Denied Claim Dispute

About the Case

Lucas Johnson recently submitted an insurance claim to his home insurance provider due to a pipe that broke down in his kitchen, causing significant damage to nearly all cabinets. However, the insurance company has denied the claim, citing that it does not meet the necessary requirements for payment. Mr. Johnson is here again to dispute the denied claim, seeking resolution and clarification.

As the insurance company representative, your primary objective is to ensure client satisfaction while demonstrating a thorough understanding of insurance policies and empathizing with Mr. Johnson’s situation.

Learning Objectives:

Address the client’s concerns with empathy and professionalism
Develop effective communication skills to handle claim disputes
Identify cause of conflict and address issue with tact
Display familiarity with the company’s rules and regulations
Develop skills to meet client satisfaction and foster trust and loyalty

Skills Assessed

Effective Communication Skills
Problem-solving Abilities
Client Retention
Client Relationship Management
Product Knowledge and Compliance

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Denied Claim Dispute

Character’s Role

Client

User’s Role

Insurance Company Representative

Scenario Location

Insurance Executive Office

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No technical knowledge required.