File Level Expectations
Documentation of all relevant activity should be found here.
Notes
90 minutes
These individuals should be provided the coverage letter in the event of a full or partial denial.
Agent and insured.
If ALE is needed, the CA should utilize this.
Preferred housing vendors.
An insured must be made aware of this right when managed repair is dicussed.
Their right to chose their own repair vendor.
Claim status letters should be sent w/in this amount of calendar days.
30 Days
First contact should be made within this timeframe.
2 hours
If a coverage decision can not be determined w/in the first week after the report, this document should be considered.
ROR
Initial LOU should be limited to the shortest time to complete a reasonable assessment of the claim not to exceed this amount of days.
14 days
These 2 items must still remain on the estimate while being handled in managed repair.
Depreciation and deductible.
Payments must reflect these items in the memo line.
Appropriate description and invoice #
If first contact in unsuccessful, you should make additional attempts w/in this amount of time.
Every 2 hours
Disputed denials should be reviewed w/ management w/in this timeframe.
48 hours
Loss of use status and action plans should be updated in the file notes throughout the life of the claim and not to exceed intervals of this many days.
30 days.
Mortgages must be listed on checks for payments over this amount.
$100k
Any request for information (verbal or written) must be responded to within this many days.
15 Days
First contact is only achieved when this happens.
The advocate has spoken to the customer.
The CA should do this to keep our commitment to transparency in the event a coverage requires additional investigation,
Advise the customer and provide expectations.
When temporary living arrangements are necessary, efforts should be made for accommodations with this feature.
A kitchen
If only item pending on claim is the managed repair, this should take place.
A summary outlining the estimated time of repair and request for TL to change status.
These 2 things are the hallmarks or our claim service.
Advocacy and Transparency
Recorded statements need to solidify these items.
Facts of loss and details related to the nature and extent of the damages being claimed, to include dates/timeframes of loss discovery.
Disputed coverage letters must be responded to w/in this timeframe.
No later than 15 days of receipt.
Coverage limits and remaining limits in timely intervals.
CodeBlue Assure status updates during repairs occur at these marks.
25%, 50%, 75%, Completion