what it is, phases and good practices

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Loss regulation is one of the fundamental pillars in the insurance industry . This process, complex and highly technical, on the ground determines how complaints and compensation after an incident are handled, which also influences the relationship of trust between the insurer and its clients.

Understanding each phase of the process and adopting efficient practices is vital to the success of insurance companies . In this article, we will explore what claims regulation entails, its main phases and good practices that can optimize this process and offer a quality service to both the company and the insured.

What is the accident regulation?
The adjustment of accidents is the process through which an insurance company evaluates and determines the value of compensable damages to reach a settlement with the affected person.

In practical terms, this procedure goes far number database beyond simply quantifying damage: it is an exhaustive investigation that considers the context of the contract, the nature of the accident and the coverage established in the country .

This process ensures transparency and precision in the fulfillment of the contract, both to protect the interests of the insurer and to guarantee that the assured receives a fair treatment and agrees to the agreed terms.

What are the steps involved in accident regulation?
Now, for this process to be a guarantee of effectiveness, it needs to be developed in a series of steps for the correct evaluation and resolution of the claim presented by the insured.

Claims adjustment

Complaint notification
The process begins when the insured informs the insurer about the accident that has occurred. This notification is key because it provides the first details about the event, including the possible causes and consequences.

Research
Depending on the complexity, you may decide to continue with the process or close it. If necessary, a specialized expert will be appointed, who will evaluate the damage and the causes of the accident in detail.

Coverage analysis
This involves reviewing the details of the contract to check whether the type of damage or loss is found among the agreed coverages.

Cause analysis
At this stage, we seek to establish whether the event originated under circumstances that could influence the decision to compensate, such as possible negligence or situations not covered by the contract.

Report preparation
With all the data collected, the regulator prepares a detailed report. This includes the collected information, the analysis of the coverage and the conclusions of the expert, in the event that he has participated in the process.

Decision on compensation payment.
The insurance company makes a final decision based on the complete analysis of the accident. You can choose:

Approve the compensation payment and conclude the case.

Reject the complaint if it is determined that it does not comply with the terms of coverage of the policy.

In some cases, it is possible to make the compensation payment and, at the same time, decide to cancel the contract at the end of its validity if the situation arises.

Now, these phases must be carried out perfectly to guarantee their transparency, which is why it requires carrying out good practices.

Do you know? Here you have them.

What are the main good practices in accident regulation?
The regulation of accidents benefits enormously from the implementation of good practices that ensure efficiency, transparency and precision in the process. Know the main ones.

Specialized team
The regulation of accidents requires a team of multidisciplinary professionals — from lawyers to analysts — specialized and highly qualified in the technical, legal and operational aspects of the process.

Training remains the key to ensuring that the team is updated in terms of standards, clauses and policy coverage, and the best customer service techniques.

Continuous monitoring of the process
Within the good practices of accident adjustment, it is essential to carry out constant monitoring and monitoring of the accident adjustment process to detect possible bottlenecks and improve efficiency.

This involves evaluating each step to identify areas for improvement and adjusting processes according to needs.

Efficient communication with the insured
Maintaining transparent and punctual communication with the client is essential to avoid misunderstandings and ensure that the process progresses without inconvenience.

Insurance companies must control the deadlines for adjusting complaints and offer the insured multiple communication channels, whether via telephone, email, online platforms or mobile applications, adapting to the preferences of each client.

Fraud prevention policies and strategies
Insurance fraud is a significant risk for the sustainability of the industry — no more than R$825 million will be lost in 2022 through insurance fraud — and insurers must establish strict fraud prevention policies.

This can include everything from exhaustive checks to data analysis to detect suspicious patrons . Therefore, having preventive strategies reduces the impact of fraudulent claims and improves the reliability of the compensation process.

Technological support
Finally, it is important to recognize that technology is a fundamental ally in the regulation of accidents , which facilitates automation and speeds up the processing of complaints.

Some of the essential tools are:

Process automation : for faster and more efficient management of complaints, reducing waiting times for the insured.

Artificial intelligence : able to analyze large volumes of data and identify possible inconsistencies in claims.

Image and video analysis : to evaluate damage accurately, especially in large-scale accidents or those where physical access is limited.

Geolocation : checking the location of an accident, which is useful in cases of vehicle and property insurance.

Chatbots with AI : offering personalized attention to customers, allowing them to resolve frequent queries and facilitating access to key information in real time.

Automates accident regulation
SYDLE ONE is a platform that allows you to fully automate claims management , using advanced technologies such as artificial intelligence, data analysis and customer service chatbots to transform claims management into an agile and precise experience.

Is it ready to take accident regulation to the next level? Automate and optimize the entire process with SYDLE ONE and ensure the best experience for your customers from the first contact to the final resolution.