4. Gathering and Clarification of Case Information
Role and Responsibilities of the Company’s Agent
The primary function of the Company’s Agent is to provide consultation and assess all relevant circumstances of a potentially insurable event. This includes identifying any issues, informing the client about the required documentation, and outlining the necessary steps for further action. The Agent determines whether the Company’s mediation is required in each specific case.
As part of the process, the Agent collects and/or verifies the customer’s personal data, including:
Full name (first and last name)
Date of Birth
Insurance policy number
Card number and issuing bank (if the insurance applies to the owner of a specific credit/debit card)
Handling Emergency Situations
In emergencies where no formal appeal is necessary, the Agent provides the client with clear instructions on the required actions. This includes specifying the documents that must be submitted and the correct order of procedures.
Communication and Case Processing
After gathering all relevant information and providing consultation, the Company’s Agent notifies the insurer or its designated representative about the potentially insurable event. Communication is conducted via electronic channels, primarily through emails and the Agents Desk system. If necessary, additional contact with the insurer or their representative may be made via phone. Once the insurer has been informed, the insured event is considered initiated.
These procedures apply universally to all types of cases, with more detailed guidance on specific scenarios outlined in subsequent sections of the work process documentation.
Case Registration and Information Management
The Agent is responsible for collecting and recording all necessary details related to the event. This may involve:
Consulting the client via email or phone
Updating or correcting the case details in the system
Requesting additional information or documentation from the client, if needed
Requests may also originate directly from the insurer via email if the client registers the event in the insurer’s information system. In such cases, the Agent manually transfers the provided data into a newly created case file and attaches any supporting documents received.
Key Points for Approving Claimant’s Expenses, Loss, or Damage
Review Supporting Documents – Ensure the claimant provides receipts, invoices, or other proof of expenses.
Assess Loss or Damage Evidence – Require photos, police reports, repair estimates, or expert evaluations.
Verify Claim Eligibility – Confirm the expenses or losses fall within the policy, contract, or agreement terms.
Identify Potential Issues – Look for inconsistencies, missing documents, or fraudulent claims.
Ensure Compliance – Check if the claim meets deadlines, reporting requirements, and legal guidelines.
Request Additional Data if Needed – If information is incomplete, ask for missing documents or clarifications.
Cross-Check Against Policy Coverage – Ensure that the claimed amount aligns with the agreed terms.
Consider Depreciation or Adjustments – If applicable, factor in wear and tear, prior damage, or deductibles.
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