CLAIMS MANAGEMENT


OPEN CLAIMS FILE REVIEW

A report is generated showing all claims currently open under all lines of insurance. The report will detail facts of the claimant as well as show amounts paid to date and reserves set by the carrier. A claims manager will meet with the client to provide up-to-date information and discuss possible resolution strategies. The report also shows loss trends over the past 5 years to help assess emerging risk management and safety concerns or to demonstrate that risk management awareness and efforts are yielding positive results.
 
CATASTROPHIC LOSS RESPONSE

Clients are provided 24/7 Emergency Response Contact Cards. We respond to all large losses immediately upon notification. We have an established network of professionals to include attorneys, accident reconstruction experts, engineers and adjusters. When a large or unusual loss occurs, we dispatch our network of professionals and immediately notify the insurance carrier.
 
INTEGRATED CLAIMS MANAGEMENT SYSTEM

Financial data is updated monthly from the TPA (third party administrator) or carrier. Loss runs and loss graphs can be created. Loss runs also contain availability of a claim allocation system and tracking of claim handling fees. The Integrated Claims Management System allows for:

  • Access to individual claims and claim analysis reports
  • Claims and claim analysis reports are available 24/7
  • Assists Claims/Risk Management/Fleet/Accounting by providing information to increase productivity and efficiency
  • Interactive claim management systems allows:
    • Ability to categorize claims for managing and specific reports
    • View and add activity notes
    • View reserve history for tracking increase/decrease in exposures 
    • Capability to report claims online
    • Established triggers to provide e-mail notification for new claims established; reserve threshold exceeded

MANAGEMENT REPORTS

Claims information is consolidated and distributed in the form of customized reports to allow for internal claims allocation, monitoring financial activity and loss analysis. Example reports:
  • Claims Financial Summary – a one page "snapshot" by policy year, coverage, open, closed, loss type and large claims limited at deductible levels. This report also includes a summary recap by policy year and coverage to track monthly changes.
  • New Claims Activity – a detailed list of new claims reported in a given month
  • Closed Claims Activity – a detailed list of closed claims in a given month
  • Change in Total Incurred 10K – a detailed list of claims where the reserves were increased or decreased in excess of $10,000
  • Open Claims Report 25K – a detailed list of open claims, at accident level with total incurred reserves in excess of $25,000
 
FILE AUDITS

Physical file audits are performed utilizing a 46-point form. A report is generated showing all claims, open and closed. Files are selected randomly from this report. Claims are evaluated on quality of investigation, appropriateness of reserves, management of expenses, documentation of file, appropriate action plans and the insured’s policies and procedures. Trends and service issues will be identified. A plan to resolve identified issues will be discussed with the service provider.
 

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