
Welcome to our Claims Technical Spotlight - January Edition!
This month, we’re proud to showcase Chloe, one of our outstanding Claims Consultants, whose empathy and persistence transformed a partial approval of $24,249.35 into a fully approved claim totaling $76,152.97. Her unwavering commitment ensured a vulnerable client*, facing personal challenges, received the comprehensive roof and solar replacement they deserved.
(*Please note, client names and sensitive information have been redacted to maintain client privacy.)
Case Overview
This case involved a vulnerable client facing significant personal challenges, including his wife’s serious health diagnosis and his own upcoming surgery. Initially, the insurer approved only a solar replacement valued at $24,249.35. Recognising the full extent of the damage, our claims consultant, Chloe, worked diligently to gather and present additional evidence of hail damage, making sure the claim received a thorough reassessment.
Throughout the process, Chloe maintained consistent communication, adapting to the client’s limited availability by providing updates via emails and voicemails. Her persistence and detailed advocacy led to the insurer overturning their initial decision and approving a full roof replacement, including solar, with an approved scope totaling $76,152.97.
Chloe’s empathy, strategic approach, and unwavering commitment not only secured the best outcome but also provided much needed support to the client during a difficult time, exemplifying the dedication we bring to every claim.
Read the full interview with Chloe below, on how she managed to secure this result:
Q. What were your first thoughts when you learned about the client’s personal challenges, and how did it shape your approach to managing this claim?
Chloe: Once I became aware of my client’s unique circumstances, I adapted our communication approach to better suit their needs. Their health and well-being were my top priority, so I took on the responsibility of being their sole point of contact for the claim. I also made sure both the insurance company and the contractors were fully informed of their situation to ensure everything was handled with care and consideration.
Q. What steps did you take to gather the additional evidence needed to challenge the insurer’s initial decision?
Chloe: Initially, the insurer had only approved coverage for hail damage to the solar panels. To make sure all damages were properly addressed, I worked with our recommended repairers to prepare a detailed roof report. The report confirmed hail damage to the solar panels, as well as to the solar hot water system. The roof report also identified 31% damage to the main house roof - warranting a full roof replacement for my client. Once the insurance company received this information, they revised their decision, overturning the partial claim acceptance and approving the full claim.
Q. How did you adapt your communication style to allow the client to feel supported despite their limited availability?
Chloe: My clients faced several challenges throughout the claims process, which required me to adapt my approach to meet their needs at various stages. At times, they preferred text messages, as they weren't always able to take calls. During other stages of the process, voicemails worked better, as they would often have their phones turned off during long hospital visits. We developed a system where, if I needed to speak with them promptly, I would leave a voicemail requesting a callback and follow up with a text message or email to ensure they received the message.
Q. What was the turning point in this case that led to the insurer overturning their decision?
Chloe: The turning point was when I was able to supply a detailed roof report along with comprehensive photographic evidence from our preferred repairer. From here, the insurer was able to reassess and overturn their initial decision.
Q. What strategies did you use to advocate for a full roof replacement, and why were they effective?
Chloe: Photographic evidence is hard to dispute! By presenting clear photos of the hail damage to the property, combined with my insurance expertise and a thorough review of the clients' policy, we were able to achieve the outcome that my clients rightfully deserved.
Q. What was the most rewarding moment for you during this process?
Chloe: It was incredibly rewarding to call my clients and share the news that they weren’t just receiving new solar panels. Thanks to the strong evidence we provided, their insurance policy was able to cover the full extent of the damage, resulting in the approval of a new roof and solar hot water system as well. My clients couldn't have been more grateful, thanking myself and ClaimsCo “from the bottom of their hearts”. That is the reason why we do what we do!
Q. What challenges did you face in getting the claim reassessed, and how did you overcome them?
Chloe: The photographic evidence we provided made sure that the insurance company had no objections to amending the claim, resulting in full approval.
Q. What did this case teach you about advocating for clients who are facing significant personal hardships?
Chloe: Every client is unique, and sometimes it takes a creative approach to truly meet their needs. I’m incredibly grateful for the opportunity to have supported my clients throughout this process, and im thrilled that I have been able to relieve some stress in their day to day life.
Chloe’s ability to combine technical expertise with empathy highlights the exceptional standard of care and professionalism we bring to every claim. By identifying the full extent of the damage and advocating tirelessly for her client, Chloe achieved a significantly improved outcome while providing invaluable support during a difficult time.
Her determination to amplify her client’s voice reflects our commitment to delivering outstanding results, no matter how complex the circumstances. This case showcases the meaningful difference our claims consultants make every day.
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