One of the elements of the policy terms that raises the most questions is the prospects assessment: for a reported case, the insurer may examine whether pursuing the claim has a reasonable chance of success. At first this sounds suspicious – "so it can reject anything it likes?" – which is exactly why it's worth looking factually at what this is, and what it isn't.
- The prospects assessment is an element set out in the policy terms: a reasonable weighing-up of the case's legal chances – not a decision based on mood.
- Its purpose is twofold: protecting the risk pool, and shielding you from hopeless proceedings.
- If you disagree with the assessment, there's typically a route to discuss it and have it reviewed – it isn't a dead end.
What exactly is it?
In the prospects assessment, the insurer – typically working with qualified lawyers – weighs up whether pursuing the reported case has a reasonable chance of success: what the facts, the documents and the legal context say. This isn't an override of your sense of what's fair, it's a legal assessment of the chances – similar to what a careful lawyer does before recommending a lawsuit. The policy terms set the framework for the assessment; we look at the details through a contract-anatomy lens in the prospects assessment clause article.
Why does it exist – and who does it benefit?
There are two reasons, and both are reasonable. The first is protecting the risk pool: funding a string of hopeless cases out of the legal protection pool would push up every client's premium. The second is more surprising: it also protects the client. A hopeless lawsuit isn't only costly for the insurer – it can cost you years, energy, and, if you lose, the other side's costs too. A fair assessment of the chances also protects you from the wrong path. That said, proportion matters: the assessment must never become a convenient tool for refusing service – which is exactly why the next point matters.
What's your route if you disagree?
If the insurer assesses the case as hopeless, that isn't necessarily the end of the road. The policy terms and practice typically offer several options: you can ask for a detailed written explanation; you can ask for the assessment to be repeated by submitting new facts or documents; under a number of policy terms, a conciliation procedure provided for in the terms (with an external expert) exists to settle a disputed question about the chances; and the complaints route is also open. The if the insurer says no article walks through the steps – and this is exactly the situation where, as broker, I stand alongside the client in the discussions too.
What can you do to help the assessment go well?
The prospects assessment can only be as accurate as the input it's based on. Complete, well-organised documentation – records, a timeline, witnesses – doesn't just strengthen the case, it also pulls the assessment of the chances closer to reality. Document collection and the dispute log are therefore not administration, they're advocacy. And a general truth: whoever can present their case factually and coherently stands a better chance at every table.
An example: when the assessment worked for the client
A typical story from practice. A client was certain they were in the right in a case against a service provider, and would have started proceedings immediately. During the prospects assessment, the insurer's lawyers pointed to two weak spots: one element of the claim was close to becoming time-barred, and the other was missing a key document. The result wasn't rejection but a change of direction: a well-documented claim narrowed down to its strong elements – which then settled within months. The lesson is twofold. First, the assessment of the chances doesn't work against the client: spotting weak points early is part of the strategy. Second, the quality of the assessment depends on the input – which is exactly why it pays to submit the report with documentation and a timeline attached. The prospects assessment is the professional basis for the insurer's cover decision: it can be useful feedback on the case's strengths and weaknesses, but it is not a legal opinion, and it is not prepared on your behalf.
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