Managing agents must determine the appropriate level of data to obtain where master/group policies are written to enable them to properly manage the business.
At a minimum, numbers of Customers for each master/group policy written (excluding group employer schemes) should be obtained . It is recognised that in some cases this will be a best estimate as the number of Customers receiving the benefit of the policy may vary from week to week or month to month.
A key consideration in relation to data is whether there is sufficient data available to allow the claims handler to determine whether coverage is in place at the point of claim. Where only numbers of Customers are obtained there needs to be an efficient and effective way to identify whether coverage is in place without the Customer’s details being readily available. In some cases the master/group policyholder may be able to assist with this but it is important that this can be done in a timely manner without delaying the claim.
For example, where all members of the group are issued with a membership number it may be that a membership number is sufficient proof of membership and proof of coverage.
Monitoring to ensure the process in place for determining coverage at the point of claim is operating effectively should form part of claims handling oversight e.g. as part of claims file reviews and/or DCA audit.