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Insurance Claims Management Services

Should I hire a claims management service to help run my claim?

You may be considering using an insurance claims management business – a for-profit  service that will represent you for a fee, and do the leg work on your insurance claim. Before you decide to sign up to one of these business – you should understand the risks involved and consider the alternatives.

WARNING: Consumers should read this factsheet before using an insurance claims management service.

TOP TIPS:

  • You may not need to as there are free resources to help you
  • If you are going to engage a company to manage your claim, make sure that you understand how they will be paid and how much (flat fee or as a percentage of your settlement), ask for independent references and to see any contract before you agree.

Having an insurance claim can be daunting, policies can be complex and full of jargon, and it can feel like the insurer is giving you the run around. There are free services for legal advice or information about your rights in most states (see below), but not everyone can get free help to run their claim from start to finish. It can seem like a great idea to pay someone to negotiate the claims maze for you, and there seem to be more and more businesses appearing to do just that through the internet, or even turning up at your door.

 What’s the harm?

Claims management services typically work for a percentage of any cash settlement offered by the insurance company. They may not have legal qualifications, or any qualifications. The industry is not subject to any specific regulation or oversight.

The risks for you could be:

  • they seek a cash settlement as the resolution. This may not always be fair as it means you lose the option for the insurer to do the works. Insurers offer guarantees (sometimes for life) on the works they do. Also, they manage the repair process which can sometimes be complicated. There are also times that the repair costs are uncertain which means a cash settlement may leave you out of pocket. Therefore, you need to be sure that accepting a cash settlement is in your best interests, not just in the interests of the claims management service to get their fee;
  • they unreasonably enlarge or inflate your claim, therefore increasing their own fee. This could work in your favour, but it could also backfire if they drag out your claim unnecessarily, by arguing for an unrealistic amount;  
  • they are not regulated, and so are not members of external dispute resolution scheme like the Australian Financial Complaints Authority (which is a free service for consumers), so If you have any problems about the quality of their work or a dispute over their cost, it can be difficult to resolve;
  • the service you hire might not have the resources to undertake all the work they agreed to do if they take on too many clients.

CHECKLIST: If you decide to engage a fee-for-service claims management, make sure you:   

  • Ask up front what the cost is before you provide any payment details such as your credit card or agree to the service by signing a contract, or agreeing to retain the service over the phone.
  • Obtain a copy of the contract and read it carefully. Seek independent advice if you are unsure about any terms.
  • Ask how do they calculate their fee? Is it a percentage of your claim or a flat fee?
  • Ask what happens if your insurance claim is unsuccessful or less successful then what they promised?
    • Do you still have to pay for the claims service?
    • How do they calculate their fee if the insurance claim is not fully paid?  
  • Ask if they are a member of a free external dispute resolution service such as the Australian Financial Complaints Authority?
  • What are their experience and qualifications?  
  • Have they provided you a written scope of the work they are going to do or will they agree to do so before you have to sign a contract with them?
  • Are you authorising them to launch legal proceedings or a complaint to AFCA on your behalf? Do they need to get your permission before they do so? Will they charge you a fee for accessing AFCA (noting AFCA is free and accessible to consumers)?

FREE NATIONAL LEGAL SERVICES

Financial Rights Legal Centre

  • Insurance Law Service                    1300 663 464
  • Mob Strong Debt Help                1800 808 488

If you can’t get through on our busy phone lines you can email us through our website: insurancelaw.org.au

National Association of Community Legal Centres: Find a CLC near you at naclc.org.au 

Australian Financial Complaints Authority: 1800 931 678

NSW Law Access have a dedicated bushfire number: 1800 801 529

Victoria Legal Aid have the Disaster Legal Help Victoria 1800 133 432