When an Investigator or Employee investigates a claim the insurer ensures they investigate only the matters needing investigation and in an appropriate and respectful manner. A quality assurance programme regularly monitors and reviews investigations (interview recordings, statements and transcripts, investigators' activity records, and complaints including AFCA disputes) and reviews the non-genuine claim indicators at least yearly to keep them relevant, appropriate and non-discriminatory. An investigation that has run 4 months is independently reviewed by an appropriately authorised, knowledgeable or experienced Employee, the customer is told, the review decides whether there is sufficient cause to continue (otherwise the claim goes for decision under Part 8), takes no more than 30 Calendar Days (failing which the customer is told in writing about the complaints process), and the customer is then told in writing why no decision has been made and what information is still needed. Requests to the customer are reasonable and relevant, made in one request where possible and with the reason explained; investigators' authority and instructions clearly limit the investigation to the claim in question and define the scope of information and the period. Before the investigation starts the insurer discusses why the claim is being investigated (with trained Employees) and tells the customer verbally and in writing about the investigations process, the primary contact, the role of the Investigator or Employee, when to expect contact and what to do if it does not come, the 10 Business Day decision commitment once all information is in, the customer's rights and responsibilities under the policy during the investigation and the complaints process; explains why any authority to access third-party information is sought; and updates the customer at least every 20 Business Days.
The graph holds this control, the 0 it maps to, and the evidence behind each claim, over MCP and REST.