Claims and complaints

Before you start

• The client's group exists, with the insured person and, ideally, the policy recorded under Insurances.
• For complaints, access to Settings (for the firm-wide register) or to the group.

Where to find it

• Claims: left sidebar → Claims. To start one: open the group → Workflows → New Workflow → Insurance Claim.
• Complaints register: Settings → Complaints.
• One group's complaints: open the group → Compliance → Complaints.

Start and run a claim

1. 1

   Step 1: Start an Insurance Claim workflow

   Under Select claim type(s), choose one or more: Life/Death, TPD, Trauma/Critical Illness, Income Protection, or a health or accidental injury claim.
2. 2

   Step 2: Enter the claim details

   Choose the Claimant and Claimant role (for example Self (insured), Beneficiary or Estate / executor). Use an existing policy to pull in the insurer, policy number and cover, or enter them manually. Add the Event / Diagnosis Date, Claim Reference, case manager details and any notes.
3. 3

   Step 3: Work through the phases

   Claim Intake → Document Collection → Insurer Lodgement → Assessment Follow-up → Decision Review → Settlement → Closure.
4. 4

   Step 4: Keep the claim record current

   Open the claim from Claims. Its tabs are Overview, Workflow, Evidence, Comms, Disputes and Audit. Record the status, decision, payout, follow-up dates and checklist items as they happen, and flag a Vulnerable customer where relevant.

Log and manage a complaint

1. 1

   Step 1: Select + Log complaint in the register, or + New on the group's Complaints page

2. 2

   Step 2: Record the details

   Enter the Title, Complainant name, Received date, Response due date, Category (such as Advice, Fees, Service or Communication), Priority and Description. Choose who it is Assigned to.
3. 3

   Step 3: Attach evidence

   Link the relevant interactions and documents, and upload evidence files (up to 20 MB each). Add notes as the complaint progresses.
4. 4

   Step 4: Move it through its statuses

   Open → Investigating → Pending client or Escalated → Resolved → Closed. Record resolution notes and, if the complaint goes to a dispute resolution scheme, the EDR scheme and EDR reference.
5. 5

   Step 5: Watch due dates

   Filter the register by Mine, Unassigned or Response overdue to see what needs attention.

What you should see

• Each claim appears in Claims with its current phase, status and activity history.
• Each complaint appears in the register and on the group, with its status, due date and owner.

What is saved or sent

• Every change to a claim is written to the claim's activity log.
• Complaint updates are recorded in the complaint's notes and activity.
• Wealthie does not lodge claims with insurers for you. Logging a complaint does not contact the complainant.
• A claim runs as a workflow, so check the workflow options, including Silent workflow, before you start.

If something goes wrong

The policy is not listed when starting a claim

Choose Enter manually and type the insurer and policy number, then add the policy to the group's Insurances when you can.

A complaint is overdue

Filter by Response overdue, assign an owner, and record the next step and a new response date in the complaint.

A claim decision is disputed

Use the claim's Disputes tab to raise or link a dispute, and log a complaint if the client is complaining about your firm.