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Claims & Disputes

Documenting a claim so the record supports you

Claims are resolved on the file. Building a good file is a skill, and it is mostly about doing dull things consistently.

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Financial information notice. Analysis and education — not personalised financial advice. Read the full disclaimer.

Whatever the line of insurance, the outcome is determined by what is in the file. Building that file is the policyholder's job as much as the adjuster's.

The claim log

A single document, chronological, recording every interaction.

For each entry: date, time, method of contact, name and title of the person, what was discussed, what was agreed, and any reference number.

This takes two minutes per call and it is the most valuable thing in a disputed claim.

When an insurer's records and yours differ, a contemporaneous log with names and dates carries weight. A recollection does not.

It also reveals patterns — the same question asked three times, a promised callback that never came, a delay with no explanation — which are exactly the facts that matter in a complaint to a regulator.

Confirm conversations in writing

After any substantive call, send an email summarizing it.

"Following our conversation today, my understanding is that you will send the itemized estimate by Friday and that the additional living expenses coverage applies from the date of the loss. Please let me know if I have misunderstood."

Two sentences. It converts a verbal exchange into a documented one and gives the other party the chance to correct it.

If they do not correct it, your version stands as the record.

Photographs and video

Extensively, immediately, before any cleanup or repair.

Wide shots establishing context, medium shots showing the extent, close shots showing detail. Include something for scale.

Photograph the undamaged areas too, which establishes the pre-loss condition of adjacent property — relevant for matching claims.

Video walkthroughs with narration are particularly useful because they capture context that individual photographs miss.

Preserve original files with their metadata rather than only sending compressed copies.

Estimates and expert reports

Obtain your own repair estimates from licensed contractors, itemized rather than a single figure.

Where the insurer's estimate differs materially, the comparison is the argument. Line-by-line differences are addressable; total-figure disagreements are not.

For complex or high-value losses, independent expert reports — engineers, industrial hygienists, specialist contractors — carry substantial weight and can be worth the cost.

Receipts

Every expense connected to the loss.

Mitigation costs, which are generally reimbursable.

Additional living expenses if displaced — accommodation, meals above your normal cost, laundry, storage, pet boarding, additional commuting.

Replacement purchases, which are required to recover withheld depreciation under replacement cost policies.

Keep them organized by category from the beginning rather than assembling them later.

The policy itself

Get a complete copy, including the declarations page, the policy form and every endorsement.

Not the summary. The actual contract.

Read the sections relevant to your loss: the coverage grant, the exclusions, the conditions, and the duties after loss.

That last section matters. Policies impose obligations — prompt notice, protecting property, providing records, submitting a proof of loss, cooperating with the investigation, and sometimes submitting to an examination under oath.

Failing to meet them can prejudice a claim regardless of the merits.

The proof of loss

A formal sworn statement of the loss, required by many property policies, frequently within a defined period.

Take it seriously. It should be complete and accurate, and it should reserve the right to supplement as additional damage is discovered.

An incomplete proof of loss can limit recovery to what was stated.

Where the deadline is tight and the loss is complex, request an extension in writing. These are commonly granted.

Preserving evidence

Do not discard damaged property until the insurer has inspected it or authorized disposal in writing.

Where disposal is necessary for health or safety, photograph extensively first and document the reason.

Keep failed components — the burst pipe section, the failed appliance part — since cause of loss frequently turns on physical evidence.

This is particularly important where a manufacturer or contractor may bear responsibility, since the insurer may pursue subrogation and the evidence supports it.

Organizing the file

A single folder, physical or digital, containing everything.

Subfolders: policy documents, the claim log, correspondence, photographs, estimates, receipts, medical records where relevant, and the insurer's documents.

Name files with dates so they sort chronologically.

Back it up.

Tone

Firm, factual and persistent works. Hostility does not.

The person handling your file has limited discretion and a large caseload. A well-organized, factual, specific communication gets attention. An angry one gets a defensive response and a note in the file.

Save the escalation for the escalation channels, which exist and which work.

General information about insurance claims, not insurance or legal advice. Policy duties, deadlines and requirements vary. Read your own policy and consult a qualified attorney for significant disputes.

Grace Mbeki
Editor, Premium Policy Plans

Grace worked as a claims adjuster for eight years. She writes the article she wishes policyholders had read before they called her.

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