
cancelled.
A policy is not considered renewed until the premium has been receipted against the policy. A lapse letter is
sent 15 days after the expiry date for renewals and the policy will auto-lapse at 45 days if the policy premium is not paid.
Monthly premiums
When an instalment dishonours due to insufficient funds in a customer’s bank account or credit card, a letter
will be automatically generated advising the customer of the dishonour and stating that two instalments will
be deducted the next month.
 If there are insufficient funds for two instalments the following month, the system will automatically
send the customer a letter advising that the policy will be cancelled 10 days from the date of the letter
unless the arrears are paid.
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ESTIMATING
Before registering a claim with an estimate of $50,000 or above, or raising an estimate to a level where the
incurred estimate exceeds $50,000, you should email the appropriate Team Manager to notify them.
Indemsure policy is that at all times the file estimate must reflect your best estimate of what the claim
will cost, based upon current information.
In simple terms, an estimate is the money Indemsure sets aside for future payments on the claim, less the
policy excess but including any associated expenses that may be incurred, such as the Loss Adjuster’s fee.
It is important to review the estimate each time new information is received and immediately adjust it when
required.
When a new claim is reported, it is your responsibility to obtain sufficient details of the extent and severity of
the loss in order to be able to register the claim with a reasonably accurate estimate.
When there is insufficient information to set an accurate estimate, the file estimate will reflect your ‘best
guess’ until better information is received. The estimate is to be adjusted immediately after better
information is received.
When registering a claim, the Claims Workflow System will allow you to set an estimate that exceeds your
level of claims authority. However, such action will automatically transfer control of the claim to the
appropriate National Claims Team and your team will be unable to process further system transactions.
Example - Your Claims Team has $10,000 claims authority. Your customer’s house and contents are
destroyed in a fire. You register the claim with an estimate of $200,000, as recommended by the Loss
Adjuster. The Claims Workflow system will automatically transfer ownership of the claim to the
appropriate National Claims Team.
On an existing claim, the Claims Workflow System will allow you to increase an estimate to a level whereby
the incurred value exceeds your authority. However, such action will automatically transfer control of the
claim to the appropriate National Claims Team and your branch will be unable to process further system
transactions.
Example - Your branch has $10,000 claims authority. Your customer’s shop is broken into and items of
stock are stolen. You appoint a Loss Adjuster and register the claim with an estimate of $8,000. A few
days later, the Loss Adjuster phones to advise that your customer has discovered that additional items of
stock were stolen, and the loss estimate has now increased to $12,000. When you increase the estimate
to $12,000, the system will automatically transfer control of the claim to the appropriate National Claims
Team.
When a claim is declined, the estimate will not be reduced and the file will remain open for four weeks. It will
then be closed, if the customer has not challenged the declinature.
APPLYING THE POLICY EXCESS

When the customer’s loss is equal to or greater than the sum insured, we pay the sum insured less the
excess.
Example - Your customer’s premises are burgled and $7,000 cash is stolen. The sum insured under the
money section of their business policy is $5,000 and the policy is subject to a $500 excess. We pay
$4,500, being the sum insured less the excess.
When the customer’s loss is equal to or greater than the policy limit of cover, we pay the limit of cover less the
excess.
Example - Your customer’s house catches fire and his collection of coins valued at $12,000 is destroyed.
The limit of cover for a collection is $5,000 and a policy excess of $100 applies. We pay $4,900, being the
limit of cover less the excess.
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THE CLAIMS WORKFLOW DIARY
Timeliness and proactivity are essential to good customer service and effective case management. It is
therefore imperative that a follow-up system is maintained and that follow-ups are actioned promptly.
Accordingly, the Claims Workflow Diary must be used to control the claim.
Files should be diarised for follow-up in accordance with the following table:
Status of claim Diarise for
Motor Claims We await assessor’s report—vehicle repairable 15 business days
We await assessor’s report—vehicle total loss 10 business days
We await repair invoice 2 months
We await further info/docs from the customer 15 business days
We send customer a declinature letter 20 business days
Property Claims We await loss adjuster’s first report 10 business days
We await loss adjuster’s follow-up report 20 business days
We await report from Fusion & Machinery Surveyors 5 business days
We await further info/docs from the customer 15 business days
We await repair invoice 2 months
We send customer a declinature letter 20 business days
WHEN IS ORIGINAL DOCUMENTATION REQUIRED?

You need to sight the originals of the following documents:
 an invoice that has been paid by the customer
 a quote where a cash payment in favour of the customer is requested
 any document submitted as proof of ownership.
When the originals are not produced, the reasons why they are unavailable must be recorded in the file.
PROOF OF OWNERSHIP
Our Property Claim Report, under the heading, ‘Important information about your claim’, states: ‘For any items which are
no longer available for inspection, please attach proof of ownership.’
The following documents can be accepted as proof of ownership:

 purchase receipt
 guarantee or warranty
 instruction/operating manual
 valuation
 photograph
 bank statement or
 a signed statement from a person who can corroborate the customer’s claim.
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The following table displays the Indemsure policy regarding proof of ownership.
Value of item(s) claimed Procedure
When the replacement value of an individual item The Claims Handler has the discretion to waive any
is less than $500. requirement of proof of ownership.
When the replacement value of an individual item You must ask the customer to provide proof of ownership.
is $500 or more. If they cannot provide proof of ownership, you must obtain
a Declaration of Ownership.
When the total replacement cost of all items You must appoint a Loss Adjuster. The Loss Adjuster will
claimed is $7,500 or more. be responsible for obtaining proof of ownership.
Money less than $500. The Claims Handler has the discretion to waive the
requirement of proof of ownership.
Money between $501 and $7,499. You must ask the customer to provide documentation to
prove when and how the cash was acquired, such as a
bank statement or a signed statement from a person who
can corroborate the customer’s claim.
Money of $7,500 or more. You must appoint a Loss Adjuster. The Loss Adjuster will
be responsible for obtaining proof of ownership.
NOTE: It is a policy condition that the customer is required to notify the police immediately if any property
is lost, stolen or maliciously damaged. However, the Claims Handler has the discretion to waive
this requirement where the total value of the loss is less than $500.
AUTHORISING A PAYMENT
The Claims Handler is personally responsible for authorising all payments and for checking that the
payment is correct.
This means confirming that:
 the amount being paid is correct
 there is documentation to support the payment
 the payee’s details are correct
 the claim settlement includes any excess to be collected or deducted from settlement amount
 the external’s fee is correct and reasonable, with a breakdown of charges
 payment is consistent with policy cover
 payment codes are correct
 input tax credits are deducted, when required.
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CHEQUE PAYMENTS
Cancelling a cheque that has been returned to you
The following process must be followed when cancelling a returned cheque.
1. Draw a diagonal line across the cheque and write CANCELLED on it, or use the ‘Cancelled’ stamp.
2. Send the cheque to the Credit Support Centre.
3. Complete the Stop Payment/Cheque Cancellation Request form and email it to the Credit Support Centre.
4. Print the Stop Payment/Cheque Cancellation Request form and place it in the claim file.
5. The Agency Support Centre will cancel the payment in the Claims Workflow System and confirm this to
you by email.
Cancelling a cheque that is not in your possession

The following process must be followed when cancelling a cheque not in your possession.
1. Complete the Stop Payment/Cheque Cancellation Request form and email it to the Credit Support Centre.
2. Print the Stop Payment/Cheque Cancellation Request form and place it in the claim file.
3. The Agency Support Centre will forward the Stop Payment/Cheque Cancellation Request form to the
appropriate financial institution or bank.
4. When the bank has confirmed that the cheque has been stopped, the Credit Support Centre will cancel
the payment in the Claims Workflow System and confirm this to you by email.
5. You inform the customer that the cheque has been cancelled.
Replace or cash settle?

When the policy provides replacement value cover, our preferred option is to replace the goods that have
been lost or destroyed, using our preferred suppliers whenever possible.
When we agree to instead make a cash settlement, it will be for the amount that it would have cost us to
supply the replacement.
When the policy provides replacement value cover and the cost to Indemsure to supply a replacement
exceeds the sum insured or policy limit, we will make a cash settlement for the amount of the sum insured
or policy limit, less the policy excess.
Example
Our customer’s house and contents are destroyed in a fire. The sum insured on contents is $65,000 but
their replacement value is assessed by the Loss Adjuster to be $90,000. We would settle the claim by
making a cash payment of $65,000, less the policy excess, to the customer.
When the policy provides indemnity cover, we settle the claim by making a cash payment to the customer
that represents the value of the property at the time it was damaged or lost, taking into consideration a
deduction for its age and condition.
Example
Our customer has unspecified personal property cover of $3,000 under his defined events personal policy
with us. While on holiday in Bali, his hotel room is broken into and various items of clothing are stolen.
We would settle his claim by making a cash payment, applying a ‘new for old’ settlement for each item of
clothing.
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Late notification of a claim
It is a requirement of all our policies that the customer:
 advises us of the claim as soon as possible
 supplies us with a fully completed claim form within 30 days of the occurrence.
If the customer fails to meet these requirements and that failure has prejudiced us, by increasing the cost of
the claim or preventing us from investigating the claim, then we have the right to reduce the amount we pay.
This will sometimes mean that we will be entitled to reject the claim in full.
Where there has been a delay and that delay may have prejudiced us, you will need to request a written
explanation from the customer and advise them that until an acceptable written explanation is received, the
claim will be considered on a without prejudice basis.
FILE NOTES ON THE CLAIMS WORKFLOW SYSTEM

The file must always ‘speak for itself’
It is essential that a record of all salient activity is placed on the file, so that the file always ‘speaks for
itself’.
The Claims Handler who is handling the claim is responsible for recording the file notes.
Notes are to be recorded from the day the claim is received to the day it is closed off.
At any time, someone who knows nothing about the claim, such as a Claims Handler who is looking after
your claim while you’re away, should be able to look at the file and clearly see what action has been taken to
date and the current status of the claim.
If a disputed claim is referred to the Financial Ombudsman Service, the content and quality of our file notes
will often be pivotal to their decision process.
To ensure uniformity in our file note recording, all notes will commence with one of the following phrases in
the subject line (in upper case):
 TAX INVOICE FROM (NAME OF TAX INVOICE SUPPLIER, noting either PAID or UNPAID)
 PHONE TO
 PHONE FROM
 LETTER TO
 LETTER FROM
 REPORT FROM
 EMAIL TO
 EMAIL FROM
 FAX TO
 FAX FROM
 DISCUSSION WITH (this is a face-to-face discussion)
 MY THOUGHTS
Recording phone call discussions

When recording details of discussions or phone calls, it is important to note the date and the full name (first
name and surname) of the person spoken to and how they made contact or how contact was made, for
example, if the customer phoned the Claims Team or the Claims Handler phoned the customer.
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New claim with partial form completed
The following procedures will apply when the customer reports a new claim and chooses to complete and
submit a partial claim form to initiate a report of claim until the claim lodgement process can be completed.
 Complete a Verbal Report of Loss form.
 Confirm what has been lost, damaged or stolen, to enable you to identify the policy risk number/s.
 Explain to the customer the importance of signing the claim form, answering all relevant questions and
providing a detailed description of the event causing the loss.
 Ask the customer to return the completed claim form to your office as soon as possible.
 Register the claim no later than the next business day.
 When the claim form has not been signed, it must be returned to the customer. Whenever possible, scan
the complete claim form—not just the page that needs to be signed—and send it to them by email. They
can then sign the form and email it back to your office.
 When the customer has not provided an adequate description of the event on the claim form, you must
phone or email them to obtain a better description. If they provide this information over the phone, you
must record the conversation in the file notes.
 When the customer has failed to answer all relevant questions on the claim form or has given
incomplete or vague answers, you must phone or email them to obtain the answers. If they provide this
information over the phone, you must record the conversation in the file notes.
IMPORTANT: Under no circumstances should the Claims Handler record anything on the claim form.
Refer to the ‘Claim Documentation’ section of this manual if the claim is to be sent to the relevant Claims Team.
CLAIM PAYMENTS
When processing a payment on the Claims Workflow System, it is recommended that a Claim Cheque Requisition form
be completed and retained on file.
Refer to the Claims Workflow System for further information on processing the payment.
FINALISING THE CLAIM

Before finalising a claim the following should be considered:
 Is there an excess applicable to the claim that is to be collected or deducted prior to finalisation of the
claim settlement?
 Have all fee invoices from service providers, such as assessors or investigators, been paid?
 Has the total loss risk(s) been deleted from the policy?
Has the sum insured been adjusted to change the estimate or reserve on the claim file?
 Have any outstanding premiums been collected from the customer or deducted from the settlement?
 Have all supply and repair invoices been paid?
 Are all documents secured within the file?
 Have you updated the file notes in the Claims Workflow system
 Have you closed the claim in the Claims Workflow System?
While the process of determining liability may take weeks or months, once the Claims Handler determines
that the policy responds to the claim then it is Indemsure’s responsibility to:
 advise the insured within 24 hours of the decision regarding liability that was made by the Claims
Handler
 make the settlement payment to the insured within 10 days of accepting liability.
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THE POLICY EXCESS
What is an excess?
An excess is the first amount paid by the customer towards the cost of a claim. The customer is responsible
for paying the excess and Indemsure will only pay amounts above the excess.
Excesses are shown on the policy schedule. The excess may vary from customer to customer and it is
therefore important to check the excess amount applicable on each occasion.
Do not assume you know what the excess is.
Collecting the excess

Where possible, the excess payable on a claim should be deducted from the claim payment. However,
sometimes we may require our customer to pay us the excess, such as when the excess is not deducted
from our settlement of a front-end claim, or when a third party is claiming against our customer’s policy.
Payment of the policy excess to us by the customer is to be avoided as you are not able to receipt excesses in
the Claims Workflow system. Instead, the policy excess is deducted from the claim settlement.
Paying an excess by cash, credit card or cheque

Our preferred method of receiving any type of payment on a claim is by credit card (Visa or MasterCard only),
and this is usually agreed during a phone conversation.
We are not able to accept cash for payment of excesses. Excesses need to be collected via non-cash means.
If the insured is paying an excess by credit card, a Direct Debit Request (available on the intranet) is to be
completed. This form and a screen dump of the ‘Claims Header’ screen should be emailed to the respective Claims
Team to receipt the excess payment against the claim.
If the insured is paying an excess by cheque, the cheque should be forwarded with a screen dump of the
‘Claims Header’ screen to the respective Claims Team to receipt the excess payment against the claim.
NOTE: An excess payment must never be receipted against a policy. If an excess payment is receipted
against the policy, the excess will not be updated against the claim, causing the processing of the
claim to be delayed.
For a motor vehicle claim where the insured’s vehicle is damaged, the repairer collects the excess.
In this instance, and where an excess is due, the simplest payment option is to provide an authority to the
repairer or supplier less the applicable excess.
GST PROCEDURES
What is GST?
Goods and Services Tax (GST) is a 10 per cent tax that the Government levies on most goods and services.
Goods and services are referred to in the legislation as ‘supplies’.
A taxable supply is a supply to which GST applies. For example, insurance is a taxable supply.
A GST-free supply is a supply to which GST doesn’t apply. Most fresh food is GST-free, as is medical
treatment.
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Input tax credit
When a registered business purchases a supply that is for the purpose of the business, it is referred to as an
‘input’.
A registered business is able to claim from the Government a refund of the GST it pays on inputs. The refund
is called input tax credit (ITC).
Example
The proprietor of a restaurant purchases an oven that costs $11,000 ($10,000 + $1,000 GST). The oven is
to be used in the restaurant kitchen, so it is an input. The proprietor of the restaurant is able to claim an
ITC of $1,000.
Example
A plumber pays the renewal premium on his Business Policy. The premium is $770 ($700 + $70 GST).
The plumber is able to claim an ITC of $70.
The GST questions we ask our customer

When our customer reports a new claim they are required to provide GST information. The GST-related
questions to the customer are:
 GST applies to the premium on this policy. Are you able to claim input tax credit on this GST?
 If YES, what percentage of the GST that applies to the premium are you able to claim as an input tax
credit?
For each item our customer is claiming for under the policy, we ask them to advise us the ITC they are able
to claim for that item.
It is the responsibility of the customer to provide answers to the above questions; however, you must check
the answers provided. If they appear to be incorrect, you must contact the customer to seek an explanation.
If it is apparent that the customer is not confident that they can correctly answer the GST questions, they
should be asked to seek guidance from their accountant.
There are no black and white rules that can be referred to in order to confirm whether the customer has
provided correct GST information. Common sense must be applied when considering whether the
information seems logical. As a guide, here are some examples of GST information that appears to be
incorrect and would therefore require clarification.
 A business states they have a zero per cent ITC entitlement to the GST on the premium of their Business
Policy. (This would only be correct if the annual turnover of the business is less than $75,000 and they
have elected to not be registered for GST.)
 A customer states he has only a 10 per cent ITC entitlement to the GST on the premium of his Farm
Policy. (Perhaps the customer has misunderstood the question and has simply recorded the government
GST rate of 10 per cent.)
 A customer states she has a 100 per cent ITC entitlement to the GST on the premium of her Personal
Policy covering her home and contents. (This seems unlikely because individuals are generally not
registered for GST.)
 A business states they are entitled to a 10 per cent ITC entitlement on the cost of repairs to their
business premises. (This is probably a business expense and they should therefore be entitled to claim
100 per cent ITC.)
 A farmer states he has a zero per cent ITC entitlement to the cost of replacing a tractor. (As the tractor is
used for farm business, he should be entitled to claim 100 per cent ITC.)
 A customer says he has a 100 per cent ITC entitlement to the GST on the cost of replacing the curtains in
his home that were damaged in a storm. (This customer is almost certainly not registered for GST and
would therefore have a zero per cent ITC entitlement).
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Why is the ITC information so important?
When our customer reports a claim they are required to tell us the percentage of the ITC refund they are
entitled to claim in respect of the total premium on the policy. This is the figure that is recorded in the
system.
An insurer is able to claim back (from the Australian Taxation Office) a proportion of some types of claim
payments. The amount the insurer can claim back is partly determined by the ITC the customer can claim on
the policy premium.
If we are making a cash settlement to our customer, it is important for us to know the ITC refund they can
claim on the item, because this will determine the amount of ITC that we must deduct (on behalf of the
government) from our payment to them to ensure they are indemnified for their net loss only.
Example
Our customer claims for fire damage to curtains under a Personal Policy. She replaces the curtains at a
cost of $550 ($500 + $50 GST) and sends you the invoice. She confirms on the claim form that she cannot
claim any ITC refund for the curtains. You will therefore pay her $550, less the policy excess.
Example
Our customer has his house insured under a Landlord Policy. It is broken into and the front door is
damaged by the burglar. He replaces the door at a cost of $880 ($800 + $80 GST) and sends you the
invoice. He confirms on the claim form that he can claim a 100 per cent ITC refund for the door. You will
therefore pay him $800 ($880 less 100 per cent of the GST), less the policy excess.
How does the GST affect our customers?

Everyone in our society is categorised for the purposes of GST. Each of our customers will fall into one of the
GST categories shown in the following table:
Category What does this mean? GST implications for our customer
1 Our customer is an They are not involved in a  The customer has no business-related
individual. business. expenses (i.e. no inputs).
 The customer cannot claim any ITC.
2 Our customer operates a The ATO does not require  The customer cannot charge GST on the
small business that has a registered business with goods or services they supply.
an annual turnover of less a turnover below $75,000  The customer cannot claim ITC for inputs
than $75,000. The to be registered for GST purchased.
business has an ABN but purposes.
is not registered for GST
purposes.
3 Our customer operates a The ATO requires a  The customer must charge GST on the goods
business that has an business with a turnover or services they supply (unless the goods or
annual turnover of of $75,000 or more to be services are GST-free).
$75,000 or more. The registered for GST  The customer is able to claim ITC for inputs
business has an ABN and purposes. purchased.
is registered for GST
purposes.
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How does the government collect GST?
Businesses collect the GST from their customers on behalf of the government, and then pass it on the
Australian Tax Office (ATO).
When a business that is registered for GST issues an invoice for a supply, it is required to add 10 per cent
GST to the amount of the invoice. The invoice is called the ‘tax invoice’.
Example
A plumber performs work to the value of $750. He issues a tax invoice for $825 ($750 + 10% GST) to the
customer. The customer pays the plumber $825. The plumber remits the GST amount of $75 to the ATO
via his Business Activity Statement.
Example
Indemsure issues Mr Jones (an individual) with a Personal Policy. The premium is $600 excluding GST.
Indemsure issues a tax invoice to Mr Jones for $660 ($600 + 10% GST). Mr Jones pays $660 to
Indemsure. Indemsure remits the GST amount of $60 to the ATO.
Example
City Holden sells a new Commodore to ABC Industries, which they will use for business purposes. The
retail price of the car is $32,000 excluding GST. City Holden issues a tax invoice for $35,200 ($32,000 +
10% GST). ABC Industries pays $35,200 to City Holden. City Holden remits the GST amount of $3,200 to
the ATO via their Business Activity Statement.
NOTE: Because they will use the car for business purposes, ABC Industries will be able to claim the GST
as an ITC.
Registering a new claim

When registering a claim in the Claims Workflow system on the ‘Insured Details’ screen you will need to
complete the ‘Are you registered for GST?’ field. If the answer is ‘yes’, you must also:
 enter the customer’s ABN in the ‘ABN’ field
 enter the appropriate percentage in the ‘Ins Tax %’ field on the ‘Estimates’ screen.
ACQUISITION OR SETTLEMENT
For GST purposes, every claim payment an insurer makes is either an acquisition or a settlement. It is very
important that we clearly understand the difference between an acquisition and a settlement, and that the
correct Claims Workflow System code is assigned to each payment. (The codes are explained later in this
section.)
Acquisition
Code 11 in the Claims Workflow System is the appropriate code for acquisitions payments.
An acquisition occurs when we:
 choose the supplier
 instruct the supplier about the supply
 enter into a contractual relationship with the supplier.
Example
We arrange for Harvey Norman to replace a computer.
Example
We have a contractual arrangement with Winfix, our preferred supplier of windscreens. If our
customer—without our knowledge—takes their car to Winfix and authorises them to replace the
windscreen, we will pay their invoice as an acquisition.
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It is also an acquisition when our customer chooses a supplier that is not a preferred supplier but we accept
the quote and authorise the work. By authorising the supply, we are deemed to have chosen the supplier.
NOTE: In these circumstances, we are required to contact the supplier, authorise the work and instruct
the supplier to charge their invoice to Indemsure Limited.
When an insurer makes an acquisition payment, it is able to claim 100 per cent of the GST component from
the ATO, in accordance with Division 11 of the GST Act.
Settlement
If the above acquisition criteria are not met any payment we make under the claim is a settlement.
A settlement is where we reimburse our customer for an invoice they have settled where they have authorised the
supply. For example, we reimburse the customer for a plumber’s invoice they have paid where they have authorised the
work.
When our customer chooses a supplier (not being one of our preferred suppliers), authorises the supply and
subsequently asks us to pay the supplier, this is a settlement, not an acquisition.
A settlement also occurs when we make a cash settlement to the customer to compensate them for loss or damage
where there is no invoice supporting the payment. For example, we pay our customer for clothing that was stolen in a
burglary.
The ITC refund that the payee is entitled to claim for the item dictates the percentage of ITC that Indemsure
must deduct when making a cash settlement to them.
When an insurer makes a settlement payment, it may be able to claim a portion back from the ATO, in accordance with
Division 78 of the GST Act (more details later).
This table gives examples of how claims are settled depending upon whether the payment is an acquisition
or settlement and whether the customer is an individual or a GST-registered business.
Payment Description of Payment When our customer When 100 per cent ITC applies
Category is not registered for to the item claimed for
GST
Acquisition We receive a plumber’s invoice of We pay the plumber We pay the plumber $990.
$990 ($900 + $90 GST)—we $990.
authorised the work.
Settlement Our customer has paid a plumber’s We pay the customer We pay the customer $990 less
invoice of $990 ($900 + $90 GST)— $990. $90 (100% of the GST) = $900.
our customer authorised the work. The customer claims $90 ITC
from the ATO.
Settlement We make a cash payment to our We pay the customer We pay the customer $1,500
customer for carpet damaged in a $1,500. less $136.36 (100% of the GST) =
fire, agreeing a pre-fire depreciated $1,363.64.
value of $1,500 for the carpet. The customer claims $136.36
ITC from the ATO.
Acquisition Our customer takes his Range We pay Winfix $1,120. We pay Winfix $1,120.
Rover to Winfix to have a broken
windscreen replaced. They send us
their invoice of $1,120.
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Payment Description of Payment When our customer When 100 per cent ITC applies
Category is not registered for to the item claimed for
GST
Settlement Our customer has paid $1,650 We pay the customer We pay the customer $1,650
($1,500 + $150 GST) to replace $1,650. less $150 (100% of the GST) =
furniture damaged in a storm and $1,500.
seeks reimbursement from us. The customer claims $150 ITC
from the ATO.
Settlement Our customer paid $880 ($800 + $80 We pay the customer We pay the customer $880 less
GST) to lift and dry out carpet $880. $80 (100% of the GST) = $800.
damaged by water and seeks The customer claims $80 ITC
reimbursement from us. from the ATO.
There will be some claims where the item claimed for is used partly for private purposes and partly for
business purposes.
Example
Our customer is a landscape gardener. His desktop computer is damaged by lightning. He has it repaired
at a cost of $385.50. He uses the computer mainly for business purposes and is able to claim an 80% ITC
refund on the repair cost. We will pay him $385.50 less $28.04 (80% of the GST) = $357.46. We will then
deduct the policy excess.
Cash settlement—property total loss

When making a cash payment to our customer, it is important to check the policy wording to confirm
whether we pay GST in addition to the sum insured.
Some covers include the following wording:
We will not pay more than the sum insured shown in the schedule (plus any applicable GST).
This means that if our customer is unable to claim any ITC refund on the item, we will pay the sum insured
plus an additional 10% for the GST.
Example
Our customer’s house is destroyed in a fire. It is insured under a Personal Policy with a sum insured of
$280,000. The policy excess is $100. Our customer is unable to claim an ITC refund on the house. We
would pay our customer $307,900, calculated as follows:
Sum insured $280,000

plus 10% GST + $28,000
= $308,000
less the excess — $100
Total = $307,900
If our customer were able to claim a 100 per cent ITC refund on the item, we would pay only the sum insured.
If our customer were able to claim less than a 100 per cent ITC refund on the item, we would pay the sum
insured plus a portion of the GST.
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Example
Our customer’s farm dwelling is destroyed in a fire. It is insured under a Farm Policy with a sum insured
of $400,000. The policy excess is $100. Our customer is able to claim an ITC refund of 10 per cent on the
house. We would pay our customer $435,900, calculated as follows:
Sum insured $400,000

plus 90% of the GST + $36,000
= $436,000
less the excess — $100
Total = $435,900
NOTE: The GST amount for this claim is $40,000. As the customer can claim 10% from the government
(perhaps for a home office, which would be considered an input), the insurer only needs to pay 90%
of the GST, hence the $36,000.
Some covers state:
The amount we will pay does not include the amount of goods and services input tax credit you are entitled to
claim from the ATO.
This means that the sum insured does not include GST and we pay only the sum insured, even when our
customer is unable to claim any ITC refund on the item.
NOTE: The following is included for your information only. Our system has been designed to automatically
calculate the refund amount that Indemsure is able claim.
Claiming acquisitions payments

When Indemsure makes an acquisition claim payment, such as paying a tax invoice, we are entitled to claim
100 per cent of the GST back from the ATO.
Example
We authorise a crash repairer to repair our customer’s car. We settle the invoice in the sum of $660. We
are able to claim $60 back from the ATO.
Claiming settlements payments

In accordance with Division 78 of the GST Act, when Indemsure makes a settlement claim payment, the
amount that we can claim back from the ATO—known as the ‘decreasing adjustment’ or DA—is dependent
upon the ITC the customer can claim on the policy premium, as explained in the following example.
Example
Our customer is a farmer and has a Farm Policy with us.
The ITC he can claim on the total policy premium is 50 per cent (A in the formula below).
His house catches fire and a printer is damaged. He has the printer repaired at a cost of $330. He pays
the repair bill and seeks reimbursement from us. He tells us the ITC he can claim on the printer is 100
per cent.
We therefore reimburse him with a settlement payment of $300 (B), being $330 less 100 per cent ITC.
The DA refund Indemsure can claim is in accordance with the following calculations, as prescribed by
the Australian Taxation Office:
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Step 1: Calculating the settlement amount
B x 11 $300 x 11 $3,300
= = = $314.29 (C)
11 less (A x 1) 11 less (50% x 1) 10.5
Step 2: Calculating the DA refund Indemsure can claim
DA refund = (1/11 x C ) x (100% less A)
= (1/11 x $314.29 ) x (100% less 50%)
= $28.57 x 50% = $14.29 (DA refund)
Therefore, the net cost to Indemsure, after taking into account the decreasing adjustment, is $285.71 ($300
less $14.29).
Using the same example, if the customer could not claim an ITC refund on the printer (though he can still claim ITC on
his policy), we would pay him a settlement of $330, being $300 plus $30 (100% of the GST).
The calculations would be as follows:

$330 x 11 $3,630
= = $345.71
11 less (50% x 1) 10.5
DA refund = (1/11 x $345.71) x (100% less 50%)

= $15.71 (DA refund)
= $31.43 x 50%
Therefore, the net cost to Indemsure, after taking into account the decreasing adjustment, is $314.29 ($330
less $15.71).
Again using the same example, if the customer could not claim an ITC refund on the policy premium or the printer, we
would pay them a settlement of $330, being $300 plus $30 (100% of the GST).
The calculations would be as follows:

$330 x 11 $3,630
= = $330
11 less (0% x 1) 11
DA refund = (1/11 x $330) x (100% less 0%)

= $30.00 (DA refund)
$30 x 100%
Therefore, the net cost to Indemsure, after taking into account the decreasing adjustment, is $300 ($330 less
$30).
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FINALISING SETTLEMENT
Once we determine that liability is to be accepted for a claim, we need to obtain a settlement release from
the claimant and pay the settlement amount.
Settlement release
A settlement release is not required for non-complex claims, for example, mobile phone replacements,
windscreen damage claims and loss of sunglasses claims.
For complex claims, which are the majority of claims received, a Settlement Release form must be signed by
the claimant to release Indemsure from future liability.
The settlement release is a legal record of acknowledgement that Indemsure’s payment of a benefit satisfies
all claims that may be made under the current policy. It releases Indemsure from all further obligations
under the claimant’s current policy.
An example of a settlement release is shown below.
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Settlement payments
Indemsure must make the following checks before making a settlement payment.
Verify calculations
The Claims Supervisor/Leader/Manager should double-check that the amounts have been correctly
calculated by the Claims Handler, taking into account any deductions, such as an excess or contributions by
the claimant.
Check authority limits
Refer to the authority limits above for the settlement amount you may independently authorise. If a claim
falls outside of your authority whilst in the process of finalisation, it must be referred to the Claims
Supervisor/Leader/Manager for approval.
Verify correctness of documentation
You must not approve payment without receipt of a tax invoice (that is intended to be a tax invoice) that
includes the following information:
 the seller's identity
 the seller's Australian Business Number (ABN)
 the date the invoice was issued
 a brief description of the item or service sold, including the quantity (if applicable) and the price
 the GST amount (if any) payable—this can be shown separately or, if the GST amount is exactly one
eleventh of the total price, as a statement such as 'Total price includes GST'
 the extent to which each sale on the invoice is a taxable sale (that is, the extent to which each sale
includes GST), for example, if the words 'total price including GST' are included.
Determine the appropriate payment method
Settlement payments may be:
 direct to the claimant, either by way of cash, cheque, direct deposit, retail store credit or debit card
 on behalf of the claimant to third parties for services, repairs or other works or goods
 an arrangement for the claimant to purchase replacement goods.
Avoid duplicate payments
Original invoices must be stamped as evidence that they have been paid and to avoid duplication. Prior to
making a claim payment, you should check the claim file to verify that it has not yet been paid.
Timeline for payment
Claims Handlers/Managers are responsible for making payment within 10 days of approving a claim.
PROCESSING A PAYMENT
For each payment processed, a GST Option Number must be entered in the Claims Workflow System.
IT IS VERY IMPORTANT that you select the correct Option Number because this will determine the refund
the customer or the customer’s business can claim from the Australian Tax Office.
Always ask for help if you are not sure which Option Number to use.
The table below explains when each Option Number (ON) is to be used.
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Option no. GST Explanation
1 Division 11 GST Free – Acquisition
There are four GST Option
2 Division 78 GST Free – Settlement
Numbers.
3 Division 11 Taxable – Acquisition
4 Division 78 Taxable – Settlement
Taxable supplies
Who are you paying?
Claim
Supplier of TP
Our customer Repairer admin
goods or service claimant
expense
You must check Did the Claims When the Claims When our You must check that
that our customer Handler or Handler or Claims customer the TP claimant has
has correctly Claims Team Team has has correctly advised us
advised us of the authorise the authorised the authorised of the percentage of
percentage of the repairs? supply or we are the supply. the ITC refund they
ITC refund they can paying a preferred can claim for this
claim for this loss. supplier. loss.
Yes No
ON 4 ON3 ON4 ON3 ON4 ON4 ON3
GST-free supplies
Who are you paying?
Our customer Supplier of goods or service TP claimant
When the Claims Handler or When our customer has

Claims Team has authorised authorised the supply.
the supply or we are paying a
preferred supplier.
ON2 ON1 ON2 ON2
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Details required on a tax invoice
Before we make a payment to a supplier we need to check that the tax invoice includes all the information
required by law, as shown in the table below:
NOTE: For a supply below $50 a tax invoice is not required.
Less than $1,000 or

Tax invoice must include this information
$1,000 more
The supplier’s name Yes Yes
The supplier’s ABN Yes Yes
The GST-inclusive price of the taxable supply Yes Yes
The words ‘tax invoice’ prominently shown Yes Yes
The date the invoice was issued Yes Yes
The name of the recipient No Yes
The address or the ABN of the recipient No Yes
A brief description of each item supplied Yes Yes
The quantity of the goods or the extent of the services supplied No Yes
When the GST payable is exactly one eleventh of the total price, either the GST
Yes Yes
amount or the words ‘the total price includes GST’
When the GST payable is less than one eleventh of the total price, the amount
Yes Yes
excluding GST and the amount of GST payable
Below is an example of a tax invoice for a supply above $1,000 with all the required information displayed.
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TAX INVOICE
Ace Hardware P/L ABN 32 123 456 789
80 Burbank Drive Wavell Heights QLD 4680
TO: Indemsure Insurance

Licence 11 22 33
9 Main Street Lurdervale
PO Box: GPO Box 66 Lurdervale
Date Invoice No Account No Order No

12/11/12 04 - 003765 4098 59875
Quantity Description of Supply Unit Cost Total Cost
200 Roof tiles $5.50 $1,100.00
50 Weatherproof sealant $1.00 $50.00
1 Delivery charge $36.00 $36.00
TOTAL AMOUNT PAYABLE $1,186.00

Total includes GST of: $107.81
Sample tax invoice

If the document is not a valid tax invoice, it must be returned to the supplier and a request made for it to be
amended.
ROLE OF THE LOSS ADJUSTER

Circumstances requiring the appointment of a Loss Adjuster
Unless there is a compelling reason, Loss Adjusters will not be appointed for low-dollar claims.
The appointment of a Loss Adjuster to a claim must be carefully considered and the Claims Handler must
take into account the circumstances and value of the loss, claims cost control and customer service.
Many claims can be resolved by the Claims Handler who is dealing directly with the customer. This may be
more ‘user-friendly’ for your customer, will often bring about a quicker settlement and, of course, save the
expense of engaging a Loss Adjuster.
Here are some examples of the action you can take yourself to ‘adjust’ the claim:
 Request photos. This will enable you to confirm the claim is authentic and verify the extent of the
damage.
 Control the cost of the loss by requesting two repair or replacement quotes.
 Request documents to support the claim, such as proof of ownership.
The important question to ask before you appoint a Loss Adjuster is: ‘If I appoint a Loss Adjuster, is it likely
to have the effect of reducing the cost of the claim by more than the Loss Adjuster’s fee?’
If the answer is ‘no’, a Loss Adjuster should not be used.
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Below is an explanation of the business rules to be followed:
Type of claim When to appoint a Loss Adjuster
All types of claims The loss is estimated at $7,500 or above.
You suspect the claim is fraudulent or that the loss is exaggerated, regardless of the
loss estimate.
All types of claims
(Instruct the Loss Adjuster to assess on a without prejudice basis, and pass the claim
to the relevant National Claims Department).
Fusion, machinery Appoint Fusion & Machinery Surveyors Australia to conduct a desktop assessment
breakdown or when the loss is $500 or more.
electronic breakdown
During the induction when a Claims Handler/Supervisor/Leader/Manager joins Indemsure, the State
Training & Development Officer will ensure that training has been provided on how to appoint a Loss
Adjuster.
NOTE: In some circumstances, it may not be feasible or economically viable to appoint a Loss Adjuster
(such as where the customer lives in a remote area). If this is the case, you must clearly justify the
reasons for not appointing a Loss Adjuster in a file note in the Claims Workflow System.
Appointing the Loss Adjuster

When you require a Loss Adjuster (in accordance with the above business rules), appoint them using the
Claims Workflow System.
If the details you have been given suggest the loss estimate is below, or equal to, the delegated level of
authority of your branch, and you are satisfied with the legitimacy of the claim and the cover provided by the
policy, you will organise to ‘Assess and Authorise’ up to the DLA.
You must use the ‘Report of Loss’ screens to appoint a Loss Adjuster or Fusion & Machinery Surveyors
Australia.
This transaction is completed online and sent to the Loss Adjuster, and is recorded on the Claims Workflow
System.
Sometimes the loss will give rise to claims against more than one risk covered by the policy. In these
situations, a separate claim number will be allocated for each risk.
Appointing the Loss Adjuster whilst the claim is being lodged

If appointing a Loss Adjuster when registering the claim, this is done in the ‘General Details’ screen in the
Claims Workflow System.
The 'Report of Loss' screens are automatically populated based on the information keyed into the required
fields and policy information contained in the system.
An email is sent to the Loss Adjuster when the claim registration is complete (this email is a text format of
the data captured in the 'Report of Loss' screens).
Instructions and notes to the Loss Adjusting Firm can be added by entering comments in the 'Comments for
the Adjuster' field in the 'General Details’ screen.
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Appointing the Loss Adjuster after the claim has been lodged
If a Loss Adjusting firm was not appointed when the claim was being lodged, a Report of Loss can be created
in the Claims Workflow System.
The ‘Report of Loss’ screens can be displayed by clicking on ‘Report of Loss’ in ‘Further Information’ on the
‘Claim Inquiry’ screen.
When these screens are displayed, you can key in the instructions and details of the claim, loss, policy and
other information before the report is sent to the Loss Adjuster.
The Report of Loss as emailed to the Loss Adjuster displays in 'Recent Transactions' on the 'Claim Inquiry'
screen. By clicking on the link in 'Recent Transactions', the correspondence email opens and the Report of
Loss (in a text format) is displayed. The Report of Loss can be edited and resent.
Changing the Loss Adjuster after the claim has been lodged
To change the Loss Adjuster from the Adjuster you appointed while registering the claim, click on the
Adjuster field on the ‘Claim Inquiry’ screen.
The ‘Modify Adjuster’ screen will display for you to select the new Loss Adjusting Firm; once selected, this
modification will be noted in ‘Recent Transactions’ on the ‘Claim Inquiry’ screen. Click on ‘Report of Loss’
under ‘Further Information’ and the ‘Report of Loss Claim Details’ screen will display, showing the
information sent to the original Loss Adjusting firm. Click ‘Print Version’ to display the Report of Loss. From
the Internet Explorer menu bar, select File>Send>Page by e-mail. Outlook opens an email attaching the
Report of Loss to send to the new Loss Adjusting firm.
IMPORTANT: If the details you have been given suggest the loss estimate is above the claims authority of
your branch, tick the ‘Please report back to Indemsure National Claims Dept.—Property
Claims’ box. If you believe there are suspicious circumstances or fraud indicators then you
should appoint an assessor to assess without prejudice and also tick the ‘Please report back
to Indemsure National Claims Dept.—Property Claims’ box. Claims suspected to be
fraudulent must be passed to relevant Fraud Department for management.
Example
Our customer, Mr Meadows, has his newsagency insured under a Business Policy. The newsagency is
burgled and then set alight with the back part of the building damaged by fire. He will claim for the
damage to the building and stock under the Business Property part of the policy. His claim for theft is
against the Theft section of the policy.
It is important to check the Claims Workflow System to see if there are endorsements to the policy that are
relevant to the claim or variances to the standard cover that will affect the claim. If so, there is a place on the
form to record this information.
Note: When the policy cover is in doubt, select the ‘Assess without prejudice’ box.
Decide on the type of assessment you would like the Loss Adjuster to perform, for example, Full
Assessment, First and Final or Desktop. You can find clarification on these types of assessments on the
intranet in the Property Loss Adjuster Comparison Table.
If a completed claim form has not been supplied to you and you have not obtained full details of the claim
using the TeleClaims process, instruct the Loss Adjuster to obtain a completed claim form.
If you have a claim form, email it to the Loss Adjuster, together with any other documents that you believe
they may require, such as the Proposal form.
The ‘Report of Loss’ screens have been designed to automatically send a copy of the claim form to the
appropriate Claims Team within the Claims Workflow System.
When you appoint a Loss Adjuster on a claim that will be managed by the Property Claims Team, all the
claim documentation will be sent to the Property Claims Team, electronically whenever possible. If you are
sending hard copy documentation to the Property Claims Team it should be sent under cover of a Claim
Documentation Submission form.
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The role of the Loss Adjuster
The role of the Loss Adjuster is to:
 provide support and guidance to our customer
 keep in frequent contact with our customer
 keep our customer informed of what is happening
 form a view as to whether the claim is covered by the policy
 form a view as to the bona fides of the claim
NOTE: If there is a concern that the claim may be fraudulent or exaggerated, the file must
immediately be passed to the relevant Fraud Department.
 assist our customer to compile their claim
 report on the facts within the timeframes required by Indemsure performance standards
 obtain proof of loss and ownership
 report on and, if necessary, secure salvage
NOTE: Any claim involving salvage must immediately be passed to the Claims Recovery Department.
 report on any recovery opportunities
NOTE: As soon as a potential recovery opportunity is identified, the file must immediately be passed to
the Claims Recovery Department to determine quantum and recommend file estimates.
 arrange the cost-effective repair or replacement of damaged or lost property
 provide feedback on underwriting issues such as physical and moral risk, security and adequacy of sums
insured
 instruct service providers, such as building consultants, with your approval only.
The Loss Adjuster does NOT have authority to pursue any recovery action or to deny a claim.
Sometimes, it will become apparent to the Loss Adjuster that the loss, or part of the loss, may not be
covered by the policy. The correct procedure is for the Loss Adjuster to draw to the attention of our customer
the possibility that the loss, or part of the loss, may be excluded from the claim and why. The Loss Adjuster
must explain that their job is simply to present the facts to Indemsure for consideration and that Indemsure
will make the decision. (When we decide to reject the claim in full, we will convey the news to the customer
by sending a declinature letter.)
Managing the Loss Adjuster

When the Loss Adjuster is appointed to conduct an assessment, there should be regular dialogue between
you and the Loss Adjuster throughout the life of the claim. It is your responsibility to work closely with the
Loss Adjuster and manage their activities.
Written reports received from Loss Adjusters require careful consideration and scrutiny before they are
placed in the file. If anything is unclear, clarification must be sought and if anything seems to be incorrect,
it must be challenged.
Consider:
 Has anything been missed or overlooked by the Loss Adjuster?
 Are the Loss Adjuster’s calculations correct?
 Have all the right questions been asked?
 Has all the required supporting documentation been collected?
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Checking the Loss Adjuster’s fee
It is the Claims Handler’s responsibility to carefully check the fee charged before processing the payment. If th e
charge seems excessive, or the calculations on the invoice are incorrect, you must seek an explanation.
The schedules of the agreed flat fees and hourly rates are on the intranet.
If a flat fee is charged:
 check the intranet for the insurance schedule to confirm the figure charged is correct
 check that the figure charged reflects the adjusted value of the customer’s claim
 If the fee is charged on an hourly basis, it is the responsibility of the Claims Handler to:
 confirm that the hourly rate is correct
 consider whether the hours charged are justified and consistent with the work performed by the
Loss Adjuster
 confirm that the amount charged for travelling is correct.
Loss Adjusters—panel and service standards

When we appoint a Loss Adjuster for a property claim, the following performance standards are required.
ACTION SERVICE STANDARD
Upon receiving the Property  The customer is contacted the same day.
Loss Adjuster Instructions  An acknowledgment email is sent to Indemsure the same day.
form from Indemsure
Make a site visit  Within three business days of being appointed. If this is not possible, the
Loss Adjuster must contact Indemsure to explain why.
If fraud is suspected or the  Phone Indemsure within one hour to explain the concerns.
recommendation is that the  Submit written report ASAP.
claim be rejected
If the value of claim exceeds  On day of site visit, notify Indemsure with a recommended estimate.
$10,000
Submit reports  Indemsure’s preference is for reports to be sent by email with scanned
documents as attachments; otherwise, reports should be sent by Priority
Post. Reports are only to be faxed when they are urgent and cannot be
emailed.
Dispatch initial written  No later than the fifth business day after the site visit.
report
Dispatch formal written  At least monthly, unless given other instructions.

progress reports
Keep customer informed of  On a regular basis.

progress
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Submit required  All required documentation to be submitted in a timely manner.
documentation  A completed claim form must be sent unless the Claims Handler has
already obtained full details of the claim via the TeleClaims process.
NOTE: A signed completed claim form must be provided for every
claim. However, the appropriate National Claims Department
may sometimes waive this requirement, for example, in a
catastrophe situation.
 Documents that provide proof of ownership.
 Photos, if they help to explain the nature and extent of the damage.
 All other relevant documentation.
Invoice  Tax invoices must show excess deductions when appropriate.

 Invoices to be charged to Indemsure Limited ABN 62 081 106 505.
Respond to communications  Respond to phone calls within 24 hours.

 Respond to correspondence within five business days.
Upon receiving a complaint  Contact the Claims Handler or Claims Leader the same day.
Obtain a signed release from  Only when a release is requested by the Claims Handler or Claims Leader.
the customer
Estimate  Every written report must record the estimate required to cover future
payments (excluding any payments recommended in the report), inclusive of
GST and the Loss Adjuster’s fee.
Use suppliers & repairers  Whenever possible, claims are settled using Indemsure preferred suppliers
and repairers.
Invoice for Loss Adjuster’s  If the appointment was based upon scale of fees, scale of fees and any
fee additional mileage and disbursements must be detailed.
 If the appointment was based on hourly rate, an itemised invoice is to be
provided showing hourly rate, number of hours, mileage and disbursements.
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MANAGEMENT OF PROPERTY CLAIMS
The following flowchart provides a guide to the major steps involved in the management of property claims,
including:
 Accidental damage
 Accidental loss
 Burglary
 Dishonesty of employee
 Earthquake
 Fusion
 Electronic equipment
 Fire
 Spoilage of frozen food
 Glass
 Illegal use of a credit card
 Impact damage
 Landlord (loss of rent)
 Lightning damage
 Machinery breakdown
 Malicious damage
 Money
 Theft
 Storm
 Water damage
Later in this manual you will find more detailed guidelines to help you manage the following types of claims:
 Burglary and theft
 Damage to buildings or contents
 Fusion, machinery breakdown and electronic equipment
 Money
 Glass
 Jewellery
 Property
 Motor vehicle
 Heavy vehicles
 Farm machinery
 Report-only claims
 Windscreen.
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Settlement options: replacement value or indemnity value?
When our customer chooses to insure for replacement value, it means that the policy pays ‘new for old’.
When our customer chooses to insure for indemnity value, it means that the policy does not pay ‘new for old’.
The following table and flowchart explain the business rules to be followed.
Replacement value Indemnity value
Item is damaged Item is lost or stolen Item is damaged Item is lost or stolen
 Repair to new  Replace with a new  Repair to the same  Make a cash
condition. item. condition as before settlement, based
 If item cannot be  If an exact the damage. upon the market
repaired, or it will be replacement cannot  If such repair is not value* of the item.
cheaper to replace, be sourced, supply possible, repair to a
replace with a new the nearest better condition than
item. equivalent in quality before the damage.
and specifications.  If cost to repair will
 Our preferred option be more that the
is to always supply a market value* of the
replacement, but if item, cash settle on
we accede to a the basis of the
request for a cash market value.
settlement, we will  If it is impossible to
pay only the amount repair the item, cash
it would have cost us settle on the basis of
to supply the the market value*.
replacement. This
means we enjoy the
benefit of any
discounted price
that could have been
secured.
* ‘Market value’ means the price a licensed second-hand dealer would have paid for the item
had the customer wanted to sell it immediately before it was lost, stolen or damaged.
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Arranging for the item to be repaired
As mentioned in ‘Key Claims Practices’, Indemsure has a panel of preferred suppliers and repairers and you
are strongly encouraged to use their services whenever possible.
Follow the steps below to arrange for the item to be repaired:
1. Contact the repairer by telephone and obtain a quote.
2. Complete the Authorisation to Supply Provisions letter and forward it to the repairer.
The Authorisation to Supply Provisions letter has a tear-off portion so that:
 the repairer can give it to the customer
 the customer can confirm their satisfaction with the repairs and return it to you.
3. Complete the Authority to Customer letter and mail it to the customer.
The Authority to Customer letter
This letter:
 advises the customer that a repairer has been authorised to repair the item(s) that have been claimed
 asks the customer to contact the repairer to make arrangements for the item(s) to be repaired
 advises the customer of any excess that they will be required to pay upon collection of the repaired
item(s).
The repairer will send a tax invoice to you—remember to check that it is valid—when the repairs have been
completed and the item(s) has been collected by the customer. The invoiced amount should be less the
applicable excess.
Replacement of goods
Whenever possible, Indemsure practice is to replace property that is destroyed or lost, and not to pay a cash
settlement.
When replacing goods, we require at least two quotes, one of which must be from our panel of preferred
suppliers
The following procedures will apply:
 The customer will be asked to provide:
 proof of purchase/ownership of the item, so that we have an accurate description of it
 a replacement quote from a supplier of their choice.
 You then email a request for a quote, including delivery to our customer’s premises, from one of our
preferred suppliers.
 Replacement is then arranged in accordance with the lower quote (subject to the next subsection of this
manual). The goods are ordered by emailing the Authority to Supply Provisions letter.
 When the replacement is to be collected from the supplier’s premises by the customer, we send a
standard letter to our customer that explains what they need to do. We also send a standard letter to the
supplier.
 When we are to arrange for the replacement goods to be delivered to our customer, we will need to
firstly collect the policy excess from our customer.
 Once the excess has been paid, we send a standard letter to our customer confirming what has been
arranged. We also send a standard letter to the supplier.
When replacing goods, use a local or an Indemsure-preferred supplier.
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Indemsure has agreements in place with certain companies to supply goods on our behalf to our customers
at discounted prices. This helps to contain our claims costs, which of course benefits our customers and
shareholders.
However, we are also committed to supporting local business communities. Therefore, under some
circumstances, Indemsure may agree to relinquish its buying power when our customer indicates a
preference to deal with a local supplier.
The following flowchart outlines the supply process.
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TYPES OF CLAIMS
Burglary and theft claims
These are some of the issues that you or the Loss Adjuster may need to address:
 Items of property not owned by the customer may not be covered, such as goods on consignment or
property left for safekeeping).
 Theft by an employee, associate, partner or family member is not usually covered.
 It is a policy requirement that the customer immediately reports the crime to the police. Ensure that they
have done so.
 After you settle the claim, notify the police of our interest by sending them the standard Subrogated
Interest on Property letter available in the Claims Workflow System. This will ensure that if the police
subsequently recover any of the stolen property, it will be returned to Indemsure.
 Were the premises secured? Check whether the policy is endorsed to require specified security
arrangements; for example, the policy may exclude cover if the alarm system wasn’t turned or the
windows were not fitted with locks.
 Check that the customer has notified issuers of credit cards, cheque books and so on, if applicable.
 Obtain proof of ownership for the items claimed.
 Do other parties, such as a finance company, have an interest in the stolen property?
 Obtain a copy of any lease agreement involving our customer if applicable.
Claims for damage to buildings and contents

 If necessary, electricity, water and gas to be cut off to protect public safety and prevent further damage.
 Carpets to be lifted or steam cleaned to avoid rotting, bad odour and permanent damage.
 Salvage of undamaged or slightly damaged property.
NOTE: If there is salvage, the file must be immediately passed to the Claims Recovery Department for
management.
 Salvaged property to be moved to temporary safe storage, if necessary.
 Debris and damaged property to be retained for inspection.
 The premises to be temporarily secured against theft by installing shutters or making other emergency
repairs. Appoint a security service if necessary.
 The interior of premises and contents to be protected against the weather.
 Facades, weakened floors and roofing to be made safe.
 Barricades to be erected to keep the public clear of unstable structures. (It may be appropriate to
demolish unstable structures.)
 Footpaths and public areas to be made safe.
 Organise for a structural engineer or architect to report on the condition of the premises.
 If the damage is to a commercial property, will there be an interruption to the customer’s business? If
so, does Indemsure provide business interruption cover?
NOTE: If there is a business interruption claim, the file must be immediately passed to the appropriate
Claims Team for management.
 It is recommended that at least two quotes be obtained for building repairs, and, whenever possible, one
should be from an Indemsure preferred repairer.
 While this is recommended, it may be necessary in some remote areas to waive the requirement for
an Indemsure supplier quote or for two quotes if the local repairer is an Indemsure preferred
supplier. Additionally, depending on the extent of the damage and the location of the property, it may
not be practicable to get two builders to quote, for example, for minor property damage at an
isolated farm.
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 Is our customer the owner of the damaged premises or contents?
 Do other parties, such as mortgagees, lessors or financiers, have an interest in the property?
 Does the cause of the damage represent a recovery opportunity?
NOTE: If there is a recovery opportunity, the file must be immediately passed to the Claims Recovery
Department for management.
 If the property is a total loss, it may be necessary to delete the risk from the policy or cancel the policy.
This can only be done by the appropriate policy underwriting department.
Fusion, machinery breakdown and electronic equipment claims

 Forward a Fusion, Machinery Breakdown & Electronic Equipment Claim report and a Fusion, Machinery
Breakdown & Electronic Equipment Repairer report to the customer and request that they return the
completed forms to you as quickly as possible.
 Confirm that the cause of the damage was an event covered by the policy.
 For losses of $500 or more, appoint Fusion & Machinery Surveyors Australia. They will assist us by
confirming the cause of the damage, checking whether the repair quote/invoice is reasonable and
identifying any items in the repair quote/invoice that are excluded by the policy (fuses, switches and
bearings are not covered).
 Does the policy cover deterioration of stock in cold chambers? (This is an optional benefit under
Machinery Breakdown cover.)
 If stock has been spoiled, obtain documentation to confirm its value.
 Ask the customer to urgently salvage any stock that is not yet spoiled and transfer it to temporary
storage elsewhere.
NOTE: If there is salvage, the file must be immediately passed to the Claims Recovery Department for
management.
Money claims
 It is a policy requirement that the customer immediately reports the theft or loss to the police. Ensure
that they have done so.
 Do the items claimed for fall within the policy definition of money?
 Is there a policy limit for money?
 Under what circumstances was the money lost, stolen or destroyed? (Some events are excluded from the
policy.)
 Were the premises occupied when the event occurred? (If not occupied, when were they last occupied?)
 From which parts of the premises was the money removed?
 How long was the money at the particular location before the event occurred? (There may be policy
restrictions that apply.)
 In whose possession was the money when it was lost?
 Where was the money when it was lost? (Geographical exclusions apply.)
 When did the loss occur, and when did the customer discover the loss? (Some policies exclude cover
when there is a delay in the discovery of the loss.)
 Can the customer supply the serial numbers of lost, stolen or destroyed cheques, credit card vouchers,
instant lottery tickets, public transport boarding tickets and so forth?
 Check that the customer has notified issuers of credit cards, cheque books and so on.
 Identify any witnesses who might provide useful information.
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Glass claims
 When the damage is malicious, it is a policy requirement that the customer immediately reports the
crime to the police. Ensure that they have done so.
 Take appropriate action to secure the premises, such as placing boarding across broken windows.
 Carefully examine the policy wording to determine how glass is defined. For example, glass may include
porcelain fittings such as toilet cisterns and hand basins.
 Confirm what types of damage are covered by the policy. For example, the policy may exclude glass that
was chipped or in poor condition before the policy was taken out, or a fracture that is not through the
entire thickness.
 If sign-writing or decoration on glass needs to be replaced, it this covered by the policy?
 Does the policy cover replacement of security foil or window tinting?
 Who broke the glass?
NOTE: If there is a recovery opportunity, the file must be immediately passed to the Claims Recovery
Department for management.
Jewellery claims
These are the business rules that apply to the settlement of claims for jewellery that has been lost,
destroyed or stolen:
 When our customer presents a claim for jewellery that is destroyed, lost or stolen, it is Indemsure policy
to replace the jewellery, not to settle the claim by a cash payment (except in the circumstances
described below).
 We will require our customer to provide previous valuations, purchase invoices, photographs or a
detailed description of the item to enable us to obtain a replacement quote from a jeweller of our choice.
 Our customer may want to obtain a quote from a jeweller of their choice.
 An insurer is entitled to replace the jewellery through a jeweller of their choosing and to receive the
benefits of any discount given.
 Indemsure has preferred suppliers of jewellery. Whenever possible, we will obtain a replacement quote
from a preferred supplier. You will find details on the intranet under ‘Preferred Suppliers & Repairers’.
 It is our responsibility to ensure that the replacement jewellery is the nearest equivalent in quality and
specifications to the item that was lost, stolen or destroyed. Consequently, for quality items, we will
obtain a quote from a manufacturing jeweller.
 We will settle the claim by replacing the item through the jeweller who submits the lower quote.
 When our customer is unwilling to have the item/s supplied by the cheaper jeweller, we will settle the
claim by making a cash settlement to our customer for the amount of the cheaper quote, less the policy
excess.
 When the lower quote is equal to or more than the sum insured/policy limit, we will settle the claim by
supplying jewellery (the customer can choose whatever jewellery they wish) to the retail value of the sum
insured/policy limit, less the policy excess.
 If the customer insists on a cash settlement, we will pay the amount of the sum insured/policy limit, less
the policy excess.
 There may be circumstances where we agree to our customer’s request for a cash settlement because it
is not fair and reasonable for us to insist on supplying a replacement.
Example
Mrs Roberts has a Personal Policy with us that covers her contents. Her unit is broken into and her
watch is stolen. However, the watch manufacturer ceased making that brand of watch some years prior
so the watch cannot be replaced by a watch of the same specifications.
She hasn’t used the watch for several years because she is almost blind. We agree to pay her a cash
settlement.
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 When we agree to make a cash settlement on an item that is difficult to value, such as antique jewellery,
agreement should be reached with our customer as to who we will use to provide the valuation.
The flowchart below will help you to understand the procedures for settling jewellery claims.
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MOTOR VEHICLE CLAIMS
Our customer will make a claim under their policy because something has happened to their vehicle. It may
have been involved in a collision with another vehicle or been maliciously damaged. Perhaps the vehicle was
stolen, or it caught on fire.
These are the important milestones in the management of a motor claim:
 Obtain a completed claim form or obtain relevant information concerning the loss using the TeleClaims
process to determine the circumstances of the loss.
 Is this one of the types of motor vehicle claims that Claims Handlers do not have authority to manage?
(Refer to the ‘Claims authority limits’ section of this manual.)
 Consider whether there is a reason why the claim might not be acceptable:
 Is this particular vehicle insured under the policy?
 Has the customer paid the premium? (Refer to the ‘Checking premiums are paid in the Claims
Workflow System’ section of this manual.)
 Did the loss occur while the policy was in force?
 Do any of the policy exclusions apply to prevent you from accepting the claim?
 Is there a possible non-disclosure issue that needs to be explored?
 Do you have concerns that the claim may be fraudulent?
NOTE: If there is a suspicion of fraud, the file must be sent to the relevant Fraud Department.
 If you decide the claim is not covered, there are standard declinature procedures that must be followed,
as detailed under the ‘Declining a claim’ section of this manual.
 If our customer needs to hire a replacement vehicle, what cover, if any, does the policy provide?
Who will manage the claim?

A Claims Handler has authority to handle only:
 windscreen claims
 claims where it is economical to repair the damage to our customer’s vehicle AND the estimated repair
cost does not exceed the Claims Handler’s delegated level of authority AND there was no other vehicle
involved or party whose property was damaged.
The Claims Handler passes all other claims to the Indemsure National Claims Department.
These include claims where:
 the damage to the customer’s vehicle is estimated at over the Claims Handler’s delegated level of
authority
 it is not economical to repair the customer’s vehicle, meaning it will be treated as a total loss
 there is another party involved, such as another vehicle or a party whose property was damaged
 the claimant is the Claims Handler or their family member, or the Claims Handler’s employee or their
family member
 there is a recovery opportunity
 there is salvage
 alcohol or drugs are involved or suspected
 arson or fraud is suspected.
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Motor vehicle claims exceeding the delegated level of authority
To ensure that claims are actioned in a timely manner and are not duplicated, you are requested to:
 register all motor claims in the Claims Workflow System
 complete the Accident Repair Notification (ARN), recording the claim number and claim circumstances,
and send it to the Motor Vehicle Assessor for action. This action must be undertaken even if the Claims
Team does not have the appropriate delegated level of authority (refer to the ‘About Indemsure
recommended repairers’ section of this manual for details)
 attach all claims documentation to the Claims Workflow System records.
A copy of the ARN does not need to be sent to the Claims Handler as notification will be sent via the Claims
Workflow System.
Indemsure Heavy Motor Assist

Indemsure Heavy Motor Assist (IHMA) is an emergency assistance service that provides assistance to our
heavy vehicle (good-carrying capacity exceeding five tonnes) customers, where, as a result of an accident,
the vehicle has been deemed unable to be driven, a total loss or the driver has sustained an injury as a result
of the accident.
The IHMA provides the following services:
 recovery of the customer’s vehicle, via a heavy motor recovery service
 support to obtain medical treatment
 trauma counselling
 delivery of messages on behalf of the driver or Indemsure customer.
IHMA will then:
 obtain full details of the accident over the phone and complete the claim form
 arrange for the damage to our customer’s vehicle to be assessed on a without prejudice basis
 report the claim to the appropriate Claims Team.
NOTE: A claim form is not required when utilising the Indemsure Heavy Motor Assist facility.
Vehicle-to-vehicle collisions—when to apply the excess

Under certain types of policies, the excess is not required to be paid if the customer can convince Indemsure
that the accident was more than 50 per cent the fault of the other driver and the customer provides us with
the registration number of the offending vehicle and the full name and address of the driver.
These policies are:
 Personal Policy (all vehicles listed)
 Commercial Vehicle Policy and Business Policy (sedans, station sedans and utilities listed)
 Farm Policy: Private Vehicle cover (all vehicles listed)
 Farm Policy: Farm Vehicle cover (all sedans, station sedans and utilities listed)
For all other types of cover, the excess is payable even when our driver was not at fault. If and when a
recovery is made from the third party, the excess will be refunded.
When the customer’s vehicle damages their own property

In some circumstances, a motor claim may also give rise to a property claim for loss or damage caused to
property owned by the customer, such as where the customer’s vehicle impacts their house or their other
vehicle.
The first thing to do is to check the policy wording to determine whether the damage to the customer’s
property, or other vehicle, is covered. If it is, two claim files will be created—one for the offending vehicle
and another for vehicle or property that was damaged by the offending vehicle.
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The motor vehicle claim
The claim for damage to the customer’s motor vehicle is to be managed in the normal manner by registering
the claim in the Claims Workflow System.
Where the motor claim is expected to exceed the Claims Handler’s DLA, all documentation is to be
forwarded to the Motor Claims Team for action.
The property claim
The property claim is also to be managed in the normal manner by attending to the repairs or replacement
of the customer’s property at the front end.
Where the damage to the customer’s property exceeds the Claims Handler’s DLA, all documentation is to be forwarded
to both the Property and Motor Claims Teams for action.
NOTE: Indemsure’s policy on applying the excess where a property claim and a motor vehicle claim arise
from the one event is that both the motor excess and the property excess will be applied.
Example
The customer has a vehicle and house insured with Indemsure. The vehicle impacts the house causing
damage to both the vehicle and the house. The vehicle is subject to an excess of $300 and the policy
covering the house has an excess of $100. The customer will need to make two separate claims and both
excesses (totalling $400) will be applied.
‘Cause’ and ‘At Fault’ fields in the Claims Workflow System

When processing a motor vehicle claim, you must complete the ‘Cause’ field by selecting one of the event
descriptions. Care must be taken to ensure the code selected is the most suitable code for the
circumstances.
You must then select one of the following ‘At Fault’ codes:
 Y (yes)
 N (no)—only select this where the policy excess will be waived
 TBD (to be determined)—use this code when liability is disputed and cannot be determined until
investigations are complete.
Damage to farm machinery

When mobile farm machinery, such as a tractor or header, sustains damage or is stolen, there is no
obligation to use Indemsure recommend repairers (IRR) for the assessment. It may be appropriate to instead
appoint a local Loss Adjuster or Motor Vehicle Assessor from our Loss Adjusting Panel who has specialist
skills.
Vehicle hire costs

The policy wording will define when vehicle hire costs are covered, and the period of cover provided.
When the policy provides cover for the hire of a vehicle, we will pay the cost of hiring a vehicle of an
equivalent standard to the one that was stolen.
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Preferred supplier of rental passenger vehicles
When the customer requests a hire vehicle, we will arrange the supply of an Avis vehicle.
Pacificar is our preferred supplier of rental passenger vehicles because:
 they are located throughout Australia
 they provide a high standard of customer service
 their prices are competitive.
NOTE: A request by a customer to use another supplier must be justified and approved by the Claims
Handler.
How to arrange a Pacificar hire vehicle

NOTE: Vehicles rented from airports incur a surcharge. Whenever possible, please avoid renting from
airport locations.
Prior to arranging the rental you must advise the customer that:
 a credit card swipe will be required, as an excess fuel bond, when they pick up the vehicle
 the cost of fuel, miscellaneous charges and extras will be borne by them
 they must return the hire vehicle on or before the agreed date
 the standard vehicle excess for passenger vehicles is $1,000. The customer has the option to reduce the
excess to $350 at their expense ($15 per day).
Arrange the vehicle hire as follows:
1. Obtain the Rental Car Request form from the intranet, available under ‘Suppliers & Repairers’.
2. Complete the Rental Car Request form. In the ‘Claims Handler ID’ field, record your Master number,
including the state code. Select the appropriate car group and record the code in the ‘Selection: car
group’ field.
3. Email the Rental Car Request form to reservations@pacificar.com.au.
 Pacificar will contact our customer to confirm the reservation.
 Pacificar will send the Claims Handler an email to confirm the reservation.
 When the vehicle is returned to Avis, they will send their invoice to the Claims Handler.
4. Process the payment.
Pacificar can be contacted, to answer any queries, by phoning 1800 116 362 or by sending an email to
sales.assist@pacificar.com.au.
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REPORT-ONLY CLAIMS
Under the terms of the policy, our customer is required to advise us of any incident that could give rise to a
claim being made against the customer by another party.
When such a report is received, the following actions will be taken:
 Obtain a completed claim form.
 Register the claim.
 Confirm excess and update details, if required.
 Pass the file to the appropriate Claims Team for management.
CASH IN LIEU OF REPAIRS SETTLEMENTS

It is Indemsure policy to repair our customer’s vehicle. We do not pay cash settlements.
IMPORTANT: When our customer insists on a cash settlement in lieu of repairs, approval is required from
the National Compliance Team before proceeding.
WINDSCREEN CLAIMS
Winfix Auto Glass Repairs & Replacements is our preferred windscreen repairer. They have a network of
repair shops throughout Australia.
The basic policy excess will be applied unless:
 the customer has paid an additional premium to have excess-free windscreen damage cover
 this is the first windscreen or auto glass claim for this vehicle during the current policy period.
If the only damage is a broken windscreen or auto glass, the age excess and the inexperienced driver excess will not
apply.
If necessary, the customer can get a replacement windscreen from a local repairer and Indemsure will
reimburse them so that the vehicle is safe to drive.
The importance of local law relating to road rules

Indemsure and Indemsure repairers must handle repairs and replacements in accordance with state or
national laws that prescribe when a windscreen must be replaced.
In Australia, these are prescribed at a state level and in New Zealand they are national.
Summary of the windscreen claims procedures

The following flowchart explains the claim procedure:
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TOTAL LOSS CLAIMS
IMPORTANT: Total loss claims must be passed to the appropriate Claims Team for management.
Following a total loss motor vehicle claim, the Motor Claims Team will arrange to delete the risk from the
policy or cancel the entire policy as appropriate.
Following a total loss property claim, the Property Claims Team will arrange to delete the risk from the
policy or cancel the entire policy as appropriate. Where a portion of a risk is a total loss, for example, one
rain water tank out of 10, the Claims Handler’s office will be advised by the Property Claims Team to delete
the appropriate part of the risk.
A copy of the email will be sent to the Claims Handler.
About Indemsure recommended repairers

Indemsure uses our proprietary list of recommended repairers to manage the process of assessing and
repairing vehicle damage.
The Indemsure recommended repairers (IRR) network comprises about 250 accredited crash repairers
throughout Australia. These repairers are required to meet stringent targets based on service, cost, quality
and speed of repairs.
IRR assessors assist in our fraud detection process by:
 identifying damage that is inconsistent with the reported accident circumstances
 ensuring we do not pay for pre-existing damage
 reporting on any modifications to the vehicle that the customer has not disclosed, such as modifications
to the engine that increase speed
 identifying and reporting on any roadworthiness issues, such as bald tyres or defective brakes.
All IRRs have imaging equipment, enabling them to submit online pictures of the damage. This substantially
reduces assessment costs because it enables most assessment to be done remotely, without the need for
the assessor to visit the repairer’s premises.
The IRR network has a web-based program to manage the assessments. Most communications to and from
IRRs are via this internet site.
You are able to access this site to obtain or lodge claim information. This ensures that a high level of
customer service is maintained with all parties being able to check the current status of the claim at any
time.
You are also able to access all communications between any IRR and the Motor Claims Team so that you are
aware of developments at all times.
IRRs also employ in-house Motor Vehicle Assessors and may use a panel of external assessing firms.
Who appoints approved IRRs

It is your responsibility to appoint an IRR to assess damage to the customer’s vehicle.
The Motor Claims Team appoints an IRR to assess damage to a third party vehicle.
IMPORTANT: You do not have authority to arrange an assessment of a third party vehicle.
If an IRR receives a request from you to assess a third party vehicle, they will not assess the vehicle, but will
instead immediately contact the Motor Claims Team.
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How does the assessment process begin?
You appoint an IRR by accessing the internet site and completing the Accident Repair Notification (ARN).
The IRR will confirm receipt of the ARN to you, quoting their ARN number.
 If you recorded the claim number on the ARN when you submitted it to the IRR, this will also be shown on
the ARN receipt.
 A claim form is not required before the claim is lodged on the Claims Workflow System or an ARN is sent
to the IRR.
 Where an ARN is forwarded to the IRR before a claim form is received, the ARN must be marked AWP
(assess without prejudice) and you must not authorise repairs. Once the claim form has been received
from the customer and everything is in order, the claim will need to be authorised on the IRR internet
site.
 Any ARN submitted to an IRR that falls outside of your DLA will be automatically forwarded to the Motor
Team for management.
 The IRR will contact the vehicle owner to determine who will be repairing the vehicle. (Whenever
possible, the IRR will encourage the vehicle’s owner to use an ARN because this will ensure a speedy
repair and minimise repair costs.)
 The IRR will supply a quote and images of the damage (if the repairer has imaging equipment).
 The IRR will appoint the assessor.
 The IRR will advise you of the name and phone number of the assessor and the date the assessment will
take place by email.
Types of assessments
The assessor inspects the damage, agrees a repair price and submits a report.
There are three types of assessments:
Desktop assessment
The repairer does not provide images of the damage. The assessor phones the repairer and, using the repair
quote, they discuss the nature and extent of damage and reach agreement on the method of repair and any
adjustments to the price quoted.
If the quote is less than $1,500, the assessor will conduct a desktop assessment (i.e. Assessment without
viewing the damage and based on available information), unless instructed to the contrary by us.
Having completed the assessment, the assessor submits the report to the IRR.
The IRR sends us an email with the report attached and their assessing fee.
The report will prompt us if they still await our authority for the repairs to proceed.
Digital assessment
The assessor examines the pictures of the damaged vehicle and then telephones the repairer to reach
agreement on the method of repair and adjustments to the price quoted.
In most cases (about 90 per cent), the assessor is able to use the imaging assessment method to remotely
assess the damage and negotiate a repair price with the repairer.
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On-site inspection
The assessor visits the panel shop, assesses the damage, agrees with the repairer on the method of repair and
negotiates a repair price.
The most common reasons why an on-site inspection will be required are where:
 the vehicle is a total loss
 the damage is inconsistent with the accident description
 two quotes have been provided that differ significantly in cost breakdown and parts
 the extent of the damage cannot be determined using the online pictures.
Authorising repairs
IMPORTANT: Do not authorise repairs until you have received the claim form or have obtained full details
of the claim using the TeleClaims process, and you are satisfied that the claim will be
covered under the policy.
As soon as we are able to accept the customer’s claim, go into the IRR internet site, authorise the repairs
and confirm the excess that is to be applied.
The IRR then telephones the customer to advise that repairs have been authorised and confirm the excess to
be paid by the customer to the repairer. If the vehicle is driveable, the customer will be asked to contact the
repairer to arrange a date for the vehicle to be taken in for repairs. The IRR telephones the repairer to
authorise repairs and then sends written confirmation to the repairer.
The IRR informs the assessor that the repairs are authorised.
Paying the repairer

When the repair work is completed, the repairer sends the repair invoice, charged to Indemsure Limited, to
the IRR.
The IRR validates the invoice, meaning they check that the amount charged is what was agreed.
The IRR submits the invoice (and any supporting receipts or documents verifying the amount charged)
together with a covering validation report giving you details of the payment you are to make. All repair
invoices must be paid promptly.
OTHER CLAIMS SCENARIOS

When the customer’s claim is denied
If a decision is made to deny the customer’s claim, you must immediately advise the IRR by telephone or
email.
The IRR will finalise the claim on their system.
When additional damage is discovered

Sometimes the repairer will discover additional damage that was not apparent when the assessor conducted
the assessment.
In this instance the repairer contacts the assessor, and the assessor:
 agrees to or rejects the additional cost
 decides if a re-inspection of the vehicle is required.
When the assessor sends us the repair invoice, they will provide a second report to explain why the repair
price has increased.
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When additional damage is discovered by the IRR
The IRR submits their tax invoice for the full amount of the repair invoice and you must ensure that the
payment is made to the IRR.
When the repairer is not an IRR

The repairer submits the repair invoice to you, and you pay the repairer direct.
Flowchart for motor claims

The claim process under the IRR arrangements is also depicted in the following flowchart (‘Claims Handler’
can refer to either the Claims Handler or the Motor Claims Team):
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Insurance claim cheque drawing
NOTE: All processing is completed on the Claims Workflow System.
Allow the following timeframe for cheques to be drawn:
 Day 1: Process the claim and have the Claims Handler authorise payment on the Claims Workflow
System.
 Day 2: The cheque run is completed in Sydney and dispatched (same day).
Cheques are posted direct to the customer to ensure they are received promptly.
Incidental salvage
Staff handling insurance claims are not expected to get involved with recoveries or salvage; however, there
may be times when you will come across incidental salvage.
This normally occurs when police recover goods from a burglary, including televisions and laptops, or when
a customer who has been paid for lost property subsequently finds the item(s).
The recovered items become the property of Indemsure and we need to obtain the best possible price for
these items. All recovered items must be offered for sale by a tender process.
As items will vary in value, Claims Handlers may use their discretion as to how they call for tenders for items
valued at $500 or less.
Example
An item with an estimate of:
 $100 or less can be tendered within your local Indemsure branch
 $200 or less can be offered for sale by tender within the nearest three branches or perhaps offered
to the public via a notice in the Indemsure shop window
 up to $500 may be advertised in the local shop or appropriate businesses may be invited to tender
 more than $500 should be referred to the Property Claims Team.
In some instances, our customer will wish to retain the salvage. Provided the offer is reasonable, this is
often a quick and efficient way of disposing of the salvage.
When a tender is successful you will be required to produce a tax invoice. Please use the standard
Indemsure tax invoice. When payment for the item is received, the file copy should be noted as paid as this
will also serve as the receipt.
Do not release recovered items to the purchaser until payment is received.
Retain one copy of the tax invoice with the claim file.
Record the following information on the other copy of the tax Invoice:
 the word ‘salvage’
 the premium class that the claim is associated with
 an explanation that it is a salvage recovery.
Send the tax invoice together with the payment to the Head Office Credit Control Team. The payment will be
credited against the relevant premium class on the claim.
Page 80 of 95
The Indemsure recovery process (IRP)
NOTE: In all cases, claims that involve third parties or recoveries will be managed by the internal Claims
Recovery Department.
Recoveries arise through the principle of subrogation. Subrogation is where an insurer indemnifies an
insured in respect of a loss and becomes subrogated to all the rights the insured may have against a third
party who caused the loss. The insurer, in effect, steps into the insured’s shoes in order to recover the cost
of the damage.
The insured’s right of action against the third party may be in tort, contract or statute. For example, if the
damage was caused by the third party’s negligence, to successfully recover from the third party in tort the
insurer must show that the third party owed the insured a duty of care and that the third party breached that
duty thereby causing loss.
Recoveries can have a substantial impact on the cost of claims and therefore need to be managed
appropriately.
Indemsure manages the recovery process in-house, providing a personalised service, often without the use
of legal representation, saving on costs and maintaining good customer relations.
While many recovery opportunities relate to motor vehicle claims, you should consider recovery
opportunities on all claims. Ask yourself the question, ‘Was there another party involved who may have
caused or contributed to the customer’s loss?’
Claims Handlers can access the Recovery website to monitor the progress of recovery actions.
Claims audits and customer surveys

At regular intervals, your claim files and procedures will be audited. Indemsure has an audit team to
undertake this task.
The primary objective of the audit program is to achieve continuous improvement in the management of
claims, and thereby deliver the best possible service to our customers.
The other objectives are:
 to ensure the correct procedures are being followed
 to deliver ongoing coaching that will bring about improvement in case management and reduction in
wastage
 to reveal skill and knowledge gaps and thereby identify training needs.
Indemsure may also undertake random customer surveys to question such things as:
 settlement timeframes
 courtesy of staff
 attitude and ability to assess claims
 customer satisfaction.
Ex gratia payments
Ex gratia payments are payments made by the insurer when there is no strict liability to make a payment
according to the terms of the contract.
NOTE: There is no front-end authority to make an ex gratia payment. This means that you cannot, under
any circumstances, make a payment that is excluded by the cover that existed at the time of the
loss.
If a Claims Handler seeks to make an ex gratia payment, the Claims Handler is required to put their request
in writing to their Claims Supervisor/Leader/Manager, giving their reasons.
If the Claims Supervisor/Leader/Manager supports the request, they will submit it to the National Claims
Operations Manager.
Page 81 of 95
CLAIMS FRAUD
The cost of claims fraud
The Insurance Council of Australia estimates that 10 per cent of claims are fraudulent. The cost of fraud is
therefore very significant.
Indemsure policy on fraud

Indemsure has a zero tolerance policy towards fraud. Consequently, where there are strong reasons to
suspect a claim is fraudulent, it will be usually be investigated, regardless of the investigation cost or the
size of the claim.
All fraudulent claims will be rejected. Indemsure may also choose to cancel the policy.
What is claims fraud?

Claims fraud occurs when we are misled by the claimant into providing cover or making a claim payment.
Claims fraud happens when:
 false information is given to us regarding a claim, with the intention of leading us to make a payment that
we otherwise would not have made; for example:
 our customer tells us on a motor claim form they did not consume any alcohol when in fact they were
drunk
 our customer has a burglary and claims for items that never existed
 our customer deliberately or innocently gives false information to us when they complete the New
Business Transaction or the Proposal form, and that has the effect of leading us to provide cover that we
otherwise would not have provided; for example:
 our customer fails to disclose full details of their claims history
 our customer fails to tell us about modifications that have been made to the engine of their vehicle
 our customer deliberately or innocently fails to disclose material information when they renew the policy
and that has the effect of leading us to provide cover that we otherwise would not have provided; for
example:
 our customer fails to disclose a drink driving conviction from four months ago
 our customer fails to tell us that the suspension of their car was modified seven months ago
 our customer deliberately or innocently fails to disclose material information when they request changes
to their cover midway through the policy term, and that has the effect of leading us to provide cover that
we otherwise would not have provided; for example:
 our customer asks us to cover an additional car under his policy. He informs us that he will be the
sole driver but in fact it will be driven solely by his son, whose licence has recently been reinstated
following a six-month suspension period for drunk-driving.
The most common kinds of fraud are:
 the loss claimed by our customer never happened
 our customer’s account of the circumstances surrounding the loss is untrue
 our customer exaggerates the value of the loss
 non-disclosure
 use of alcohol or drugs is concealed.
Page 82 of 95
Types of claims more likely to be fraudulent
Industry experience has established that the following types of claims account for the majority of insurance
fraud:
 single vehicle motor accidents—often caused by drugs or alcohol
 vehicle thefts—can be staged
 vehicle fires—can be staged
 vehicle collisions—can be staged
 burglary and theft losses—can be exaggerated
 building fires—can be deliberately lit.
What is claims non-disclosure?

Claims non-disclosure is when a customer innocently or deliberately fails to disclose pertinent information
that would affect the insurer’s decision to insure. You can to check the information provided by your
customer in the ‘History Details’ section of the claim form to check whether there has been a non-
disclosure.
Examples
 The claim form or Motor Vehicle Assessor’s report reveals that your customer’s vehicle has been
modified from the manufacturer’s specifications and has accessories that were not fitted by the
manufacturer or dealer. Was this information disclosed when this policy was renewed last year?
 Our customer completes a claim form for a burglary loss and states that six months ago he was
convicted for common assault. Was this information disclosed when the policy was renewed last
month?
 Your customer, Miss Spiers, is aged 23. She arranged insurance on her Mazda 121 in February this
year. She visits your office to report that the vehicle has been stolen. While completing the claim
form, she mentions how unlucky she has been recently. She tells you that this is the fourth insurance
claim that she has made in the past 12 months. She was previously insured with Allianz and had been
involved in three collisions, all of which were her fault. Were these claims disclosed in the ‘Claims
History’ section when she completed the New Business Transaction or the Proposal form in February?
 Mr Broad’s pizza bar is badly damaged in a fire. During the course of investigating the loss, the Loss
Adjuster discovers that he was declared bankrupt two years ago. Did Mr Broad disclose this
information in completing the New Business Transaction or the Proposal form when he took out the
policy last year?
Parents insuring their children’s vehicles in their own names

It is common practice for parents to insure their children’s vehicle in their own names. They do this to avoid
paying the high premiums that apply to young drivers, or to secure cover for a person who would otherwise
be uninsurable because of their poor claims history or traffic convictions.
Example
Our customer is Mrs Jones, aged 44. She has her HSV Holden, registration number WALY 95, insured
with us. In completing the New Business Transaction form, she listed herself as the main driver, with no
mention of her 20-year-old son—Wally, who was born in 1995—being a regular driver.
Wally was driving her vehicle when he lost control on a bend and hit a tree. On the claim form, Wally
disclosed that he had his driving licence suspended for six months because of some speeding offences.
He stated that he only drives the vehicle about five per cent of the time.
Page 83 of 95
The Claims Handler thought it strange that a 44-year-old woman would own a HSV Holden and choose
WALY95 (her son’s name and year of birth) as the registration number. He suspected that the vehicle was
owned by Wally, but his mother insured it in her name because they both knew that no insurance
company would insure a HSV Holden that was owned and driven by a 20-year-old with a serious traffic
offence history. The Claims Handler immediately referred the claim file to the Indemsure National
Claims Department.
An investigation by the Investigation Claims Handler confirmed that the vehicle was owned and driven by
Wally. After confirming the underwriting guidelines with the relevant Product Underwriter, the
Investigation Claims Handler rejected the claim on the basis of non-disclosure.
How will I know if a claim is fraudulent?

You will be alerted to the possibility that the claim may be fraudulent in one or more of the following ways:
 you form the view, for whatever reason, that the claim may be fraudulent
 an informant suggests that the claim is fraudulent
 the Loss Adjuster contacts you to express concern that the claim may be fraudulent
 completion of the Fraud Indicator checklist (for a front-end motor or property claim) reveals one major
fraud indicator or two other indicators.
Claims that may be fraudulent are to be referred to the Investigations Team

Any claim where fraud is considered a possibility is to be referred to the Investigations Team immediately.
The following documentation must be sent to the Investigations Team under the cover of the Claim Documentation
Submission form:
 Fraud Indicator checklist (front-end motor or property)
 Verbal Report of Loss form, if appropriate
 original claim documents.
NOTE: Originals of the documentation must be sent to the Investigations Team and photocopies are to be
retained in the claim file in your office.
The Claims Handler must record any other relevant information in Section 4 of the Claim Documentation
Submission form.
The importance of carefully examining documents

It is important to carefully examine all documentation and be constantly aware of the possibility of fraud.
Example
Mrs Sheila Smith (aged 46) runs her Mitsubishi Lancer into the back of a stationary vehicle at an
intersection. Sheila completes a claim form, stating that she was the driver of the vehicle at the time of
the accident. However, the Claims Supervisor notices that the repair quotation for the customer’s vehicle
is made out to a Ms Wendy Smith. The Claims Supervisor contacts the third party who confirms that
Wendy Smith, who was aged about 18, was driving the vehicle. The Claims Supervisor contacts Mrs
Smith, seeking clarification. She admits that her daughter was driving the vehicle at the time of the
accident but she states that she was the driver on the claim form to avoid paying the age excess. The
Claims Handler immediately refers the claim to the Investigations Team. The Investigation Claims
Handler denies the claim for both the customer’s and the third party’s damage on the basis that the
claim was made fraudulently.
Page 84 of 95
Informants
What is an informant?
An informant is a person who contacts us to provide information that indicates that a claim is fraudulent.
When you receive a phone call from an informant

It is vital to maximise the opportunity provided by a telephone call from an informant.
The informant will often be in a nervous and anxious state because the person that they are ‘dobbing in’ is
usually a family member or close friend. Consequently, it is important that you handle the call very carefully.
If you feel that it would be better for a more experienced person to take the call, ask the caller if they would
mind if you pass them on.
NOTE: If the caller is at all reluctant, do not insist on transferring the call because this may prompt them
to hang up or discourage them from calling again.
A telephone call from an informant should be conducted in the following manner:
 Put the caller at ease by speaking in a calm and friendly tone.
 Ask the caller to confirm the name and address of the person being reported (this will usually be our
customer).
 Listen very attentively to what the caller is saying and make written notes in as much detail as possible.
 If anything the caller says is unclear, politely ask them to repeat it.
 Ask the caller if they know the motive for the alleged fraud.
 Ask the caller why they are providing this information.
 Ask the caller how they obtained this information.
 Ask the caller if they are prepared to give you their contact details.
NOTE: If the caller chooses to remain anonymous, explain that you will need to check the information they
have provided and this may lead you to request further details from them. Ask them if they would
be willing to call you again tomorrow. If so, give them your name and direct telephone number.
 Thank them for their co-operation.
As soon as the call is completed, immediately type a summary of your conversation, recording as much
detail as you can remember. Then refer the matter to the Fraud Manager for Claims.
Verbal Report of Loss

A Verbal Report of Loss (VRL) form must be completed when the customer verbally reports a loss, either by
telephone, during a visit to your office or during a meeting away from the office, unless at that time:
 they complete a claim form
 provide details of the loss using the TeleClaims process.
The VRL form plays a vital role in preventing claims fraud.
Having reported the loss verbally, the customer may subsequently decide to change their story when they
complete the claim form.
Examples
 Mr Porter telephones your office to report that his house was burgled. He gives you the details of the
stolen items, including a 34 cm Teac television. You record this information on the VRL form and
send Mr Porter a claim form to complete. Mr Porter decided to exaggerate his loss and states on the
claim form that a 50 inch Panasonic television was stolen.
 Mrs Smith phones you to report that her son, aged 18, was driving her car when he lost control and
hit a fence. You subsequently receive her claim form which states that she was driving. (She has
decided to fraudulently attempt to avoid paying the age excess.)
Page 85 of 95
By comparing the information on the VRL form with the claim form you are able to detect the attempted
claims fraud.
Completing a VRL form

1. Complete the VRL form. (NOTE: The person who receives the report must complete the VRL form.)
2. File the VRL form in alphabetical order, by name of customer, in a folder and attach the VRL to the
Claims Workflow System records.
3. When the claims form is received, compare the details on the VRL form with the details on the claim
form or the Loss Adjuster’s first report to confirm that they are the same.
4. If there are pertinent discrepancies contact the customer and seek an explanation.
5. If the customer’s response to your questions gives you concern that their claim may be fraudulent,
immediately seek guidance from the Claims Leader or Supervisor.
6. If the Claims Leader or Supervisor elects to handle the claim, send the VRL and the original documents
to the Investigations Claims Handler under the cover of a Claim Documentation Submission form.
When you receive a verbal report of a loss that is not covered by the policy
IMPORTANT: If the loss is not covered by the policy and you have explained this to the customer, you must
NOT discard the VRL form. The VRL form should be scanned and attached to the policy so
that you can refer to it later, if necessary.
Having reported the loss verbally and been told that the loss is not covered, a customer may attempt to claim
for the same loss at a later date.
Example
Mrs Capone telephones your office to report that her son’s bicycle was stolen. It was stolen from a park
while he was playing football with some friends. You explain to Mrs Capone that the loss is not covered
under her Personal Policy because she has Defined Events cover, which means that the bicycle would
only be covered for theft from her home. Details of the conversation are recorded on a VRL form and the
form is filed. A few months later, Mrs Capone submits a claim for her son’s bicycle, stating that it was
stolen from a shed in their backyard.
A check of the VRL folder will quickly alert you to the fact that Mrs Capone may be trying to claim for the
same bicycle, prompting you to investigate the possibility that this is a fraudulent claim.
Fraud Indicator checklists

You must complete the Fraud Indicator checklists for certain types of motor vehicle and property claims as
explained below.
When there is one major indicator or two or more other indicators, the claim must immediately be
referred to the Investigations Team.
If the Investigations Team believes that the claim is legitimate and does not feel that it warrants an
investigation, despite the fraud indicators, the Claims Handler must send the Fraud Indicator checklist to the
Investigations Claims Handler under cover of an explanatory email. The Investigations Claims Handler will
decide whether to assume ownership of the claim.
For audit purposes, the Fraud Indicator checklist must be attached to the Claims Workflow System records to
provide evidence that the possibility of fraud has been properly addressed.
Front-end motor claims

The possibility of claims fraud must be checked for the following types of motor claims:
 single vehicle accidents estimated above $3,000
 vehicle fires, regardless of the estimated repair cost
 stolen vehicles, regardless of the estimated value of the vehicle.
You do this by completing the Fraud Indicator Checklist—Front-End Motor Claim.
Page 86 of 95
Page 87 of 95
Front-end property claims
The possibility of claims fraud must be checked for the following types of property claims:
 burglaries
 thefts
 fires.
You do this by completing the Fraud Indicator Checklist—Front-End Property Claim.
Page 88 of 95
A CATASTROPHE EVENT
What is a catastrophe event
When an event generates a number of claims and the total cost is estimated to be greater than $1.5 million,
it will be classified as a catastrophe and allocated a catastrophe (CAT) code.
Catastrophe procedures
On the ‘Cause of Loss’ screen in the Claims Workflow System, there is a field to enter a catastrophe code.
The authority to allocate a CAT number to the claim must be given by the National Claims Operations
Manager.
Code of Practice catastrophe claims

Section 4.5 of the Code of Practice stipulates that when an insurer finalises a claim within one month of the
catastrophe or disaster that gave rise to the claim, the insured has the right within the following six months
to request the insurer to review the claim if they are dissatisfied with the settlement.
When you settle a catastrophe claim within one month of the event, the settlement cheque must be sent
under cover of the standard letter that informs our customer of the above procedure. You will find the letter
on the intranet under ‘Standard Letters & Templates’.
Catastrophe Response Manual

Indemsure has set in place detailed procedures to ensure that we provide a high standard of claims service
to our customers in the event of a catastrophic event. These procedures are detailed in the Catastrophe
Response Manual, which you will find on the intranet under ‘Catastrophe Claims Procedure’ (CCP).
There are certain claims with a reserve less than $500,000 ($100,000 for professional liability claims) that
must also be reported. These claims fall in the category of ‘Special Circumstance’ (SC) claims. These losses
must be recorded within the Claims Workflow System.
The ‘SC’ field defaults to ‘N’ and must be changed to ‘Y’ upon registration of an SC claim or through the
‘Claim Modify’ screen if the SC criteria are identified at a later date.
Special Circumstance claims comprise losses that:
 may attract industry or media attention
 may create an exposure for several regions or branches
 may present a significant hidden exposure for the company
 are one of the following claim events:
 a class action
 a claim that has the potential to be worth $1M or more
 any claim where an SC is to be instructed
 are one of the following claim types:
 brain injuries
 quadriplegia (tetraplegia)
 paraplegia
Page 89 of 95
 involve any of the below incidents:
 when arson by the insured is established
 when fraud by the insured is established
 flood
 asbestos- or dust-related disease
 sexual abuse or molestation
 any accident involving the death of two or more persons.
NOTE: These incidents will be regarded as SC regardless of our insured’s liability, our position on policy
indemnity or the company’s share of the risk, as a co-insurer or reinsurer.
CLAIMS REFERENCE DOCUMENTS

Purpose of the library
Almost every day each of us will face a claim situation that we have not previously encountered.
You may have questions such as:
 What does this policy wording mean?
 What does the law say about this set of circumstances?
 What is Indemsure’s policy regarding this scenario?
 What is the correct procedure I should follow here?
To help answer some of these questions, a Claims Reference Library has been developed to support you in
your decision-making, located on the intranet under ‘Insurance’, ‘Claims Reference Documents’.
The purpose of the database is to provide quick and easy access to a library of reference material that can
assist in day-to-day management of claims.
Suggestions for additions or changes to the library database should be sent to the National Claims
Operations Manager, who approves additions.
Page 90 of 95
GLOSSARY OF TERMS
Roles and Teams Definition
Approved Authoriser The Claims Handler will register the claim and process the
payment/s, and the approved Authoriser will authorise the
payment/s.
Call Centre Deals with first stage of lodgement, which covers the initial
triage process to assignment to the applicable specialist claims
team.
Call Centre Consultant An employee working in the Call Centre. Consultants can lodge a
claim and, at times, settle a claim such as a windscreen or
broken window claim. They take the claim, authorise the claim it
and organise the repair process.
Claims Handler Anyone who processes claims at any level. They could be in the
Call Centre or in one of the National Claims Teams.
Claims Leader/Supervisor/Manager Generic descriptions of management levels
Claims Recovery Department In all cases, claims that involve third parties and recoveries will
be managed by the Claims Recovery Department.
Compliance consultant (part of the National Compliance consultants manage DLAs

Compliance Team)
Credit Support Centre The department responsible for cheque payments and deleting
all total losses for motor vehicles upon request from the Claims
Department.
Fraud Department The team of Investigation Claims Handlers who investigate

suspicious claims at any level as part of the claims process.
Investigation Claims Handler Anyone who investigates suspicious claims at any level as part of
the claims process. They work in the Investigations Team.
Investigations Team The team of Investigation Claims Handlers who investigate

claims at any level as part of the claims process.
National Claims Operations Manager The person responsible for approving requests for increased
DLA, ex gratia payments, CAT code assignment and additions to
the library.
Page 91 of 95
National Claims Teams include: National Claims Teams handle all specialist claims above the
 Motor Claims Team ‘fast-track claims’ level.
 Property Claims Team Claims Teams are normally organised by product type and
(House & contents, jewellery) claims for that product are sent to the team that is authorised to
manage that product type.
 Commercial Claims Team
 Statutory Claims Team
 Travel, Liability and Investigations Team
National Compliance Team The team of consultants who manage DLAs, buddies and cash
settlements.
Policy Underwriting Department The team of Product Underwriters who advise on the policy
conditions of products.
Product Underwriter Product Underwriters advise on the policy conditions of a

particular product. For example, for a motor vehicle, the
relevant Underwriter to refer to would be the motor vehicle
Product Underwriter.
Recovery agents Members of the Claims Recovery Department who manage all
claims that involve third parties and recoveries.
Training and Development Officer The TDO is the staff member responsible for confirming that all
required training has been completed and approving buddies.
Systems Definition
Claims Workflow System The system through which claims are processed
Claims Workflow Diary The Claims Workflow Diary must be used to control claims. It
enables claims dates to be diarised so that Claims staff are
automatically reminded of important dates for follow-up.
Indemsure Claims Lodgement website Used by preferred suppliers to lodge claims
The intranet An internal internet system for Indemsure staff where all
support documentation is located.
TeleClaims The process used for claims reported verbally: over the phone,
during a visit to your office or during a meeting with the
customer away from your office.
Claims Handlers obtain details of the claim by asking the
customer questions. They follow an online script and key in the
answers given by the customer.
Page 92 of 95
Documents and forms Definition
Claim Documentation Submission form The form to be used to cover all required documentation
required for a claim.
DLA Request form The form to be used to requested an increased level of claims
authority.
Fraud Indicator checklist There are two fraud indicator checklists, one for front-end motor
claims and one fir front-end property claims. These checklists
must be completed in the event of certain claims types or
wherever you suspect fraud may be present.
New Business Transaction form The form to be completed by potential new customers (they
could also complete the Proposal form).
Proposal form The form to be completed by potential new customers (they

could also complete the New Business Transaction form).
Rental Car Request form The form to be completed to arrange rental car hire where this
is a policy inclusion.
Report of Loss The report detailing the claim that is generated by the Claims
Workflow System and emailed to the Loss Adjustor in the event
that a LA needs to be appointed.
Settlement Release form The form that customers must complete when Indemsure pays a
claim. It ensures that customers cannot re-claim the same
event and that payments cannot be accidentally duplicated.
Stop Payment/Cheque Cancellation Request The form that must be completed in the event that a cheque
form needs to be cancelled. Must be sent to the Credit Support
Centre.
Verbal Report of Loss form A form completed by the Claims Handler in the instance that a
claim is reported over the phone verbally by the customer who
has not yet completed the written claim form.
Page 93 of 95
Processes Definition
Catastrophe Claims Procedure (CCP) A set of processes used to lodge claims in the case of a
catastrophe event, such as cyclone, flood, fire or hail storm.
Claims Teams ‘buddy’ system The system whereby two Claims Teams have an informal
arrangement to support each other by providing temporary
assistance to process front-end claims in the event that a team
member is on leave. It is preferable, but not essential, that the
buddy Claims Teams have the same DLA.
Indemsure recovery process (IRP) A set of steps to complete when recovering or requesting back
monies that are owed to damage caused to the customer’s
property and/or motor vehicle or any loss suffered by the
Indemsure customer.
Internal services Definition
Customer Dispute Resolution Policy & Includes escalating the complaint to a Leader/Manager, IDR
Procedures (Internal Dispute Resolution) and FOS (Financial Ombudsman
Service).
Claims Help Desk Claims call centre for customers to phone to lodge, enquire on
1300 CLAIMS or update their claims.
Internal Dispute Resolution panel Internal body for dispute resolution
Indemsure Heavy Motor Assist (IHMA) Roadside assist service provided by Indemsure.
(facility)
Page 94 of 95
External Providers Definition
Accident Repair Notification (ARN) A form to be completed by preferred suppliers in the event that a
car involved in an accident requires repair.
Financial Ombudsman Service (FOS) The Financial Ombudsman Service fairly and independently
resolves disputes between consumers—including some small
businesses—and member financial services providers.
Indemsure Recommended Repairers (IRR) IRR is a network of about 250 IRR accredited crash repairers
throughout Australia.
Motor Vehicle Assessor (for vehicles) A person who determines the value of damaged or stolen motor
vehicles.
Pacificar A rental car company on the Indemsure preferred supplier

panel.
Property Loss Adjuster (for other property) A person who determines the value of damaged or stolen
property.
Winfix Auto Glass Repairs & Replacements A glass repairer on the Indemsure preferred supplier panel.
Other Jargon Definition
Declinature A declinature is where the claim or circumstances are deemed

(also Declining and Declined) to not respond to the policy, which means that the policy or
contract of insurance does not cover that loss.
(Note: do not use the term ‘deny’.)
Delegated level of authority (DLA) Standard jargon when talking about claims authorities
ITC (input tax credits) The input tax credit refund that the payee is entitled to claim for
the item dictates the percentage of ITC that Indemsure must
deduct when making a cash settlement to them.
Page 95 of 95

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Processes and Procedures Manual

The objectives of this claims manual

INSURANCE CONTRACTS ACT 1984

CLAIMS HANDLING PROCEDURES

Our rules of conduct

Job level/role DLA

Claims Handler $50,000

Commercial Claims Handler $500,000

Claims Supervisor or Leader $1,000,000

Settlement payments are requested as follows:

Requested Purpose of payment Who can authorise

Third payment: To rebuild the factory (building costs). Manager

How often is the claims authority level of a Claims Handler reviewed?

When claims authority may be revoked

INDEMSURE NATIONAL CLAIMS TEAMS

Postal Indemsure Indemsure Indemsure Indemsure Indemsure

Internal Indemsure Indemsure Indemsure Indemsure Indemsure

Email motorclaims@ propertyclaims@I Commercialclaim Statutoryclaims@i TLIclaims@

Types of policies governed by the code

Performance standards required by the Code

3.2.1 Within 10 business days of receiving your As above for 3.1

3.2.2 If we decide to appoint an assessor, As above for 3.1

3.2.4 We will respond to your routine requests As above for 3.1

3.2.5 When we have all necessary information As above for 3.1

3.4 The standards in this section apply to all claims

3.4.1 We will conduct claims handling in a fair, As above for 3.1

3.4.4 Where an error or mistake in dealing with As above

3.4.5 If we decline your claim, we will provide: As above for 3.1

3.5 The standards of section 3 of this Code do As above for 3.1

3.6.4 Our Employees or our Service Providers As above for 3.1

3.6.5 Our Employees and Service Providers will As per 3.6.4

3.6.9 We will: The results of the various monitoring and supervision

3.6.11 We will handle complaints relating to or We comply with this requirement

3.8 We will notify any financial institution that As per 3.7

3.9 If you are unhappy with our decision, we As per 3.7

3.10 We and our Service Providers will comply As per 3.7

3.11 If a person is experiencing difficulty Indemsure’s Approved Panel providers service

3.12 If we are unable to reach an agreement As per 3.11

4. RESPONDING TO CATASTROPHES AND DISASTERS

4.2 We will respond to catastrophes and Addressed in Claims Manuals

6. COMPLAINTS HANDLING PROCEDURES

6.1 The following standards apply to all complaints handling.

6.1.5 Where an error or mistake in handling your As above

6.10 Insurers subscribe to the independent Member of FOS

6.11 The FOS Service is available to customers Yes.

6.12 External dispute resolution determinations We advise customers of this.

Await a possible challenge from our customer to the declinature

Internal Dispute Resolution (IDR) process

The Financial Ombudsman Service

KEY CLAIMS PRACTICES

Two people are needed to process a claim

Indemsure preferred suppliers and repairers

Adequate product knowledge

Educate your customer to contact you for claims direction

Ensure all mail is date stamped upon receipt

Identify paid invoices

A claim must be lodged promptly

How does TeleClaims work?