What this risk is, and why it matters
Claims governance is the disciplined process by which an organisation notifies, evidences, tracks and recovers insurance claims. Its purpose is to reduce leakage - value lost to under-claiming, late notice and thin documentation - and to improve recovery rates. For a senior executive, the issue is straightforward: without governance, the protection paid for is only partly realised, and recoverable losses are routinely understated or forfeited through avoidable process gaps.
Legal and regulatory framework
Effective governance must satisfy policy conditions, notification timeframes and proof-of-loss obligations, while drawing on the insurer's good-faith duties and any claims-handling or policyholder-protection standards regulators enforce. Several markets now expect insurers to handle claims fairly and promptly, which a well-run claims function can hold them to. This report describes the framework relevant to your chosen jurisdiction and industry, without advising on the design of any specific claims programme.
Typical scenarios and impact
Leakage commonly appears as missed deadlines, unquantified business-interruption losses, fragmented records across business units and inconsistent valuations. The effect is recoveries that fall short of entitlement and settlements that arrive late. Improvements from stronger governance vary by portfolio and claim type, but mature processes can recover a materially larger share of eligible losses. The uplift and leakage ranges described here are indicative, not guarantees of any particular result.
Mitigation framework and when to engage an expert
Build governance around clear ownership, a standard notification and evidence protocol, a consistent quantification methodology, a central claims register and periodic recovery reviews. Define escalation thresholds and capture lessons across incidents. Engage brokers to optimise programme structure, loss adjusters and forensic accountants to substantiate quantum, coverage counsel on contentious claims, and claims specialists to embed the process. This report presents these controls as research to inform programme design, not as advice on a specific claim.