Good claims outcomes are about more than settlement.
Claims frameworks across insurers, MGAs and TPAs are well established. Clear authority, strong governance and consistent decision-making deliver fair outcomes at scale. That foundation matters – and it works.
What’s changing is how those outcomes are being judged
Increasingly, the FCA is looking beyond whether the “right” decision was made. The focus is shifting to whether customers understood that decision, whether it was made under pressure, and whether it actually works in practice.
Nowhere is this more visible than during surge events, where customers are often required to make complex decisions at moments of heightened stress.
When the right decision still leads to the wrong outcome
A settlement can be technically correct, but still result in a poor outcome.
Cash settlements in particular place significant demands on customers. They may be expected to:
- Interpret technical scopes of damage
- Anticipate future repair costs
- Make long-term decisions quickly.
All at a time when they are dealing with loss, disruption or financial strain. This isn’t a failure of claims handling. It’s a service quality challenge.
Customer effort is now a defining measure
Customer effort is becoming a key indicator of claims performance. The FCA is clear, claims processes must not create unnecessary barriers or confusion. Reducing customer effort helps ensure customers are supported, understand their options, and achieve fair outcomes.
When too much complexity sits with the policyholder, responsibility can shift at the very moment they are least equipped to carry it. Under Consumer Duty, firms are expected to recognise and address this, particularly where vulnerability is situational.
Outcomes don’t end at settlement
Good outcomes are no longer judged at the point of payment alone. Regulators increasingly expect to see that:
- Repairs are achievable
- Reinstatement is completed
- Issues do not return months later.
Outcomes that look sufficient on paper, but fail in practice, undermine confidence and create long-term risk.
Strengthening outcomes without changing decisions
Loss Recovery Insurance (LRI) addresses this gap without changing claims decisions.
It sits alongside existing claims frameworks, providing independent explanation and guidance at critical decision points. This helps customers understand the implications of a settlement without challenging the claims authority or outcome itself.
By reducing customer effort, supporting vulnerable customers and improving the sustainability of outcomes, it strengthens the experience around claims rather than interfering with how they are settled.
A shift in what “good” looks like
In a regulatory environment focused not just on what is paid, but on how outcomes are delivered and sustained, service quality is no longer secondary. It is central to demonstrating good claims outcomes.
Consumer Duty has raised the bar, but the real test comes at the point of claim. Where are the unnecessary barriers in your claims journey today?