Coverage & Investigation
Before adjusting a claim, the claim professional must confirm this is in force.
What is the insurance policy?
Initial contact with all parties should generally be attempted within this number of business hours.
What is eight business hours?
These should reflect the reasonable cost to repair covered damage at the time and location of the loss.
What are estimates?
When a claim professional notices possible fraud indicators, who must they notify immediately?
What is SIU?
A thorough investigation may include collecting these types of items for documentation.
What are statements, photos, diagrams, & police reports?
Adjusters must review this report for claims history, investigate any findings, and document relevant results in the file.
What is the ISO report?
When contacting a customer, the claims adjuster must verify information, explain the process, and ensure the customer gets to do this before ending the call.
What is ask any additional questions or express concerns?
Photos in the claim file help with documenting damage and increase the probability of this type of recovery.
What is subrogation?
When referring a claim to SIU, what type of information must be provided?
What is specific information about the suspected fraudulent activity?
These are the type of questions claims adjusters use to gather as much information as possible about the loss?
What are open-ended questions?
This document must be sent as soon as a potential coverage issue is identified.
What is the Reservation of Rights letter?
Adjusters must make reasonable efforts to locate parties using available sources, including the agent, a police report, or ______.
What is an ISO search?
When adjusting reserves, they should reflect the ______ expected cost of the claim based on known or expected information.
What is highest?
These types of claims automatically qualify for a transfer to a specialist.
What are claims involving severe injuries or death?
This section of the claim file must reflect all efforts and relevant information, including clear labels and specific descriptions for uploaded documents.
What is claim file documentation?
When another insurance policy may apply to a loss, what action should be taken to determine whether coverage applies on an excess basis?
What is contact the other insurance company and discuss policy language regarding excess.
This is the amount of time a claims adjuster must respond to a voice mail or an email.
What is one business day?
Any adjustment to reserves must include this in the file.
What is a reserve rationale?
This plan must be updated whenever steps change and should include all remaining actions needed to bring the file to conclusion.
What is the Action or Resolution Plan?
Any unfavorable risk discovered during claim investigation—such as unlisted drivers, garaging discrepancies, or late reporting—should result in one of these being submitted.
What is an Underwriting Advisory?
After making a liability decision, the file must show the percentages of negligence for each party, the contributing factors, and an update to these fields in Claims Center.
What are the Fault Code and Percentages?
A quality recorded statement helps clarify exposure and protect this important company right.
What are subrogation rights?