COVERAGE
FUN with FACTS
BEST PRACTICES
AUDIT
APD CLAIM HANDLING
100

What policy endorsement covers a custom $10,000 stereo system installed in the insured's vehicle?

Extra Equipment Coverage

100

What does PVU stand for? 

Policy Verification Unit

100
Mrs. Insured vehicle caught fire at home while parked and unoccupied. Is a recorded statement required?

Yes - R/S should be taken on ALL fire claims

100

You called Joe Hudson's to get an update on claimant repairs. What subclaim should you document this call in?

ZPD

100
First contact with claimant should be completed within ___ hours of claim assignment.

24

200

What is covered under the Enhanced Exterior Repair Option?

OEM parts

200

What button do you click in FACTS to toggle between Display and Change mode?

Pencil with glasses

200

Charlotte has made 2 unsuccessful attempts to reach Mr. Claimant. The FNOL reports that CV is non-drivable and located at Bernie's Towing. How often should Charlotte attempt contact with Mr. Claimant?

Daily

200

Raimund finalizes liability on a claim as probable. He adds the liability template, adds the IR file marker, and notifies all parties involved of the liability decision.

What step was missed?

Updating liability in FACTS 

200

After acceptance of liability with the adverse carrier, diary every ___ days, follow up with adverse carrier for status, and then diary another ___ days before closing.

60 / 30

300

The insured is driving for Uber with a passenger in the rear when he is rear-ended at a red light.

He carries TNC coverage on his policy. Would this loss be covered?

No, TNC coverage only applies during a standby period.

300

What is the max amount a check can be issued for on a closed claim?

$1,000

300

***DOUBLE JEOPARDY***

Loren runs PMOI for Mrs. Insured's vehicle. PMOI recommends TLE - Predicted Total Loss. Mrs. Insured had mentioned that she was already interested in an ACE shop, so Loren sets up DRS. Is this proper handling? 

No - We should always follow PMOI when circumstances allow

#FollowThePMOI

300

Angelina's new claim has FOL listed as "Bucket flew and hit IV." The ZCOM folder is opened and incident-type reads Non-Accident.

After first contact, Angelina determines that the insured hit a stationary bucket that was in the road. She closes the ZCOM folder and opens ZCOLL.

What else needs to be updated? (2 part answer)

Incident Type & Loss Cause

300

Mr. Insured calls in and leaves a voicemail at 4:45 PM. By what time should his call be returned?

Before noon the following business day

400

***DOUBLE JEOPARDY***

Terrence calls out on a new out-of-state loss. Mrs. Claimant tells him that it's snowing badly where she's at in Michigan and only has a few moments. Tessa quickly takes the recorded statement, confirms the loss happened in Detroit, advises Mrs. Claimant that we have accepted liability, and facilitates an inspection. Mrs. Claimant thanks Terrence and disconnects the call.

Is this proper claim handling?

No - Michigan is a licensed state, so Terrence should have assigned Michael Curtin to handle the liability investigation.

400

Under what tab do you update an Unidentified Person in Facts?

Occurrences

400

Frank has an unsettled total loss for Mr. Claimant. How often should she be dairying out to settle the total loss?

Every 2 days

400

True or False: We are strongly encourage to send the survey notice at the time of claim closure, but it is not required.

FALSE - Audit requires that we notify the insured of the NPS Survey (unless the survey is excluded on the claim)

400

***DOUBLE JEOPARDY***

Terrence sent an ROR for non-cooperation. Mr. Insured's received the letter and called John to provide a recorded statement. What letter should John send out after his conversation with Mr. Insured?

ROR Rescind Letter

500

Enhanced Total Loss Replacement Coverage requires the insured vehicle must have under ____ miles on the odometer at the time of the loss.

24,000

500

Who is the EFT vendor?          

One INC

500

What does the "H" stand for in the Call Guidelines?

Hear your customer's concerns (active listening)

500

Krystal receives the estimate for Mr. Insured's vehicle on Tuesday. Coverage is clear. Payment should be issued no later than what day?

Thursday

500

If the repair estimate says 7 days, how many days of rental should we authorize if the insured drops off at ACE on Monday?

between 9 and 11 days

Rental Formula: repair days from estimate + 2 days for parts (if on order) + weekend/holidays (if     applicable) = total # of rental days

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