Ronan Kelveth

The journal · Claims decisions

A claim needs two clocks, not one settlement measure

The time to pay an established amount and the time to conclude every question are different management obligations. Measuring both can make a complex claim more useful to the policyholder without disguising uncertainty.

I believe an insurer should report how quickly it pays an undisputed amount separately from how quickly it settles the entire claim. The distinction matters most when a business can act on an agreed payment while a different component still needs examination. A single end-to-end settlement measure can obscure that opportunity. It can also make a team look efficient by encouraging early closure of uncomplicated cases while the economically important part of a complex loss remains unpaid.

This is not an argument for paying before there is a proper basis to do so. It is an argument for identifying the basis precisely. The amount needed to replace damaged equipment may be established while the interruption calculation remains uncertain. A handler needs authority, documentation and a clear explanation of the unresolved position. If those conditions are absent, exhortations to be faster will produce either nervous delay or poorly controlled payments. Neither serves the member or the wider pool of policyholders.

Name the decision that is waiting

Claims reports often describe a file through its administrative status: documents outstanding, assessment underway or awaiting approval. Those descriptions can be accurate and still fail to identify the next substantive decision. Which document is missing? What amount depends on it? Does its absence prevent every payment or only one part? Asking those questions changes the discussion from moving a file through stages to establishing what the insurer can responsibly do now. It also reveals where a request for more material has become habitual rather than necessary.

I learnt this distinction early in claims administration. A record could be labelled incomplete because evidence was filed under a different reference, because nobody had requested it clearly or because the underlying fact remained genuinely unknown. Those situations require different responses. They should not all produce the same waiting status. When executives examine a sample of files, they should follow the evidence trail far enough to understand the difference. An average duration alone cannot tell them whether delay is justified, avoidable or simply badly described.

At Brindleharbour Mutual, we began with defined commercial property cohorts rather than announcing a universal service objective. We wanted to know which claims offered a sound basis for an earlier payment and which required more complex judgement. The initial cohort boundaries were deliberately explicit. They allowed reviewers to compare similar situations and prevented an apparent improvement from being achieved by excluding inconvenient files after the programme began. A useful measure needs a stable denominator and a record of why particular cases sit outside it.

The member's practical need should inform this work without determining the coverage decision. A workshop owner may need funds urgently, but urgency does not establish entitlement. Equally, a valid unresolved question about one component does not automatically justify withholding an amount already established elsewhere. The discipline lies in keeping those propositions separate. I expect colleagues to explain what is agreed, what remains under review and what the member can reasonably expect next. Ambiguity can be more damaging than an answer that is unwelcome but clear.

Make a partial payment accountable

Delegated authority is central to the approach. If every interim payment requires a senior committee, the insurer can preserve the old delay inside a new label. Experienced handlers need boundaries within which they can act, access to specialist advice and a record of their reasoning. The authority should reflect the complexity and consequence of the decision, not merely the handler's job title. A narrow financial limit can still leave a difficult coverage issue that deserves further review before any payment is made.

Our decision record identifies the accepted amount, the evidence supporting it, the unresolved elements and the explanation provided. It does not attempt to reproduce the entire claim file. A record that becomes too elaborate creates another reason to postpone action. We tested the format with handlers who were already carrying live workloads and removed fields that duplicated reliable records elsewhere. That simplification required care: eliminating repetition is useful, but eliminating the link between a payment and its basis makes subsequent review harder.

Finance colleagues need to be involved in the design. Partial payments affect reconciliation, reserves and the interpretation of later settlements. Legal and technical claims colleagues need to be comfortable that communications do not imply agreement on issues still open. Distribution colleagues need the same explanation because a broker may speak to the member before the handler does. This is not work that can be assigned entirely to claims and later announced as a service improvement. The surrounding functions determine whether the decision remains coherent outside the file.

I also want independent sampling after payment. The sample should include mistaken payments, reopened questions and cases where an earlier payment was considered but rejected. The last category is easy to omit because it produces no transaction to review. Yet it may contain the clearest evidence of avoidable delay. A system that audits only money leaving the insurer can become very good at explaining caution and much less good at examining its cost. Both forms of error deserve management attention.

Keep the difficult files in the result

Our eligible commercial property cohort moved from a median of 23 days to 9 days for the first undisputed payment during the 2023–2025 review. That is a useful result with a defined meaning. It is not the average settlement time for all claims, and it says nothing by itself about the final resolution of a coverage dispute. I insist that the cohort definition travel with the number. Removing the qualification would make the claim easier to promote and less useful to a director trying to assess operating quality.

The board should also see the distribution around the median. Which files remain slow? Are particular types of loss, regions or member circumstances associated with delay? Did the programme improve the middle while leaving the longest waits unchanged? A single summary number can conceal those questions. I prefer a small number of clearly explained cohorts to a dashboard crowded with measures nobody can interpret. Each measure should point towards a decision, further investigation or a reason to maintain the present course.

There are costs. Training and review expenditure in our first year was A$1.1 million. Managers spent time resolving authority questions that had previously remained implicit. Some initial broker explanations needed correction. Those are part of the programme's record, not embarrassing footnotes. If an insurer wants experienced judgement closer to a member's problem, it must support that judgement with capability and oversight. Merely raising a service objective and asking colleagues to work harder will not produce the same result.

The practical test I would set another executive team is straightforward: select ten complex open claims and identify the next payment decision on each. Separate the amount that is established from the issues that are genuinely unresolved. Record who can authorise action and what would change their conclusion. The exercise may reveal no safe opportunity for earlier payment in several files. That is an acceptable finding. Its value lies in replacing a general claim of progress with a precise account of what the insurer owes the member next.