Claims Assessment & Decision-Making Training Course

Course Overview

Learning Objectives

• By the end of the course, participants will be able to:
• Analyze the complete claims assessment lifecycle from notification through evaluation, decision, settlement, and closure.
• Evaluate policy coverage, conditions, exclusions, limits, deductibles, and applicable requirements when assessing claims.
• Develop structured methodologies for reviewing claim facts, documentation, evidence, and financial information.
• Assess the cause, circumstances, and extent of insured losses using consistent analytical approaches.
• Apply evidence-based criteria to accept, partially accept, reject, refer, or escalate claims.
• Evaluate the financial exposure associated with individual claims and identify potential areas of claims leakage.
• Assess liability, causation, contributory factors, and the responsibilities of relevant parties.
• Improve decision-making when information is incomplete, contradictory, delayed, or subject to dispute.
• Apply appropriate escalation and delegated authority principles to complex and high-value claims.
• Evaluate settlement alternatives and formulate commercially and technically sound recommendations.
• Strengthen documentation, auditability, governance, and consistency in claims decisions.
• Improve claims decision-making through performance analysis, lessons learned, and continuous process improvement.

Who Should Attend

Learning Outcomes

• Upon successful completion of the course, participants will be able to:
• Assess claims systematically from initial notification through final resolution.
• Interpret policy provisions and determine their relevance to individual claim circumstances.
• Review and validate documentation, evidence, statements, estimates, and supporting information.
• Determine the relationship between the insured event, cause of loss, and claimed damage.
• Evaluate physical, financial, operational, and consequential losses.
• Identify missing information, inconsistencies, unusual patterns, and areas requiring further investigation.
• Make structured decisions to accept, decline, partially settle, or escalate claims.
• Evaluate claim reserves and financial exposure in support of sound decision-making.
• Apply appropriate authority levels and escalation procedures to complex claims.
• Assess settlement options and negotiate outcomes based on evidence and policy requirements.
• Identify opportunities for recovery, subrogation, contribution, salvage, and loss mitigation.
• Prepare clear, defensible, and well-documented claims assessment recommendations.
• Apply quality assurance and governance principles to improve consistency in claims decisions.

Course Outline