What happens when you make a claim?

Person on phone

By its very nature, making a claim on your protection is a stressful time. It means something has gone wrong — whether it’s an accident, a theft or a major disaster like a fire or flood.

So, when you pick up the phone to call Capricorn Risk Services to tell them what has happened, you want the comfort of knowing the claims process will be straightforward and the person on the other end of the phone will be knowledgeable and helpful.

But do you know what the claims process actually looks like? Lots of people don’t, but if you’re making a claim it can be helpful to know what to expect.

We asked our Claims and Administration Team Leader Manager, Anthea Jacobs, to talk us through it.

Call Capricorn Risk Services to lodge a claim

If you call between 6am and 5pm WST on a weekday, you’ll get straight through to one of our claims team.

“Someone in the claims team will lodge the claim with you over the phone, putting all the details into our claims system,” Anthea said. “They’ll explain to you what claims documentation you need to provide and talk you through the next steps.”

After the call you’ll be sent a lodgement email for your claim. The email will include a claim number and confirmation of the instructions on what to do next.

People in reception

What if I call outside normal hours?

Outside of normal business hours, you’ll go through to an after-hours service provider who will either take a message or refer you through to one of our on-call team members.

“For example, if it’s an emergency, like you’ve had a fire at your property and you need action straightaway, that gets referred to the person on the after-hours phone,” Anthea said.

“Any urgent action required is organised immediately to make sure you and your family are safe, then someone from our claims team will call you back the next business day to lodge your claim.”

Confirmation with a claims officer

Next, you’ll receive a call from a claims officer, who will reconfirm all the details with you, answer any questions you have and make sure you understand exactly what you need to do next and what will happen.

Assessing and processing

Exactly what happens next depends on the type of claim you’re making but, in short, your claim will be assessed to confirm the circumstances of the claim.

  • We may appoint an assessor to review your claim
  • We may appoint a builder to quote on repair
  • We may ask you to provide further evidence (like photographs, receipts)
  • We may ask you to get quotes to repair the damage.

“The type of claim and its complexity determines what actions need to happen next. This could range from getting assessments and reports to investigators or specialists” Anthea said.

“In most circumstances it is straight forward. However, at times there may be some toing and froing in terms of reports to confirm the cause of damage, and to confirm that it can be accepted within the terms and conditions of the product disclosure statement (PDS).”

Anthea said throughout this time, Capricorn Risk Services keeps Members fully informed of progress.

Approval, repair and replacement

Once the claim has been approved we will provide a repair authority and generally you will be able to go ahead and repair or replace the items damaged or stolen or carry out the work that needs to be done to get you back up and running like you were before unless you are otherwise instructed.

Send in your invoices for payment

Once the repairs or replacements are complete, the repairer will generally send the appropriate invoices through to the claims team, who will arrange for them to be paid or for you to be reimbursed for them.

People in workshop

The mutual advantage

While making a claim is never a fun process, it can at least be an easy and efficient one. Anthea said that’s where Capricorn Risk Services being a discretionary mutual is a real advantage for Members.

“While we are bound by the terms and conditions of the PDS, as a mutual we do have the ability to make discretionary decisions, to help you in your time of need,” she said.

“This can often very much help Members get back on their feet.

“For example, if a Member has had a large fire, maybe they’ve had a total loss, they may need a cash injection to help them get on top of things while the claim is progressing. We can consider releasing a payment to the Member just to help them cover any costs to help them continue running their business, or maybe to relocate to another property so they can start their business again.

“For us it’s really about trying to think outside the box and work out what can we do to help a Member get back to the position they should be, and to keep things running for them until the claim is settled.

“We have that ability to put Members first and we do. That sets us apart from a normal insurance company.”

AU: Products sold through Capricorn Risk Services Pty Ltd (ABN 93 111 632 789) are: (i) discretionary risk protection products issued by Capricorn Mutual Ltd; and (ii) general insurance products issued by a range of insurers and brokered through Capricorn Insurance Services Pty Ltd. Before deciding to acquire any product you should consider the Product Disclosure Statement available from Capricorn Risk Services Pty Ltd to see if the product is appropriate for you. Capricorn Risk Services Pty Ltd is a Corporate Authorised Representative (No. 460893) of Capricorn Mutual Ltd (AFSL 230038) and Capricorn Insurance Services Pty Ltd (AFSL 435197).

NZ: Products sold through Capricorn Risk Services Pty Ltd (NZBN 9429041139813) include discretionary risk protection and general insurance products. Discretionary risk protection is issued out of Australia by Capricorn Mutual Ltd. Before deciding to acquire discretionary risk protection you should consider the Product Disclosure Statement to see if it is appropriate for you. This can be obtained from Capricorn Risk Services Pty Ltd by phoning 0800 555 303 via email info@capricornrisk.com or by visiting website capricornrisk.com. General insurance products are issued by a range of insurers and are available through Capricorn Risk Services Pty Ltd as a member broker of PSC Connect NZ Limited. Capricorn Risk Services Pty Ltd is a registered financial services provider (390446) and a corporate Authorised Representative (No. 460893) of Capricorn Mutual Ltd (AFSL 230038).

This article was published 11/10/2021 and the content is current as at the date of publication.