ADMIN/LETTER REQUESTS
NF4 IS SENT TO THE HOSPITALS AND NF3 IS SENT TO PROVIDERS. TRUE OR FALSE?
TRUE
WHAT DO WE NEED TO UPDATE IN CLAIMPRO IF THE FILE OWNER HAS NOT & WE HAVE REVIEWED THIS INFORMATION FOR SUBRO PURPOSES?
LICENSE PLATES / VEHICLE INFORMATION
WHAT ARE THE BIG 3 FOR COVERAGE IN PIP?
IV / DWI / WC
WHAT SHOULD YOU REVIEW AND DOCUMENT FOR CVQ "PRIOR LOSS HISTORY/ ANOTHER LOSS FOR VIN"
REVIEW AND DOCUMENT PRIOR LOSS HISTORY / CHECKING FOR PRIORS WITH PIP OPENED
NEW LOSSES NEED TO BE WORKED ON THE SAME DAY THEY ARE ASSIGNED. TRUE OR FALSE
TRUE: REVIEW AND CALLS NEED TO BE MADE SAME DAY
WE CAN SEND AN NF4 TO THE AMBULANCE AND URGENT CARE. TRUE OR FALSE?
FALSE ; YOU WILL ONLY SEND AN NF4 TO AN EMERGENCY ROOM FACILITY
100% LIABILITY ON IV MEANS THERE IS NO OPPORTUNITY TO SUBROGATE. TRUE OR FALSE?
TRUE ; WHEN IV IS 100% AT FAULT WE CAN R/O SUBRO AUTOMATICALLY
IF LIAB IS 0% ON IV, WHAT COVERAGE CAN WE RULE OUT AUTOMATICALLY?
DWI: WE DO NOT HAVE TO WAIT FOR ER/PR IF LIAB IS 0% ON IV
ILR COMPLETED, YOU CONFIRMED CIO ON CLAIM & YOU IDENTIFIED AN OPPORTUNITY FOR FAST TRACK.
WHAT TEMPLATES SHOULD YOU FILL OUT AND WHAT DOES THE DIARY TO YOUR LEADER LOOK LIKE?
ILR / SUBRO / CIO / FAST TRACK
CAN DO 1 DIARY "AUTH ILR / CIO / FT"
2 WEEKS
WHAT INFORMATION DO YOU NEED TO PUT IN A LETTER TEMPLATE?
NAME OF INJURED PARTY
NAME OF LETTER
NAME AND ADDRESS OF RECIPIENT
IF WE DO NOT HAVE A WAY TO OBTAIN THE LICENSE PLATE FOR A VEHICLE - WHAT IS A RUN WE CAN DO TO OBTAIN IT?
DMV
WC RULED OUT - NOD WAS DRIVING TO WORK FROM HOME AT TOL.
DO WE HAVE ENOUGH TO CLEAR WCOMP?
NO; IF THERE IS A WORK COMMUTE INVOLVED, WE NEED TO CONFIRM WHAT THEY DO FOR WORK, TRAVEL / MILEAGE REIMBURSEMENT
IF WE HAVE EMS AT THE SCENE BUT NO ER TREATMENT OR FOLLOW UP. WHAT CAN WE DO WITH THIS PIP FEATURE?
FAST TRACK - FILL OUT THE TEMPLATE AND THEN SEND AUTH TO YOUR SUPERVISOR
IF YOU DO NOT HAVE COVERAGE IN ORDER DURING YOUR ILR , WHEN SHOULD YOU FOLLOW UP WITH THIS CLAIM ON COVERAGE?
2 WEEKS: IF AT THE 2 WEEK FOLLOW UP YOU DO NOT HAVE CIO, YOU WILL FOLLOW UP EVERY 2 WEEKS UNTIL CIO !
WHAT INFORMATION DO YOU NEED TO ORDER A POLICE REPORT?
POLICE DEPARTMENT
POLICE REPORT #
LICENCE PLATE AND/OR VIN
CAN WE SUBROGATE ANYONE FOR A SINGLE VEHICLE ACCIDENT DEER HIT?
NO - WE CAN AUTOMATICALLY RULE OUT SUBRO HERE
100% LIAB ON IV
SVA , ER VIA EMS
PR NO CITATIONS
CAN WE RULE OUT DWI HERE?
NO: WE WILL WANT ER RECORDS TO RULE OUT
YOU COMPLETED THE COVERAGE IN ORDER TEMPLATE BUT YOU NEED AUTH FROM YOUR SUPERVISOR. WHAT SHOULD YOUR BT LOOK LIKE?
BT TO NO - "CIO PENDING AUTH"
IF ONE OF YOUR CLAIMS HAS AN ADDITIONAL PERSON INJURED; YOU WILL GET THE NEW PIP FEATURE ASSIGNED TO YOU & YOU ARE EXPECTED TO WORK IT THE SAME DAY. TRUE OR FALSE?
TRUE: THAT WILL BE A NEW FEATURE COUNTED TOWARDS YOUR DAY. TO GET CREDIT SEND DIARY TO "FEATADD" - "PIP FEAT #_"
WHAT DO YOU WRITE IN THE ADDITIONAL INFORMATION SECTION WHEN SENDING OUT A LETTER?
DEPENDS ON THE LETTER
NF3&NF4 - NOTHING
ADDITIONAL LETTERS - WE WILL CHECK STEM FOR WHAT IS NEEDED
IV 0% AT FAULT. CV IS A HEAVY TRUCK OVER 6500. NOD IS SORE BUT EMS DID NOT CHECK THEM OUT & NO TXT FOR MVA. SHOULD WE REFER SUBRO?
NO - THERE IS NO EXPOSURE , NOTHING PAID OUT TO BE SUBROGATED
IV 60% LIAB
CV 40% LIAB
LANE CHANGE ACCIDENT
NOD WENT TO ER VIA EMS - BILLS NOT IN YET
F/U WITH CHIRO - BILL IN MDP
PR - NO CITATIONS FOR DWI
CAN WE RULE OUT DWI HERE WITH JUST PR ?
POTENTIALLY YES; THIS IS THE SCENARIO OF GRAY AREAS THAT YOU WILL REVIEW WITH YOUR SUPERVISOR
IF THE CV ALSO HAS PROGRESSIVE , WHAT SHOULD YOU DO DIFFERENTLY WITH YOUR INITIAL LOSS REVIEW?
REVIEW THE DUAL CLAIM FOR INFORMATION PERTAINING TO YOUR PERSON.
2 WEEK FOLLOW UP
IF ON GOING TREATMENT CONFIRMED NEXT STEP IS ____. IF EIP HAD TREATMENT BUT NO FOLLOW UP IS CONFIRMED NEXT STEP IS____.IF NO EMS AND NO TREATMENT CONFIRMED, NEXT STEP IS ____.
PMMR
FAST TRACK
CLOSE PIP