What is the role of the adviser during claims

Last Updated on 23, March 2014

During insurance claims, the duty of the adviser is:

1. To check that the policy which the claim is made against cover the intended risk;
2. To advice the policyholder the documents to prepare for claim submission;
3. To submit the documents to the insurer. The policyholder can also do it as all insurers have a customer service center to accept walk-in enquiry;
4. If the claim is rejected, the adviser’s duty is to provide his opinion as to whether the reason for rejection is fair in accordance to industry’s practice. If the reason is unreasonable, the adviser can advise the policyholder the next course of action such as helping him to draft a letter of appeal and/or to obtain further documentation to strengthen the claim.

Normally the adviser tagged to the policy will do the above. However, it is common that the original adviser has resigned, retired or died. So the takeover adviser may be reluctant to process the claim since there is no remuneration for doing this.

Strictly speaking, any adviser is able to perform the duties mentioned above since most of the tasks are related to advising the policyholder. Due to this reason, policyholders do not need to worry if the original adviser has left the company.

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