A commercial client buys a program of policies through its broker and hopes never to use them. When a large loss comes, the broker’s claims practice is the client’s side of the table: it gives notice, reads the carrier’s letters, chases the carrier’s clocks, assembles the proof of loss and tells the client what the claim is worth.
In short
- The work is reading and counting: notice conditions, coverage positions, clocks, documents, the loss schedule.
- It lives in inboxes. The carrier’s letter is a PDF, the policy another, the clocks a spreadsheet if anywhere.
- The misses are quiet: an other-line notice nobody sent, a grant nobody raised, a sublimit applied to the whole loss.
- A workbench turns each of those into a row an engine can check and a person can decide on.
The five jobs on every large claim
every policy that
may respond"] --> C["Coverage
read each position
against the wording"] C --> K["Clocks
hold the carrier
to its commitments"] K --> P["Proof
documents owed,
by whom, by when"] P --> S["Settlement
what the claim is
worth on the record"]
Notice
Every policy has its own notice condition. Occurrence forms say “as soon as practicable”; some declarations name a number of days; claims-made forms set a reporting window tied to expiry. The first loss facts decide which lines are in play: damage to a neighbour brings in general liability, a funds transfer brings in crime, lost income is a property time-element loss.
Coverage
The carrier’s reservation of rights or denial is an argument made of positions: an exclusion, a sublimit, a condition, “not covered”, late notice, a general reservation. Each one can be held against the wording the client was issued — including the carve-backs at the end of exclusions and the grants the letter never mentions.
Clocks
Carriers commit, in claims service agreements, to acknowledge, contact, decide and report within set days. Regulators set their own timelines. Without counting, a carrier that is late on everything looks merely slow.
Proof
The sworn proof of loss, repair estimates, business-income worksheets, leases: each requested by someone, owed by someone, due on a date. While one is outstanding, a condition position stands.
Settlement
When the carrier asks what it would take, the answer should be built from the loss schedule and the strength of each disputed position — and the client should be able to follow it.
Where it goes wrong
| The quiet miss | What it costs the client |
|---|---|
| The other-line notice | A late-notice defence on a policy that should have paid. |
| The excess layer nobody told | An excess carrier that learns of a claim when it is already in its layer. |
| A carve-back unread | An exclusion conceded that, by its own words, doesn’t apply. |
| A sublimit applied to the whole loss | A cap meant for one kind of damage swallowing the rest. |
| Wording that isn’t in the policy | A denial resting on an endorsement the client was never issued. |
| The carrier’s clocks | Months lost with no escalation and no leverage. |
What a workbench changes
InsightAdvocate keeps each claim as a structured record — policies, clauses, the carrier’s letters and positions, the timeline, the loss schedule, document requests — and runs deterministic engines over it. Ten agents prepare the work those engines point to: the notices, the rebuttal, the escalation, the floor, the client update. A person decides each one. The rest of this blog shows how.
What this blog will not do
Every client, carrier, claim and figure in these posts is invented and labelled illustrative. We won’t quote results we haven’t measured, and nothing here is legal advice.
