The Claims Lifecycle

Seven Stages of a Claim

Every insurance claim follows the same fundamental lifecycle, regardless of the product type:

1. Notification: The policyholder reports a loss. This can happen via phone, WhatsApp, email, walk-in, or through the agent. First response time matters enormously: acknowledge receipt within 2 hours, even if full assessment will take longer.

2. Registration: The claim is logged in the system with a unique reference number. Key data captured: policy number, date of loss, nature of loss, estimated amount, contact details. The policyholder should receive their claim number immediately.

3. Documentation: Gather supporting evidence. For motor: police report, driver's licence, photos of damage, repair estimates. For fire: fire service report, inventory list, photos. For life: death certificate, proof of identity, policy documents. Be realistic about what documentation is available in the Ghanaian context.

4. Investigation & Assessment: Verify the claim is valid. Was the policy in force? Is the loss covered? Are the circumstances consistent? For complex or large claims, appoint a loss adjuster. For straightforward claims, an experienced claims officer can assess directly.

5. Reserving: Set a claims reserve: the estimated cost of settling the claim. This is an actuarial and accounting requirement. Reserves affect the company's financial statements and solvency position. Reserve accurately: under-reserving creates hidden liabilities; over-reserving ties up capital unnecessarily.

6. Settlement: Pay the claim. Options include: direct payment to the policyholder, payment to a repair shop or hospital, or replacement of the lost item. In Ghana, mobile money settlement is increasingly expected: nobody wants to visit a branch and wait for a cheque.

7. Recovery & Closure: Where applicable, pursue recovery: subrogation against a negligent third party, or salvage of damaged property. Close the claim file with complete documentation.

The 48-Hour Rule

Best practice: make initial contact with the policyholder within 2 hours of notification, complete preliminary assessment within 48 hours, and communicate a clear timeline for resolution.

For straightforward claims (e.g., a windscreen replacement or a simple medical claim), settle within 48 hours if possible. This sounds ambitious, but it's transformative for customer trust.

Even for complex claims, the 48-hour rule applies to communication: within 48 hours, the policyholder should know what's happening, what documentation is needed, who their claims handler is, and what the expected timeline is.