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Processes & procedures are adopted into a claims operation to:
- Promote Productivity
- Reduce the possiblity of error
Why must flexibility be built into any system?
To allow for personal judgement of loss adjusters
What is file leakage ?
Refers to any situation the a claim is overpaid
What are the con's of telephone adjusting?
- Claims are over paid
- Exaggerated claim are not controlled
- Fraudulent claims sometimes cannot be identified
Why may a personal visit from an adjuster be required?
- Allows adjuster to verify the COL
- Complex claims require special attention
- Severe losses
- Questionable losses, probably not covered by the policy
- Losses with high possibility of Subrogation
- A high level of customer service
Why may an Independent Adjuster be needed?
Insurer may not have sufficient volume of claim to justify hiring a permanent employee
During a busy claims period for insurer, incoming claims could overwhelm staff
During vacation periods or storm periods or other claim emergencies
Special lines of business an outside expert may be required.
What is the Claim Examiners Role?
To oversee and control claims assigned to independent or staff adjusters
The Claims Examiner communicates with each adjuster to:
- Outline the scope and terms of the loss assignment
- Provide instructions on coverage
- Explain what is expected
The Claim Examiner's duties on each file include:
- Analyzing all reports produced
- Determining further action needed
- Ensuring the claims file is well documented
- Ensuring the policy conditions are appropritely applied
Insureded often look at Loss adjusters to :
- Provide guidance in claims process
- Provide reassurance
- Be generally supportive
The screening of claims to assign tasks to appropriate people
List the 6 Claims Handling Guidelines
- Coverage Analysis
- Loss Reserving Process
- Reporting to others
- Negotiation and Settlement
Explain Coverage Analysis
At the outset of the claim the role of the adjuster is to determine the coverage by seeing what can be done based on the policy in force
Explain Loss Reserving
- It is imperative that reserves are set after investigation is complete.
- The money that is set aside must be done so at the early stages of the claim and they must be manages through out the life of the claim.
Reporting to others
Staff adjusters & independent adjusters need to provide a peliminary report
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