How To Manage A Claim

Front 1

The claims professional must exercise ____ in investigating a claim, because a Professional's reputation is at stake.

Back 1

Sensitivity

Front 2

As the claim develops, the Claim's Professional must update the file and diary and adjust _____

Back 2

Reserves

Front 3

Determing the amount of a loss payment is one function of the ______ process

Back 3

Settlement

Front 4

_____________ and investigation are key processes for developing the facts of a case

Back 4

Fact-Gathering

Front 5

Within 24 hours, most Insurers contact the Policyholder to ___________ receipt of the claim and provide contact information and the __________ number

Back 5

Acknowledge/Claim File

Front 6

One key responsibility of the Claims Professional is to alert the Policyholder to __________________

Back 6

Coverage Issues

Front 7

The Claims Professional can maintain effective communication by setting Policyholder _______ for the claims process

Back 7

Expectations

Front 8

What are 3 unfair claims practices prohibited by most states' Fair Claims Practices regulations

Back 8

Mispresentation of facts or policy provisions, failing to acknowledge or act promptly upon communications, failing to maintain reasonable standards for the prompt investigation and processing of claims, failing to deliver prompt, fair, and equitable settlements of claims, failing to provide a reasonable explanation for coverage denial, refusing to pay a claim without first conducting a reasonable investigation

Front 9

Coverage determination includes an analysis of what critical elements?:

Back 9

Definition of a claim, critical claim dates, and allegations

Front 10

What are the insurer's options for responding to a claim:

Back 10

Refusing to defend or indemnify based on policy provisions, defending the policyholder without reservation, defending under reservation of rights

Front 11

Briefly describe how defense counsel is selected.

Back 11

Panel Counsel List, Outside Counsel, In-house Counsel, Policyholder Counsel

Front 12

Describe three of a cliam professional's administrative responsibilities in litigation management.

Back 12

Appoint Defense counsel, provide reporting guidelines to counsel, provide billing guidelines to counsel.

Front 13

Briefly explain the three basic duties of an insurer

Back 13

Duty to Indemnify, Duty to Defend, Duty to Reimburse

Front 14

What duty includes duty to pay for damages or losses on the claim.

Back 14

Duty to Indemnify

Front 15

What duty includes the right and duty to select counsel and defend the claim.

Back 15

Duty to Defend

Front 16

What duty says that the the insurer doesn't have to defend a claim but it has to pay for cost to the insured for defense.

Back 16

Duty to Reimburse

Front 17

What is the purpose of a claims file quality audit?

Back 17

Confirm that dollars are being spent efficiently for claims, confirm that reserves are being set, monitored, and adjusted properly and efficiently, Confirm that performance standards are being met

Front 18

What are some of the unique characteristics of a claim against an insurance agent/broker that the claims professional should consider?

Back 18

The type of role the agent/broker played in the claim. is the agent/broker a wholesaler or managing general agent? Does he represent one insurer or many?

Front 19

What is a claim within a claim

Back 19

An issue that must be resolved when an attorney is sued. It refers to the underlying claim for which the Attorney is being sued. The claims professional must first determine the attorney's error and liability. If found liable, damages will be determined based on the worth of the underlying case.