Preparation
Why is it important to prepare?
To deliver the most advanced claims experience.
What is the primary point of verification?
Last 4 of the SSN
What tab do you use in Next Gen to update injuries?
Participant Details, Injury & Compensation
5 ISO data elements:
Legal first name and last name, DOB, SSN, home address, and legal gender.
What does a red ambulance icon mean?
Potential for BI, further investigation is needed?
Review FOL and statements; Check to see if you agree with _______ or if _______ is need.
Liability, Further Investigation
If primary verification is not available, how many secondary verification points are required?
2.
What constitutes an Injury?
Specific body part, Related to the accident, specific complaint. Ex, soreness in right shoulder and upper arm.
Other than confirming ISO data points and liability, and updating injuries/treatment, what information should you obtain from the injured party?
Wage loss information.
What does a zero by the insured's name mean?
Insured is potentially 0% liable.
5 key items to review prior to initial contact.
Coverage, Is it proper?; Liability, Do you agree?; Cross Insured, Injury and treatment information, Potential wage loss.
What should be expressed during all calls with injured/affected parties?
Empathy
What is the primary injury type dealt with in Moderate Unrepresented claims?
Soft Tissue
How often should we check for information retention?
Every 3 info points.
Where is the injury segmentation information located?
On the BI coverage tab, under assignment strategy.
What 2 tools can be used to review FNOL and previously obtained statements?
LAT and Digital Claim File.
What is the required disclaimer script for all calls?
Just so you know, this call may be recorded or monitored for quality assurance and claims handling purposes.
True or False; Anxiety about driving qualifies as an injury.
False.
What should we provide at the end of the initial call?
Contact information/mailing address, claim number, next steps.
When reviewing coverage, where would you find the Declarations Page?
Click the policy link, under Policy Documents tab.
Three questions used by the adjuster to prepare for initial contact.
Know, Need, Ask
If unable to authenticate the caller, what should you say?
(Caller's name) I'm sorry, but I am unable to verify your involvement in this claim, therefore I cannot discuss claim details with you. Please contact me when you can provide the information we discussed and I will gladly answer your questions.
CLMT rear-ended INSD and is complaining of acute lower back pain that she did not experience prior to the accident which was diagnosed as a muscle strain by her PCP, and she has been treating with chiro. Is this covered?
No, the INSD is not the liable party.
What should we be building with every contact?
Rapport.
To what do you associate a guardian on the claim tree, if they are not otherwise involved in the loss?
Directly to the minor they represent.