Claims Investigation Standards and the General Insurance Code of Practice Course

This training equips insurance professionals with the knowledge, skills, and ethical foundations to conduct fair, compliant, and customer-focused claims investigations in line with the General Insurance Code of Practice. The course emphasizes regulatory alignment, ethical standards, support for vulnerable customers, and the importance of accurate, respectful investigations. Target Audience Claims investigators (internal & external) Claims handlers, assessors, and adjusters Compliance and regulatory teams Legal and dispute resolution officers Underwriting and customer service teams Risk, fraud detection, and governance professionals Personal Impact Mastery of Code-aligned investigation practices Enhanced ethical judgment in sensitive situations Increased ability to handle vulnerable customers empathetically Sharpened report-writing, interviewing, and documentation skills Organisational Impact 1. Lower regulatory risk through Code compliance 2. More efficient and consistent claims investigations 3. Increased customer satisfaction and reduced complaints 4. Strengthened reputation and transparency across processes Course Level: Foundation Course Objectives By completing this course, participants will be able to: 1. Understand and apply the General Insurance Code of Practice. 2. Conduct lawful, ethical, and respectful claims investigations. 3. Identify vulnerability and respond with appropriate support strategies. 4. Engage and manage third-party investigators within compliance frameworks. 5. Document findings clearly and objectively, using evidence-based reporting. Course Outline Module 1: Understanding the General Insurance Code of Practice Introduction to the Code: Purpose, history, and updates Principles and obligations for Code subscribers Customer rights and expectations Legal & ethical foundations in insurance investigations Case Study:Case: Breach of Code – The Miscommunication Claim An insurer fails to communicate properly with a policyholder during a claim investigation, resulting in a Code breach. Participants analyze what went wrong and how it could be prevented. Module 2: Claims Handling and Vulnerable Customers Claims lifecycle: Lodgement to resolution Customer experience and timeframes Recognizing and supporting vulnerable customers (financial hardship, disability, trauma) Communication and empathy techniques Case Study:Case: “The Elderly Policyholder” An 80-year-old claimant is subjected to a standard investigation process, unaware of her rights. Learners evaluate how vulnerability was overlooked and redesign the handling process with best practices. Module 3: Investigation Planning, Interviews & Surveillance Responsibilities before, during, and after an investigation Conducting ethical and effective interviews Legal use of surveillance and privacy considerations Investigator conduct and Code expectations Case Study:Case: “Caught on Camera?” An investigator uses surveillance on a claimant recovering from surgery. The legality and ethics of the operation are debated in line with the Code and privacy laws. Module 4: Engaging Third Parties & Documentation Best Practices Selecting and supervising external investigators Contractual obligations and reporting standards Gathering, storing, and analyzing evidence Writing investigation reports and audit trails Case Study:Case: “Outsourced Trouble” An external investigator intimidates a policyholder, resulting in a complaint. The team examines how to vet third-party investigators and ensure Code compliance throughout engagement. Module 5: Simulation, Review & Certification Interactive course recap Mock investigation scenario: Plan, conduct interviews, document, report Final written assessment (MCQ + scenario-based questions) Feedback, Q&A, and course wrap-up Certificate distribution Case Study (Simulation):Case: “The Flood Claim Dilemma” Participants work in teams to investigate a claim where a customer reports damage after a flood. Teams plan the investigation, identify signs of vulnerability, and apply Code principles to manage the case from start to finish.