Chapter 2

• Promote Productivity
• Reduce the possiblity of error

control expenses

To allow for personal judgement of loss adjusters

Refers to any situation the a claim is overpaid

• Claims are over paid
• Exaggerated claim are not controlled
• Fraudulent claims sometimes cannot be identified

• 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

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.

To oversee and control claims assigned to independent or staff adjusters

• Outline the scope and terms of the loss assignment
• Provide instructions on coverage
• Explain what is expected

• Analyzing all reports produced
• Determining further action needed
• Ensuring the claims file is well documented
• Ensuring the policy conditions are appropritely applied

• Provide guidance in claims process
• Provide reassurance
• Be generally supportive

The screening of claims to assign tasks to appropriate people

• Coverage Analysis
• Loss Reserving Process
• Reporting to others
• Investigation
• Evaluation
• Negotiation and Settlement

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

• 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.

Staff adjusters & independent adjusters need to provide a peliminary report