Roux Afrique Claims Adjusters documenting industrial damage

ROUX AFRIQUE CLAIMS · AFRICA & MIDDLE EAST

CLAIMS MANAGEMENT

CLAIMS ADJUSTER · CLAIMS ADVOCACY · TPA

MOBILISE · QUANTIFY · NEGOTIATE · SETTLE

A major loss is not an administrative file

Roux Afrique Claims supports insured companies, industrial groups, institutions and investors facing major or complex losses.

We organise facts, evidence, property damage, business interruption and negotiations through documented settlement. Any TPA authority remains strictly governed by the mandate, jurisdiction and authority matrix.

Report a major loss Review our methodology

FROM THE FIRST HOURS

The claim starts before all information is available

After a major event, the company must act quickly without weakening its future claim.

A technically justified expense can become difficult to recover if it is not documented and connected to the loss and policy.

protect people and the environment
secure facilities and limit deterioration
preserve evidence and chronology
notify relevant parties
maintain critical operations
document emergency expenditure
plan repair or replacement
measure financial consequences

Roux Afrique Claims balances operational urgency, evidential discipline, policy analysis and financial control.

Stakeholders

BoardsCEOCOOCFOIndustrial managementRisk & Insurance ManagersHSEMaintenanceProductionLegalBrokersInsurersReinsurersLoss AdjustersLendersInvestors

THREE DELIVERY MODELS

Responsibilities that must remain distinct

Claims Adjuster acting on behalf of the insured

Appointed by the insured to build and advocate a documented claim.

Claims Management end-to-end

Operational management from notification through settlement.

TPA & Delegated Claims Administration

Delegated administration within a valid legal, contractual and regulatory framework.

The TPA designation grants no implied authority; every power remains subject to the mandate.

CLAIM GOVERNANCE

Eight workstreams for a complex claim

Mobilisation, safety & governance

Loss team, decision-makers, approval paths, emergency measures, decision log and initial strategy.

Notification & programme architecture

Policies, periods, insured interests, deductibles, limits, extensions, coinsurance, fronting, reinsurance and documentary duties.

Evidence preservation & causation

Locations, photographs, exhibits, witnesses, logs, maintenance, analyses, chain of custody and established-fact register.

Property Damage

Buildings, machinery, stocks, safeguarding costs, debris removal, transport, erection, testing, salvage, depreciation and betterment.

Business Interruption & financial loss

Lost capacity, trends, seasonality, gross profit, savings, ICOW/AICOW, mitigation, repair and ramp-up.

Mitigation, repair & recovery

Repair or replacement, temporary solutions, outsourcing, long-lead items, permits, commissioning and critical path.

Claim Preparation & negotiation

Statement of Claim, quantum, evidence reconciliation, memoranda, issue register, interim payments and executive decisions.

Settlement, closure & lessons learned

Allocation by coverage, agreement and payment tracking, reserved items, recovery, archiving and prevention recommendations.

METHODOLOGY

From event to settlement in nine steps

01
Mobilise
Assemble the team, secure the mandate and establish governance.
02
Notify
Identify policies and record communications.
03
Preserve
Protect people, facilities and evidence while limiting deterioration.
04
Establish facts
Build a sourced chronology and separate facts, statements and assumptions.
05
Quantify
Assess PD, BI, costs and mitigation on explicit bases.
06
Document
Link each item to evidence, calculations, responsibilities and assumptions.
07
Challenge
Test technical, contractual, financial and documentary consistency.
08
Negotiate
Present positions, address gaps and seek a documented agreement.
09
Settle & learn
Track approvals and payments, close the file and capture lessons learned.

Every material amount must link to a fact, damage, calculation basis, supporting document and documented coverage position.

GOVERNANCE BY EXCEPTION

Manage gaps, not document volume

Registers structure amounts, positions, decisions and uncertainties.

Claim Register

Initial, updated, agreed, disputed and paid amounts; evidence, owner, status and next action.

Claim Issue Register

Party positions, factual and policy basis, financial impact, expected decision and deadline.

Decision & Communication Log

Safeguarding measures, approvals, commitments, communications, reservations and provisional agreements.

Data Gap & Assumption Register

Missing or conflicting information, assumptions, sensitivity and remediation action.

RECOVERY CASH FLOW

Interim payments should not wait for the entire adjustment

An interim payment request can be prepared when part of the loss is sufficiently evidenced and undisputed.

amount requested and relevant coverages
items already evidenced
committed expenditure and cash-flow requirements
reservations on open items
supporting evidence
reconciliation with earlier interim payments

The payment decision remains with the insurer or authorised party.

CONTROLLED DELEGATION

A TPA framework governed by an authority matrix

The matrix defines what may be executed, recommended, authorised or escalated.

claim categories, territories and coverages
information-request and expert-appointment powers
recommendation, approval and escalation thresholds
reserving rules and settlement conditions
payment process and antifraud controls
sanctions, embargoes and data protection
customer complaints and conflicts of interest
SLA, reporting, audit rights and business continuity

No authority is presumed; anything beyond delegation is referred to the principal.

DATA ROOM

A structured Data Room from the first hours

Depending on the loss, the team assembles operational, technical, financial and policy records.

policies, endorsements, schedules and notifications
incident reports, chronology, photographs and videos
drawings, diagrams, SCADA/DCS, alarms and event logs
authority reports, causation analyses and maintenance records
Asset Registers, Statement of Values and purchase invoices
quotes, orders, invoices, payments and timesheets
stock, production, sales, budgets and forecasts
management accounts, BI calculations and mitigation measures
supplier and customer contracts and reconstruction programme
minutes, issue registers and agreements

Access is governed by data sensitivity, confidentiality and party rights.

INDEPENDENT QA/QC

Independent review before submission

The review tests factual, technical, financial, policy and documentary coherence.

mandate compliance and chronology consistency
source traceability and separation of facts and assumptions
causation for each claim item
absence of double counting
quantities, unit prices, taxes and currencies
salvage, depreciation and betterment
PD and BI consistency
savings, mitigation, ICOW and AICOW
deductibles, limits and sublimits
interim-payment calculations and version reconciliation
Statement of Claim and appendix consistency
qualification of uncertainty and independent review

A claim is not presented as final while material investigations or decisions remain open.

DIGITAL EVIDENCE

Inventys® and VRA3D supporting traceability

Technology organises and spatialises evidence without deciding coverage.

Inventys®

Structures the claim file and its progress.

items, evidence and damaged assets
costs, responsibilities and open issues
versions, interim payments and amounts
closure evidence and multi-site consolidation

VRA3D

Creates a spatial record of the loss.

site configuration and damaged areas
equipment location
visible extent of damage
progress and changes during the works

VRA3D does not replace testing, causation analysis or specialist inspection.

DELIVERABLES

Deliverables designed to advance settlement

Depending on the mandate:

01Immediate Action Plan
02Claims Management Protocol
03consolidated chronology
04Coverage & Notification Matrix
05Claim Strategy Memorandum
06Evidence Preservation Register
07Property Damage Assessment
08Business Interruption Assessment
09Mitigation Register
10Statement of Claim
11Claim Register & Claim Issue Register
12Data Gap & Assumption Register
13interim-payment submissions and supporting files
14negotiation presentations and periodic reports
15financial dashboard and photographic file
16claim–agreement–payment reconciliation
17Settlement & Closure Report
18lessons learned and recommendations

DECISIVE MOMENTS

When should Roux Afrique Claims be mobilised?

immediately after a major loss
when business continuity is threatened
when several sites, countries, policies or insurers are involved
for coinsurance or international programmes
when causation or quantum is complex
when a material interim payment must be prepared
when expert discussions stall
when an old or blocked claim must be restructured
to outsource a claim portfolio
before closing items that remain reserved

Late mobilisation may remain possible but cannot recreate evidence that was not preserved.

SECTOR EXPERTISE

Losses requiring specialised expertise

Teams are assembled around damage type, technology, coverage, financial stakes and jurisdiction.

Energy & UtilitiesOil, Gas & PetrochemicalsMining, metals & materialsIndustry & ManufacturingAgri-industryInfrastructureTransport, ports & logisticsTelecommunications & Data InfrastructureReal estate, hospitality & major portfoliosHealthcare & critical servicesConcessions & PPPFinancial institutionsMulti-site portfolios

Technical and financial depth is calibrated to the actual significance of the claim.

DISTINCT EXPERTISE

A responsible mandate. Distinct scopes.

Roux Afrique Claims

Structures facts, evidence, damage, loss, claim submissions and post-loss negotiations.

Roux Afrique EVS — Valuation

Provides reconstruction or replacement bases when appointed; a pre-loss value does not automatically determine indemnity.

Roux Afrique EVS — Business Interruption

Establishes pre-loss BI values, dependencies and periods; Claims quantifies the loss actually sustained after the event.

Roux Afrique EVS — Engineering Risk Survey

Assesses hazards and protections before loss; post-loss investigation requires a separate mandate.

Roux Afrique Advisory

Addresses programme architecture, Risk Financing and governance; Claims manages the event once it has occurred.

Roux Cyber & legal counsel

Roux Cyber acts as Cyber Claims Adjuster and coordinates specialist digital investigation; legal opinions, litigation and arbitration remain with authorised counsel.

FRAMEWORKS

Frameworks applied to the market and mandate

The policy, endorsements, applicable law, facts and authorised decisions remain decisive.

01CIMA Code where applicable
02national insurance regulation
03programme contractual rules
04market Claims Management Principles
05coinsurance and Claims Agreement procedures
06rules governing TPAs or Delegated Claims Administrators
07sanctions, KYC and antifraud requirements
08accounting, tax and data-protection rules

Reference to a market standard grants no licence.

An advisory mandate creates no regulated decision or payment authority.

FREQUENTLY ASKED QUESTIONS

Understand the mandate before acting

How does the insured's Claims Adjuster differ from the insurer's adjuster?

The former supports the insured in preparing and advocating the claim; the latter acts under the insurer's mandate.

Does Roux Afrique Claims decide coverage?

No, except under an explicit and valid delegation. Under an insured-side mandate, the insurer decides coverage.

Can the mandate run through settlement?

Yes. It may include quantification, negotiation, agreement tracking and payment reconciliation; payment authority remains with the authorised party.

Does Roux Afrique Claims negotiate with reinsurers?

It may support technical presentations where the programme and mandates permit, without presuming a direct right of the insured.

How do Claims Management and TPA differ?

Claims Management governs the file; TPA requires a delegation defining authority, limits and oversight.

When should a loss be notified?

As soon as the policy, law and circumstances reasonably allow; missing details may be supplemented later.

Must every expense await prior approval?

Urgent safety measures should not be delayed, but must be documented and notified under the policy.

Can an interim payment be requested?

Yes, when part of the loss is evidenced, subject to approval by the authorised party.

How is betterment handled?

It is isolated and assessed against policy terms, technical necessity, depreciation and regulatory requirements.

How is Business Interruption calculated?

From the actual loss, financial data, trends, savings, mitigation and policy wording.

Does Roux Afrique Claims replace legal counsel?

No. It addresses technical, financial and insurance matters; legal opinions remain with authorised counsel.

Can an old or stalled claim be recovered?

Yes, subject to available evidence, by reconstructing facts, amounts, positions and blockages.

CLAIMS MANAGEMENT & TPA

A credible claim rests on the strength of its evidence

Share the event, policies, first actions, apparent damage and operational impact. We will define the appropriate governance, expertise, evidence strategy and negotiation framework.

Speak with Roux Afrique Claims