Coverage Basics
Confirm permissive use, confirm any other insurance, review policy.
What type of losses require recorded statements?
All except simple rear end accidents.
You just sent an LLR on a file, should you upload the referral into the claim file?
No
You receive a transferred claim with a DOL 9/20/24 and in review of liability there were no documented attempts to obtain a statement from claimant and witness. What are your next steps?
Call and request statements from both parties and document all attempts.
If handling CRS identifies a coverage issue, they handler must first to do this a manager and then complete this formal request.
Discuss with CM for authority and then request coverage opinion.
You receive a vendor estimate for an accident recon for $6,500.00, what do you do next?
Document the necessity of said recon and what it will be used for in the claim file and obtain authority from CM.
It is important to run the following when you are investigating potential other coverage for the tortfeasor.
Asset check and carrier discovery (for driver/owner and vehicle).
You receive a new claim, when is your BI Initial Analysis due?
Within 30 days
What questions would you ask an insured to confirm insured's reason for operating auto?
Were you in the course and scope of employment?
(example, delivery, door dash etc)
When analyzing liability what are the elements of negligence to consider?
Duties Owed (ex. yield ROW, maintain proper lookout), Duties breached and proximate cause
You receive a new 1PCO claim, upon review the insured has a 5th car policy that does not list UM/UIM, what are your next steps?
When you have a claim such as a fatality, it is important to preserve vehicle for potential inspection, how do you do this?
Request seller hold be added by PD adjuster and confirm it was completed.
Our insured's friend was operating our auto at the time of the loss. She did have permission to use the vehicle, what are the next steps in your coverage investigation?
Obtain friend's insurance information, open claim, request policy language, obtain priority of coverage agreement with other carrier.
You have completed your investigation and concluded the insured is not at fault, what are your next steps?
Contact insured, claimant/claimant's attorney, send written correspondence with reasons for denial.
It is important to obtain this document when you have a claim between a tenant and homeowner.
Lease agreement
Your insured was charged with a DUI, what do you need to obtain to help with your investigation?
Recorded statement, prior DUI history, BAL, and discuss with insured's criminal attorney to determine charges and how they intend to plead.
You receive a demand that alleges punitives in a state where punitives are not covered in our policy, what should your next course of action be?
Order complete policy (need it to confirm all endorsements), review policy language, complete ROR and discuss with CM if necessary.
You receive a new intersection loss that is currently word vs. word. What tools/steps can you use to continue your investigation?
Street delivery (intersection photos, light sequencing)
Canvas surrounding businesses yourself for potential video or request via vendor if necessary
Request Open records
You receive a new claim with a dog bite, what are your next steps in your coverage investigation?
Order full policy (to confirm if dog was disclosed at inception of policy), obtain recorded statement from insured, confirm background on dog, how long insured has owned dog and any prior aggression/incidents and confirm breed/photo of dog.
You receive a claim of a slip and fall within the insured's home on their staircase, what are your next steps in your liability investigation?
Obtain r/s from all parties, obtain photos of loss location, if necessary send vendor for measurements and code compliance.