Criteria used to assess the Validity of a Complaint - Insurance Company

[virajs]

Dear Friend
I work in an Insurance company and i was requested to state the criteria used to assess the validity of complaint.

How do we assess whether a complaint is valid or not valid?
Regards
viraj

[Jennifer Kirley]

I would establish validity using a two-step test during investigation:

1) Did the events occur as the claimant described?
2) Did the actions of the claimant and/or insurer conform to terms of contract?

[dQApprentice]

Hi Viraj,

Assess the validity of complaint against your insurance company services, limitation and exclusions, provision in the insurance agreement, and procedures involved in availing services. Remember that customer/member should not be deprived of privileges because they are paying premiums regularly and insurance is primarily for protection against financial losses not a way to grow member/customer’s money.

[virajs]

Dear Friend

Thanks friend for your prompt reply

Sorry, i dont know your name

Can you please elaborate on '...paying premiums regularly and insurance is primarily for protection against financial losses not a way to grow member/customer’s money'

Do you mean that we must not maximise profit at the expense of clients

Rgds

viraj

[dQApprentice]

Originally Posted by virajs

Can you please elaborate on '...paying premiums regularly and insurance is primarily for protection against financial losses not a way to grow member/customer’s money'

Do you mean that we must not maximise profit at the expense of clients

Viraj,

What kind of insurance plans do you provide? Life insurance? Health and Medical Insurance? Home Insurance or Motor Vehicle Insurance? Insurance plans are designed to protect a client-member and his/her family from financial disaster when an unfortunate event occurs.
I didn’t say don’t maximize your profit. In fact, you can maximize your profit by providing quality service. That way, your customer will come back. Satisfied client will likely to refer you to their family, friends - more clients, more income.