Claims Management Legal and Regulatory Training Course

Participants can assess claims handling conduct against fair treatment and customer protection requirements.

• Fair treatment principles applied to notification, assessment, settlement and closure
• Customer duty concepts: foreseeable harm, support needs and communication quality
• Reasonable claims timescales, delay explanations and proactive customer updates
• Managing vulnerable customers through documented adjustments and specialist referrals
• Plain-language outcome letters explaining evidence, policy terms and review rights
• Quality assurance testing against conduct rules and internal service standards

Participants can create a structured and defensible record for coverage, liability and settlement decisions.

• Coverage analysis using insuring clauses, exclusions, conditions and endorsements
• Liability assessment using duty, breach, causation, loss and defences
• Proximate cause analysis for concurrent causes and intervening events
• Quantum evaluation using evidence, mitigation duties and policy limits
• Reservation of rights letters drafted without prejudicing coverage positions
• Decision records linking facts, evidence, legal reasoning and authority

Participants can plan proportionate investigations and control the integrity of claims evidence.

• Investigation plans aligned with material facts, coverage issues and risk
• Evidence preservation: documents, recordings, photographs, metadata and physical items
• Witness statements structured around chronology, observation and source reliability
• Expert instructions defining scope, assumptions, independence and reporting deadlines
• Chain-of-custody controls for fraud evidence and disputed physical property
• Surveillance, social media and lawful information-gathering boundaries

Participants can make lawful and controlled decisions about claims information, disclosure and retention.

• Personal data categories commonly collected throughout a claims lifecycle
• Lawful bases for processing claims data and sensitive information
• Purpose limitation, data minimisation and retention schedule application
• Data-sharing decisions involving brokers, experts, reinsurers and service providers
• Subject access requests, redaction methods and third-party confidentiality
• Data breach escalation, containment records and notification decision criteria

Participants can identify fraud indicators while ensuring fair treatment and controlled referral decisions.

• Fraud typologies: fabrication, exaggeration, identity misuse and organised fraud
• Red-flag assessment separated from evidence sufficient for adverse decisions
• Fraud referral criteria, case triage and investigation governance
• Customer communications during suspected fraud investigations and claim delays
• Financial crime reporting duties, confidentiality and tipping-off restrictions
• Outcome recording for repudiation, withdrawal, recovery and prosecution referrals

Participants can distinguish claims dissatisfaction from formal complaints and manage both through controlled processes.

• Complaint definitions, acknowledgement requirements, response deadlines and ownership
• Root cause analysis using five whys and cause-and-effect diagrams
• Distinguishing service failures, coverage disputes and allegations of unfair treatment
• Redress calculations covering financial loss, distress, inconvenience and interest
• Final response letters stating findings, remedies and external review rights
• Ombudsman referrals, mediation options and records supporting defended outcomes

Participants can prepare claims files for dispute resolution and manage recovery opportunities within authority limits.

• Pre-action correspondence, limitation periods and preservation of legal positions
• Litigation-ready files: pleadings, evidence bundles, chronology and witness materials
• Instructing external counsel with clear questions, budgets and settlement authority
• Mediation preparation, negotiation mandates and without-prejudice communications
• Subrogation rights, salvage interests and recovery pursuit documentation
• Contribution claims between insurers, responsible parties and co-defendants

Participants can establish governance controls for claims teams, service providers and delegated claims arrangements.

• Claims authority matrices defining monetary, technical and settlement limits
• RACI matrices for handlers, managers, legal advisers and compliance teams
• Delegated authority agreements covering reporting, audit rights and referral triggers
• Third-party administrator oversight through service levels and file audits
• Three Lines Model applied to claims risk ownership and assurance
• Management information linking complaints, leakage, fraud and conduct indicators

Participants can assess a claims operation's legal-risk controls and prioritise practical improvements.

• Claims file review criteria for legality, fairness, evidence and documentation
• Sampling methods for targeted quality assurance and thematic reviews
• Control gap assessment against laws, conduct rules and internal procedures
• Regulatory inspection preparation: records, governance evidence and responsible owners
• Remediation plans with actions, deadlines, owners and effectiveness measures
• Personal application plan for improving claim decision and escalation practices