Insurance Contracts, Claims and Dispute Resolution

Claims turn into disputes for predictable reasons. The policyholder did not understand the cover or its conditions, material facts were not disclosed at placement, a notification deadline was missed, exclusions were drafted ambiguously, or the claim was handled slowly and without clear communication. Insured organisations often discover the limits of their cover only after a loss, and insurers face complaints, regulatory attention and litigation costs that could have been avoided.

This programme follows the life of an insurance contract from placement to settlement. It moves through five stages: the legal principles behind insurance contracts, reading and interpreting policy wordings, managing the claims process, handling complex and disputed claims, and choosing the right route to resolve a dispute.

Built on recognised practice. The programme references the core principles of insurance law, including utmost good faith, insurable interest, indemnity, proximate cause, contribution and subrogation, the Insurance Core Principles of the International Association of Insurance Supervisors (IAIS) on conduct of business and fair treatment of customers, ISO 10002 on complaints handling, and widely used dispute resolution frameworks such as the UNCITRAL Model Law on International Commercial Arbitration and the New York Convention. Participants learn to apply these principles, while local law and regulation are treated as the final reference.

Decisions this programme improves. Whether a loss falls within cover and how exclusions and conditions apply; how to reserve rights without damaging the relationship; when to appoint a loss adjuster or expert; whether to settle, negotiate or defend a claim; which dispute resolution route fits the value, complexity and relationship; and how to draft or buy wording that prevents the next dispute.

How it is delivered. Twenty hours across five sessions, built around one running case: a commercial property and business interruption claim following a fire, with disputed disclosure, a contested exclusion and a subrogation opportunity. Participants analyse the wording, assess coverage, plan the claim, negotiate a settlement and compare dispute resolution options.

In-house option. For organisations, the programme can be tailored to your own lines of business, policy wordings, claims procedures and regulatory environment, and delivered to underwriting, claims, legal and risk teams together so that wording, handling and dispute decisions are consistent.

Who Should Attend

Insurance professionals: claims handlers, claims managers, underwriters and technical staff

Brokers and intermediaries: account executives and claims advocates supporting commercial clients

Risk and insurance managers: staff in corporations, government entities and national companies who buy insurance and manage claims

Legal and compliance professionals: in-house lawyers, legal advisers and compliance officers dealing with insurance matters

Regulatory staff: officers in insurance supervisors and complaints units

Objectives

Explain the legal principles of insurance contracts and how they affect cover and claims

Read a policy wording and identify the insuring clause, definitions, exclusions, conditions and warranties

Assess disclosure and misrepresentation issues and their possible consequences for a claim

Map the claims process from notification to settlement and identify common failure points

Apply indemnity, average, excess and limit provisions to calculate a claim settlement

Evaluate when to appoint loss adjusters and experts and how to manage their work

Recognise indicators of insurance fraud and respond proportionately

Identify recovery options through subrogation, contribution and reinsurance

Compare negotiation, complaints schemes, mediation, arbitration and litigation for resolving a dispute

Recommend wording and process improvements that reduce future disputes

Course Outline

The Legal Foundations of Insurance Contracts

Formation of the insurance contract: proposal, offer, acceptance and premium
Utmost good faith, disclosure duties and misrepresentation
Insurable interest and indemnity
Proximate cause and its role in coverage decisions
The role of brokers and agents and their duties
Conventional and takaful insurance: key contractual differences

Reading and Interpreting Policy Wordings

Structure of a policy: schedule, insuring clause, definitions, exclusions and conditions
Conditions precedent, warranties and their consequences
Rules of interpretation and ambiguity
Property, business interruption, liability, engineering and motor wordings
Life and health cover: common areas of misunderstanding
Drafting clear wordings and reviewing cover before a loss

Managing the Claims Process

Notification, first response and claim documentation
Coverage assessment, reservation of rights and declinature
Loss adjusters, surveyors and experts: appointment and oversight
Quantifying losses: indemnity, average, excess, limits and business interruption
Reserving, claims files and management information
Fair treatment of customers and claims handling conduct expectations
Digital claims handling, automation and analytics

Complex Claims, Fraud and Recoveries

Large and complex losses: coordination and communication
Insurance fraud indicators and proportionate investigation
Subrogation and contribution between insurers
Reinsurance involvement in claims and its effect on settlement
Negotiating settlements: preparation, positions and documentation
Settlement agreements and releases

Resolving Insurance Disputes

Sources of dispute: coverage, quantum, delay and conduct
Internal complaints handling and ISO 10002 principles
Regulator complaints channels and ombudsman schemes
Mediation and expert determination
Arbitration clauses, the UNCITRAL Model Law and enforcement under the New York Convention
Litigation: when it is the right route and what it costs
Lessons from disputes: feeding findings back into wording and claims practice

Competencies

Insurance contract principles and disclosure duties

Policy wording analysis and interpretation

Coverage assessment and reservation of rights

Claims process management and loss quantification

Oversight of loss adjusters and experts

Insurance fraud indicators and response

Subrogation, contribution and recoveries

Claims settlement negotiation

Insurance dispute resolution options

Kuala Lumpur

Explore professional training in Kuala Lumpur across Elite Academy’s full range of disciplines. The city’s position as a well-established Southeast Asian business hub with strong international connectivity makes it an attractive international setting for scheduled courses and programs arranged to your preferred topic and dates. Elite Academy can deliver its full range of professional training programs in Kuala Lumpur, Malaysia. Because the city is a well-established Southeast Asian business hub with strong international connectivity, it provides a strong international environment for participants from organizations as well as individual professionals. The courses shown on this page represent the programs currently scheduled in Kuala Lumpur; they do not limit what can be delivered there. If your preferred course or date is not listed, you can request any program from our portfolio to be arranged in Kuala Lumpur, subject to scheduling and delivery requirements.