Coverage
In a NY risk/NY loss scenario, if we are the striking vehicle, which coverage is a pedestrian/bicyclist entitled to?
Basic PIP and OBEL
What does PIP Option A include?
$50,000 medical coverage with a $2,000/month work loss, up to $25.00 per day other necessary expenses. ********** NO DEDUCTIBLE **********
In order for a bill to be paid under the No-Fault portion of the policy, What (3) criteria must be met?
1. The injury(s) are related to the motor vehicle accident.
2. The treatment is medically necessary.
3. The healthcare provider is billing in accordance to NYS fee schedule.
What three things should be done when placing a customer on hold?
Ask the customer permission to place them on hold, explain the reason for the hold, and thank them for holding
A police report was received with an interested party that is not listed in ATLAS. What page in ATLAS can you add the interested party to the claim?
Parties Involved
On your newly assigned claim the injured party has soft tissue injuries. The coverage on the policy is PIPA, APIP, and Med Pay 5K. There are no coverage issues. Which exposure and reserve line should be opened at the start of the claim and why?
PIP -Basic PIP – Medical Expense - since the injuries are soft tissue and there is no coverage concern.
What does PIP Option J include?
$50,000 medical coverage and up to $25 per day for other necessary expenses with work loss exclusion for the named insured ONLY and ********** $200.00 DEDUCTIBLE **********
How long does an injured party have to send in the NF2 form?
30 days.
What is the maximum amount of time an FPM adjusters can keep a phone call on hold?
3 minutes
When adding a Chiropractic Office as an AP under New Associated Party which relationship are they added as?
Medical Related: Medical Facility
The ____________________ and ____________________ are responsible to pay the $200 deductible on PIP Option B policies.
named insured/co-insured; resident relatives
What does PIP Option I include?
$50,000 medical coverage and up to $25 per day for other necessary expenses with work loss exclusion for the named insured ONLY. ********** NO DEDUCTIBLE **********
For what coverage do we send out the NF 13 form?
OBEL
Based on the Verification matrix, if Medical Provider who is treating our injured Named Insured calls, obtaining which of the below pieces of information would properly verify the caller
Callers Name, Name of Company, Full Name of the IP and Claim Number
Where would you go to request Advanced Authority?
Financials Page
What claim scenario listed below would an injured party be excluded from PIP Benefits?
a) Policy Cancellation
b) Occupant of a Motorcycle
c) Operating a Motor Vehicle in a race or speed test
What does PIP Option B include?
$50,000 medical coverage with a $2,000/month work loss, up to $25.00 per day other necessary expenses and ********** $200.00 DEDUCTIBLE **********
What is in an NF10?
Denial of Claim Form
A customer is requesting an email containing the GEICO P.O. Box information to mail in a copy of a bill containing injury information. How should the adjuster handle this request?
Send an email through Letters in ATLAS
What reserve line should be opened if the claim has fatal coverage condition codes listed in ATLAS?
No Coverage PIP- Loss
A GEICO insured vehicle strikes a pedestrian who has a valid Allstate policy. Who is primary for the pedestrian's PIP coverage if the loss occurs in New York?
GEICO
What does PIP Option 12- MOTORCYCLE POLICY include?
$50,000 medical coverage, $2,000/ month work loss, and up to $25 a day other necessary expenses for those struck by the motorcycle and OBEL option of $25,000.
How long is MEDPAY good for?
1 year from the date of loss
Our named insured called in requesting information. What is the combined payout for a PIP Option A policy that has exhausted, when there has been a fatality?
$52,000
The Desktop at the top of your ATLAS window will display:
A list of standardized activities and mail entries assigned to the adjuster specifically