CWOP Basics
What does CWOP stand for in property claims?
What is Closed With Out Payment
What part of the policy defines what we cover and what is excluded?
What are Perils Insured Against and exclusions
A claim is denied, but the customer provides new photos. What should you do
What is reopen the claim file, and review all new information as a part of the ongoing investigation, set expectations with all parties and document findings in the claim file and verbally with the insured.
What is positive positioning?
What is Framing information in a way that highlights what we can do, rather than focusing on what we can’t.
Name two types of CWOP claims?
What are withdrawn, under deductible or denied claims?
True or false: Plumbing and pipes are never covered in a water loss?
False - pipe breaks due to freeze are covered as sudden and accidental losses.
A customer files a claim and that claim has just been assigned to you, what are your first steps in your initial claim review?
Review prior losses, if there are prior losses with us, you must be in the claim file and rule out any potential for unrepaired damages.
Review ISO and contact/document any attempts to gather information from a prior carrier
note this in a loss history note prior to a MIC
What’s one thing you can do to make a customer feel heard during a difficult conversation?
What is acknowledging the customer’s situation and express understanding before explaining the decision.
What is the key difference between a denial and a withdrawn claim?
A Denial would include a complete investigation and a result of a loss not covered by the policy
What are specific state documents associated with some policies and why is it critical to review them before making a coverage decision?
What are Special Provisions - they overwrite and change coverage sections in the standard policy in some cases and must always be reviewed prior to making a coverage decision.
The cause of loss is a drain line clog located in the front yard of an insureds home, there is resulting damage to the dwelling due to the water backup from the clog. The insureds do not have a backup endorsement - what key items are critical to document in the file before granting coverage?
-verbal or plumbers report outlining the on premises clog
-timeline of when it happened to rule out seepage
-water process task sent to People Leader
Name a phrase that helps soften the impact of a denial.
What is “I understand this may not be the claim outcome you were hoping for…”
True or False: A claim under deductible is considered paid
False
What type/topic note called which is viewable to our agency partners
What are ROC (record of contact in/out) notes
How can you use active listening to improve the customer experience?
What documentation is essential when issuing a CWOP decision?
What would to effectively review and cite the policy and attribute any photos, statements, invoices back to the language which would deny coverage.
RORs early in the investigation are usually needed, and an accurate, quality denial letter with claim file notes of verbal contact to all insureds and agents on Safeco claims.
What section of the policy outlines the insureds responsibilities when filing a claim which could impact coverage? This section also outlines an action the insured can pursue incase of a settlement or coverage disagreement - what is that called?
What is the conditions section and what is the Appraisal process
A customer reports minor water damage below the deductible from w/t to a pipe with no seepage. What’s the appropriate CWOP type?
What is a partial denial, under deductible (deny the pipe and be under deductible for the covered resulting damage). All would result in a CWOP claim.
Name one thing you can say to show positive positioning on a call.
What is "While this particular damage isn’t covered, I can walk you through the next steps and resources available to you.”