When the claim is received a member of the claims team will contact the broker and then the claimant advising who their Case Manager is and our claims procedure. Within 5 working days from the receipt of claim, the Case Manager will make one of the following 3 decisions:
Accept the claim and payment will commence, in accordance with the waiting period and our payment dates.
Reject the claim and notify the broker and claimant of our decision and provide reasons why we have rejected the claim. We will also give the claimant details of their rights to appeal our decision.
Requiring further information, such as further medical or employer information etc.
In the case of point 3 where we require further information for the assessment of the claim and cannot make a decision within 5 working days we will:
Give you detailed notification of what information is required to make a decision on the claim.
Provide an initial estimate of the time required to make a decision on your claim.
Keep you informed of the progress of your claim at least every 10 business days and respond to your routine requests for information within 10 business days.
Once all the necessary information is received and investigation complete to assess the claim, we will decide to accept or reject the claim and notify you within 5 business days upon receipt of all the relevant information.
At times we may receive claims with which our standard time frames for assessment are not practical. This may be due to the complex nature of the claim where there may be factors which will delay the normal assessment process. In these situations will look at working with you to reach a mutual agreeable alternative time frame.
If an alternative time frame cannot be reached with you we will advise you of your right to access our complaints handling procedures.