Coverage & decisions
Policy documents, endorsements, coverage positions and the information recorded at relevant points in the claim.
Our approach
The relationships
within the record.
A claim file is more than a collection of documents. It is a sequence of statements, decisions and actions. Fault Audit is designed to make those connections easier to examine.
The starting point
A defined record.
A considered review.
The review begins with the material in scope. Its limits matter as much as its contents.
An unanswered question is not a finding of wrongdoing. A document not located in the available material is not, by that fact alone, a document deliberately withheld.
Establish the record
Identify the documents and source material available for review, including incomplete, unreadable or unavailable items. Preserve the distinction between an original record and a later reproduction.
Reconstruct the sequence
Bring events and communications into context: who made a statement, what it concerned, when it was made and what followed.
Compare related material
Consider passages across correspondence, reports, claim notes, policy documents and financial records. A difference in wording may reflect new information, a condition or a correction—not necessarily a contradiction.
Develop the working file
Organize issues with their supporting material, contrary evidence and open questions. Keep the route back to the underlying record visible.
What the review considers
Beyond the isolated passage.
Accounts & correspondence
Accounts of the same event, the identity and role of the speaker, and subsequent qualifications or corrections.
Investigation & response
The relationship between requests, acknowledgements, reports, commitments and decisions.
Payments & loss
Estimates, invoices, payments and credits, distinguishing claimed, estimated, incurred and paid amounts.
Disclosure & gaps
References to records not located in the material reviewed, with the search scope and unresolved points kept explicit.
Other explanations
Material that supports an issue alongside evidence that may explain, qualify or undermine it.
The distinction
The observation.
The interpretation.
The open question.
What a record says, what can reasonably be inferred from it and what remains uncertain are different things.
The intended working file keeps those distinctions visible. It connects a proposed issue to the relevant passages and context, rather than presenting an isolated quotation as a settled conclusion.
See illustrative work productCommon questions
A few useful distinctions.
Is this a document-summary service?
Summaries can form part of the working file, but the focus is the relationship between records: how statements, decisions, actions and amounts fit together, and which questions require closer examination.
Does the review focus only on insurer conduct?
No. The intended scope includes coverage positions, disputed accounts, repair and valuation issues, documented loss and payment history, alongside claim handling and disclosure questions.
How is contrary material treated?
Corrections, explanations, conditional statements and contrary evidence belong alongside the issue they affect. A useful review makes the strength and limits of the record visible.
What types of material are relevant?
Policy documents, correspondence, claim notes, reports, estimates, invoices and document productions may all be relevant. Treatment of particular formats and source limitations forms part of the scope discussion.
Does an issue summary determine the legal position?
No. An issue summary brings together the factual question, source material and unresolved points. It is distinct from a legal opinion or a determination of liability, entitlement or remedy.
Further information.
Contact us to learn more about the approach and its potential application within your practice.