Special Investigation Unit
Insurance fraud cost the insurance industry an estimated _______ a year.
$160 Billion
If you received a letter of representation, where do you go to add them to the claim?
Parties involved, add them as an associated party under the contact they are respresenting.
If you are on a call with a claimant, navigator is running and the calls disconnected. You attempted to call the customer back but no one answered. What do you do next?
Stop Auto Play and document that the line disconnected
If the insured is using their Uninsured Motorist coverage who would be marked as the CBP in Claim IQ?
The Claimant
Claimant Bill Gates who is insured by Billco Insurance CO is responsible for our insured Bill Clinton damages. When completing the responsible party details page who would be selected as the responsible party?
Bill Gates
What are the two types of fraud concerns
Opportunistic and Organized Fraud
What type of paycode would you assign to a claim reported by a lien holder who indicated they repossessed the insureds vehicle?
Inspect Only
The claimant called in to make first contact on a claim reported by the insured. Based on the contact information entered, ATLAS performs a data prefill search and displays the results on the "reconcile Data Search Response page. What should you do with this information?
Confirm that all the information is correct with the claimant before updating the prefill information
Use Knowledge Tool to determine if UM or UIM coverage is available in the state you are handling by going to what page?
States Basic Page
The packet of information requesting payment for damages paid by one insurance carrier but owed by another is called what?
Demands
What are the 3 elements of fraud
A Lie
The intent to lie
The person benefits from the lie. If they are truthful they will not benefit
If you receive a call from the insured that they received a notice to file suit, what department would you assign the claim to?
Casualty
If the insured is represented by an attorney what would you update the First Contact Status Indicator to?
Contact Attorney
What is the UMPD Limit for Alaska?
How much is the deductible?
Is a police report required?
$25,000.00
$250.00
Yes - for hit and run within 24 hours
Adverse carriers that are part of Arbitration Forums are called?
Signatory Carriers
Before sending the referral for SIU what 5 things must be completed.
Make contact with the parties involved.
Compare details with all parties involved.
Verify information provided on police report.
Do the damages match the accident description?
If you become suspicious, get SIU involved ASAP!
A legal process involving checks that are not cashed within 180 days of issuance.
Escheat
If the claim is reported by the insureds spouse Mrs Money, what would you update the first contact status to for Mr. Money?
First Contact completed
In order to determine if the claim qualifies as an Uninsured or Underinsured Motorist claim, you will need to determine and/or confirm these 4 things
Determine fault
Verify Damages (including injuries)
Identify the Claimant
Verify Claimant coverage
What does R.I.D.E. stand for?
R - Recorded interviews on every claim
I - ISO documents
D- Data Prefill
E- Evidence for liability
How do you locate the SIU adjuster contact information?
From the claims details page, select the SIU case number located on the right side of the page.
Before issuing a payment, what 3 things need to be determine?
If you need to make additional phone calls related to the claim you are handling what code would you place your phone in
File Handling
Three things to consider when identifying if Underinsured Motorist coverage are?
When contacting the adverse carrier what 3 disposition questions are you gong to ask?
What is the coverage status
What is the Liability decision
Has the adverse carrier advanced our insureds deductible