Claims Fun

SS

100

The insured’s vehicle is drivable after an accident and is at their residence in CO. You have read ADSP and the Select Service word track but the customer doesn’t know what shop to use.  What are your next steps for the customer’s repairs?

Undecided Workflow

200

• The insured’s vehicle is not drivable after an accident and they will be repairing in their home state of VA. You have read ADSP and the Select Service word track and the customer wants to pursue repairs at the non-program repair facility where the vehicle is located. How should you proceed?

Read the NPS wordtrack, follow Max's prompts to determine the best inspection option

300

• We have accepted 50% liability for claimant damages in a state with a “pure comparative” negligence standard. The claimant can recover 50% of their damages from the insured.
• Should you read the Select Service word track to the Claimant?
• Should you read the Select Service word track to the Insured who carries G coverage?

Claimant- no

NI- yes

400

• The insured reported a claim for a single vehicle loss and the described vehicle is reported to be at their residence in NE. You review the file and repairs have not been setup. You make an outbound call to the insured and they do not answer, what should you leave on their voicemail?

undecided word track, send SS assignment and CH

500

The NI is requesting to cash settle. No original estimate has been created. Should you offer SS?

No

Subrogation

100

Claim reported by NI. FOL are V2 rear ended V1. Claimant is unknown. NI is calling us now. She has claimant’s personal details but she does not have OIC info. How should you proceed?

ISO, CD, OIC repository

200

What is the first thing you should look at to determine if a claim has sub potential?

Liability

300

You are working tasks and review new mail. It is a PR. What information should we review in the PR?

FOL and claimant info including contact info and OIC info

400

FOL are a merging accident. Complex has established liability 100% against the unknown claimant. You receive a phone call from the claimant wanting to discuss the accident. How should you proceed?

Obtain all contact info including DOB and OIC info from claimant. Explain liability, if claimant disputes, escalate the claim to complex

500

Define a “cause of action” What state requires a COA?

Signed permission to pursue dub. Missouri

Rental

100

What should you review before setting up an initial rental for a claimant?

JRs

200

What should you review before extending a rental for a claimant?

The estimate, estimated completion date if known

300

V1 has been at the NPS for 40 days. Peter Policyholder calls you to check on the status of his estimate. You notice Amy Associate noted that she set up a staff GV but there is nothing footprinted in the FH and MAX does not show any assignment has been sent. NI rental benefits are expiring tomorrow. What should you do?

Send Hope a FN to review for XR

400

NI has R1 50/1000 on their policy. They were involved in a collision loss. Amy Associate states she cannot set up a rental reservation for this claim due to a coverage issue. What issue might Amy be noticing?

*1 Vehicle

500

The claimant has been in a rental for 70 days and we have an extension request. V2 is non drive due to a parts delay. How should you proceed? Give an example of what you would say

Terminate rental

Storage

100

What items need to be entered in order to run RPT

body type, drivable, damages, airbag, liability for claimant

200

What steps should you take if NI is refusing our salvage process and wants to use their NPS where V1 is currently located?

Set LDS, send mitigation letter, set up inspection

300

Loss occurred on 5/10 and was reported the same day by AO. Vehicle location is unknown. NI is calling back today to inform us that V1 is non drive in storage. NI wants to have vehicle moved to SS. Storage fees are 2.5k. No one has tried to contact NI. LDS was not set. No mitigation letter sent. Will we pay for the storage?

Yes, as long as fees are reasonable

400

When should you escalate a claim due to storage fees?

If fees are unreasonable

500

V1 is currently in storage. It is showing as repairable. What steps should you take to set up an Agero tow other than filling out the template?

Obtain storage fees and update Agero additional comments. Consider approving additional fees to allow for handling

QFC

100

You just completed a QFC with the NI. You were able to establish liability against the NI. What is your next step once the call is complete with the NI?

Call the claimant

200

Claim was repoted by “insured”. FOL state “Accident with another vehicle”. Pending calendar states “QFC 2nd attempt”. You receive an inbound call from NI and she is returning a missed call from SF. What should you do?

Obtain FOL, do not complete a QFC

300

You just completed your second QFC attempt with the NI. They did not answer and liability is still pending. What are your next steps?

Call every number

Send a Contact Letter: If pending indicates E-Mail is preferred method, send via E-Mail

• Insured or Claimant:
  • FC0016855 / FC0016918 (Sp.)

Claim Associate: Set 2 day Super High CR calendar. Contact the State Farm Agent for the insured, notify them of the claim being presented and advise that we have not been able to make contact with policyholder.

400

Lindsey Smith is calling in about an accident in which she was the driver of her mother’s vehicle which is V1. The claim was reported by the claimant. You check the policy’s listed drivers and the only drivers are Ann Smith and Terry Smith. How should you proceed?

Verify insured

iver is:

• Unlisted Driver – Contact the NI directly to verify the following:

Did the DD have permission to drive the insured vehicle?If Yes,

Proceed to next question

If No,

Claim Associate: Proceed to Reassign to Property-Complex

Claim Specialist: if unable to confirm proceed to Coverage Issue/Question 

Were there any restrictions placed on the use? 

If Yes,

Claim Associate: Proceed to Reassign to Property-Complex

Claim Specialist: if unable to confirm proceed to Coverage Issue/Question

If No, Proceed to next question

 Does the DD reside primarily with the insured (or have regular use of the vehicle)?

Note: Regular use is defined as once or more in a typical month.

Document current address of DD in MAX/ECS and  proceed to next question Is the DD related to the FNI/NI?If Yes,

update DD participant information accurately in ECS/MAX and complete Verify Driver flow in ECS/MAX.  Update Resident Relative fields. Does the DD have their own Auto Insurance Policy? 

500

V2 rear ended V1. We just completed a QFC with NI. His coverage is as follows. A 250/500/100,P37/1,000 50,D1000,G1000,H,R1 50/1200,U. Explain his coverage to the NI

Explain liability, collision, rental