Explaining your claim information
If you want to access the information we hold about you, you can request a copy of your claim file. The summary of your claim contains information and communications about your claim.
On this page
A claim summary is a record of your claim information
Your claim file has two parts. The first is your claim summary, which is a record of the management of your claim with us.
The second part is your virtual claim file, which contains all the documents and reports we’ve received or sent about your claim. If there are no documents, your claim file will only have the claim summary.
What a claim summary includes
A claim summary has:
- a table of contents
- a list of the information we have about you in relation to your claims
- basic client and claim details
- copies of emails
- notes from phone discussions
- summaries of the tasks completed during the management of your claim.
Information will vary depending on the level of claim management and support you’ve received.
Assessing a claim
We’ve introduced a new way of assessing claims, using a system where some claims are accepted without further review by our claims teams.
This new system identifies and fast-tracks acceptance of straightforward claims where the information provided shows that an injury was clearly caused by an accident. It helps us to make decisions quicker, so you can get help faster. If we have your mobile number or email address, you may receive information telling you what’s happening with your claim much sooner.
The system won’t decline any claims. A staff member will always review and assess complex claims.
Initial cover status log
The initial cover status log is a new section with information about how we process your claim. You’ll only see this section for claims submitted after September 2018.
This log includes the details of business rules and statistical scoring that affects how we make a cover decision.
Scores and their meanings
We use statistical scoring to help us categorise claims and make sure you get the right level of support. These scores help us to fast-track straightforward claims. Staff members will review all other claims that need a more detailed review.
Probability of acceptance score
This score is based on an analysis of data from 12 million previous, anonymised claims. It identifies claims we would usually accept and process without further review. If the claim scores above a specified probability score it’s able to be fast-tracked.
Case complexity score
A claim is also assessed for complexity. This score considers several factors such as:
- the type of injury you’re claiming for
- your age
- previous injury claims you may have submitted.
This helps us understand how much help you might need from us. Some claims, which have a lower probability of acceptance score, but are simple, may still be fast-tracked.
The probability of acceptance score and the case complexity score work together in the system to identify the claims we can accept straight away. Staff members will review all other claims, as they have always done.
We'll include the details of a contact person on your claim summary report, if you have any questions.
If you have any problems, contact our claims team:
Phone 0800 101 996 (Monday to Friday, 8:30am - 5pm)