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For many care providers, insurance is there to protect the business when something goes wrong. However, that protection can be put at risk if claims, incidents or circumstances are not reported to insurers promptly.
At Quality Care Group, we regularly support care providers through complex claims situations. While insurers will always review claims on their individual merits, one issue that continues to cause concern across the insurance market is late notification.
In a recent example, an insurer sought to decline a claim due to late notification, alongside concerns regarding documentation and the availability of evidence to support the defence of the claim. Following extensive negotiations by our Claims and Risk Team, the insurer agreed to contribute 50% of the claim costs. While this was a positive outcome compared to a complete decline, the client was still left to fund the remaining 50% themselves, resulting in a significant financial loss.
When an insurer receives prompt notification of an incident, they can:
When notification is delayed, key information can be lost, documents may be unavailable and witnesses may no longer be able to provide reliable accounts. This can significantly prejudice an insurer's ability to investigate and defend a claim.
One of the most common misconceptions is that only formal claims need to be reported.
In reality, insurers often require notification of:
Even if you are unsure whether an incident will develop into a claim, it is usually safer to notify your broker or insurer and seek guidance.
Many insurance policies contain strict conditions requiring claims or circumstances to be reported within a specified timeframe. Failure to comply could allow insurers to reduce settlement payments or, in some cases, decline claims altogether.
While insurers may not always rely solely on late notification when declining a claim, it remains an important factor in many coverage decisions. As claims become more complex and costs continue to rise, care providers should expect insurers to take a closer look at compliance with policy conditions.
If you are unsure whether an incident should be reported, our specialist Claims and Risk Team can provide guidance. Early intervention can often make the difference between a claim being successfully defended and a costly uninsured loss.
When in doubt, report it. A quick conversation today could prevent a significant financial exposure tomorrow.
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