Season 4 of TIA Talks continues with a deeper look into the realities of insurance claims and what happens when it matters most. Host Jason Mizen is joined by TIA Alumni Christopher Appanah, Deidré Henneberry, and Wayne Moorcroft for a comprehensive conversation unpacking how claims are assessed, managed, and ultimately resolved. From understanding the relationship between clients, brokers, and insurers to navigating high-pressure claim situations, the discussion explores the dynamics that can shape outcomes in real time.
The conversation dives deep into the complexities of the claims process, highlighting not just the technicalities, but also the human side of claims handling. It brings to light the often-overlooked emotional challenges that professionals face and reflects on the key challenges within the claims process. Central to this exploration is the importance of transparency, clear communication, and accountability across all stakeholders.
The role of brokers in claims
The episode starts by delving into the process of rejecting claims and the amount of rigour and scrutiny it involves. Christopher Appanah offers insights into how claims are handled, stating: “When a matter is up for rejection, there’s a lot of rigour in that process. It isn’t just a person sitting in front of a computer deciding I’m going to kick this claim out. Ordinarily, insurers have a mechanism set up – a technical committee of some sort where various people within the business provide input into whether this claim should be rejected or not.”
Christopher elaborates that these committees include everyone from the CEO to the policy administrator, and everyone plays a role in questioning and scrutinising the claim. If there are gaps in the reasoning behind rejecting a claim, it is sent back to the claim specialist for further review. The key takeaway here is that “there’s a lot of rigour around when a claim gets rejected.”
However, it’s not always a straightforward decision. Brokers often play a pivotal role in navigating these situations. Christopher adds: “Before we even refer a matter to a technical committee, we’re meant to contact the broker or visit them, depending on the type of claim, and explain the challenges. If they can overcome these challenges, we have no issues. But if not, there’s no valid basis to pay the claim. What do you think?”
While the process seems clear-cut on paper, Wayne Moorcroft brings up an important point about the emotional aspect that brokers face when handling claims. He acknowledges that while brokers may understand the technicalities of the claim, it’s the emotional pressure of dealing with clients that often complicates things.
Wayne stresses that while brokers’ emotional empathy is important, it often makes it difficult for them to separate personal feelings from professional responsibility. Instead, he advocates for better relationship management and clearer communication with insurers. “I think our technical knowledge is not where it should be. We’re sitting with not just a broker issue but an industry-wide issue of skills transference.”
The growing gap
Deidré Henneberry, another TIA alumna, shares her perspective on how claims professionals often struggle to gain the necessary support and knowledge in handling difficult claims. She explains that, over time, knowledge gaps in the industry become more apparent, especially in the middle management and entry-level staff.
“We see it regularly that if you go to any function at a big insurer, you’ll see a certain age group. I always used to joke that when I went to these functions, I was the youngest person there, and now 20 years later, I’m still the youngest person.”
Deidré’s point about the ageing workforce is echoed by Wayne, who brings attention to the lack of formal programs within organisations for knowledge transfer and training. Without sufficient investment in talent development and knowledge sharing, these gaps persist. “What you knew 10 years ago is definitely not going to help you today. If you thought you knew a process, it’s not going to help you today,” he says, emphasising how knowledge is often lost when employees leave, taking their experience with them.
Wayne continues to highlight the critical issue of “skills transference,” which refers to the industry’s inability to pass on valuable knowledge, especially when seasoned professionals retire or change roles. This often results in inconsistencies in claims handling, which can further erode trust with clients. “Most of the brokers die with the knowledge with them, the relationships, all of that.”
Empowering claims professionals and educating the industry
To address these challenges, Wayne, Deidré, and Christopher, along with a group of other TIA alumni, launched The Claims Forum – an initiative aimed at improving claims handling and knowledge sharing in the industry. According to Wayne, the forum was born out of a desire to give back to the industry by sharing their combined expertise. He recalls: “The founding members are all ex TIA or TIA alumni. The idea started around dinner conversations when we were competing. A lot of us had claims as our passion, and we wanted to address the gaps we saw in claims knowledge.”
The forum’s mission is to engage middle management and entry-level claims staff, helping them navigate the complexities of claims management. The ultimate goal is to “improve the standard of claims in the industry.” They host seminars – either in person or online – where they discuss pressing issues in claims. Deidré elaborates on the forum’s core values: “Our values are to put people first. We always forget people. And yes, we have systems, we have processes, but there are people behind them who need to be supported. That’s the most important thing for us.”
In addition to fostering education, the forum also focuses on mental health within the claims profession. Deidré stresses that mental health is often overlooked, but it is crucial to provide a platform for claims staff to discuss the emotional toll the job can take. “Some people don’t want to say they’re not okay until they sit and reflect, and those things can fester.”
Claims are not just about process
The discussion around the forum’s values shifts to a broader reflection on how the industry handles claims. While technology and automation play key roles, they often lack the human touch that can make all the difference in a claim’s outcome. Deidré draws attention to medical aid claims as a prime example, stating that many issues arise because “no one’s behind it” to ensure claims are coded properly. She adds, “I find the most issues come through the medical side because it’s all automated, and the system or the person behind the scenes doesn’t understand where to put this claim.”
In closing, the group reflects on their personal journeys in claims, sharing how emotional moments and instances where they’ve seen clients at their lowest points inspired them to push for better processes and better treatment. Wayne recalls a particularly challenging case from 2011 or 2012, when a client faced a traumatic burglary, and the insurer wrongly accused them of fraud. After fighting for the claim, Wayne says, “That day we felt like heroes.” This experience was pivotal for him, cementing his belief that “we are dealing with people, and people make mistakes.”
For Deidré, it was the realisation that claims professionals often forget the human aspect of their work: “We’re actually dealing with somebody on the other side of the line, and we’re there to make a difference.” This realisation changed her perspective and continues to drive her passion for the profession.
Trust, communication, and the future of claims
The conversation concludes with a shared recognition that claims handling is not merely a business process – it is about people. For claims professionals, it is crucial to balance the technical aspects of their work with empathy and understanding. As Deidré puts it, “Sometimes it becomes so mundane and so routine that we become robotic. We forget that there’s still some empathy we need to display.”
Through initiatives like The Claims Forum, these industry veterans are working to change the narrative around claims, offering a platform for discussion, education, and mutual support. Ultimately, it’s clear that claims aren’t just about the systems and processes – it’s about the people involved and the trust that needs to be built and maintained across the entire claims ecosystem.
Watch the episode here