Basics
This should be completed on every claim file you review for the first time and documented in file.
Coverage analysis or PCIEO
CDW. What is it and do we owe it?
Collision Damage Waiver. No.
You identify a potential UDD claim. What is the first thing you send to the insured?
ROR
DWI and fleeing the scene are examples of what?
Factors increasing value that go into the modifier's tab.
Last binged South Park
Rob!
This is the amount of money we think an injury claim may be worth based on the current information in file to date.
CROV or current range of value
Insurer has a duty to its insured to accept all reasonable settlement offers within PL that is within the scope of coverage, within the limits, agrees to release the insured AND the terms of the demand are such that an ordinary prudent insurer would accept it considering the degree of potential excess exposure it presents. What is this known as?
Stower's Demand
Insured is driving a V*1 who is insured with Progressive and we are the at fault party. Who is paying for this loss?
We need policy language to understand primary, excess or pro rata.
Significant delay in treatment, inflated billing and no objective findings are examples of what?
Strengths
Lives outside the smallest national park...
Jodi!
The smallest national park in the United States is Gateway Arch National Park in St. Louis, Missouri, which is 91 acres in size
Where were you headed that day is also known as what in the claim file?
POT or purpose of trip
You can sue for damages if you are partially at fault for an accident, but you cannot recover damages if you are more than 51% at fault. This is also known as the "51% bar" or "proportionate responsibility". Texas is a (blank) state.
Comparative Negligence
For extra cash, insured works part time out of her own car dropping packages. She was on her way to a customer's home when she rear ends the claimant... Is she covered?
Yes.
We think the claim value for past P&S is too low and we want to deviate. Where do we document that in the IED?
General damages tab
Does not indulge, but would prefer bacon for breakfast if it did our body good...
Bill
If it's not a clear liability loss or you believe the insured to not be the at fault party you need what?
Recorded statements
NID caused an accident. NID's husband was her passenger. They retained an attorney to help with the BI and we evaluated his claim to be worth $100k and the policy limits are 1100/300. What will his settlement payout be?
Due to resident relative exclusion, max payout is capped at $30,000.00
5. bodily injury to you or any resident relative, except to the extent of the minimum limits of Liability Coverage required by Transportation Code Sec. 601.071, entitled ‘‘Texas Motor Vehicle Safety-Responsibility Act.’’
Sarah lives in New Orleans and carries LA state minimum insurance of 15/30. She's here in Houston visiting friends when she rear ends someone causing injuries. We value the claimant's eval at $40,000.00. What are we paying?
30,000.00
We need to deem the limits as they roll up in TX
We have come to a verbal agreement to settle with the atty for the PL of $30,000. What do we update in the IED?
Settlement information in the demands/offers tab.
Katie's 3 monkeys are...
Avery, Rocco and Tallulah
30/60/25- Hidalgo County. Insured fell asleep and rear ended a G Wagon that got pushed into a Tesla that in turn hit a 1989 Mustang. What should you be thinking?
PD limits issue.
Notify insured. Explain to claimants: No payments until we have all final estimates or values. Encourage them to use their own carriers for collision/UIM. Don't forget to send excess insurance letter.
MPU stands for what and why is it used?
Minor prove up. Used on claim settlements for minors as a full and final release of their claims.
Insured is driving through Hill Country. It's dark. A herd of deer come dashing across the roadway. Insured totals his new car, kills 4 deer and his passenger is really banged up. The attorney sends in the passengers $48,000 ER bill. Policy limits are 30/60. Atty is demanding limits. What do you do?
This is a comprehensive loss and BI does not apply to comprehensive losses.
However, if the injuries or risk is high: we do need to take a second look at any negligence we may have contributed and reconsider denials, our authority and home office referrals.
We have a DD on our claim who lives with the NI. What are the two items in the participant details tab that should be updated?
Household resident relative and excess insurance
Name the 3 that we can thank our West Texas office for...
Katie, Nikita and Komal