Chapter 2

  1. Processes & procedures are adopted into a claims operation to:
    • Promote Productivity
    • Reduce the possiblity of error

    control expenses
  2. Why must flexibility be built into any system?
    To allow for personal judgement of loss adjusters
  3. What is file leakage ?
    Refers to any situation the a claim is overpaid
  4. What are the con's of telephone adjusting?
    • Claims are over paid
    • Exaggerated claim are not controlled
    • Fraudulent claims sometimes cannot be identified
  5. 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
  6. 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.
  7. What is the Claim Examiners Role?
    To oversee and control claims assigned to independent or staff adjusters
  8. 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
  9. 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
  10. Insureded often look at Loss adjusters to :
    • Provide guidance in claims process
    • Provide reassurance
    • Be generally supportive
  11. Define
    Claims Triaging
    The screening of claims to assign tasks to appropriate people
  12. List the 6 Claims Handling Guidelines
    • Coverage Analysis
    • Loss Reserving Process
    • Reporting to others
    • Investigation
    • Evaluation
    • Negotiation and Settlement
  13. 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
  14. 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.
  15. Reporting to others
    Staff adjusters & independent adjusters need to provide a peliminary report
Card Set
Chapter 2
Chapter 2-pg 13