Coverage
When is it OK to RPO a file?
When the insured is Not At-Fault, no Coverage Issues, no injuries and not filing for damages through their policy.
Which parties do you call when you resolve liability?
All owners and drivers involved and Adverse Carrier.
What is the last thing to do after setting up an inspection?
H/C
What 3 questions do we need to ask A/C when we speak to them?
Coverage decision, liability decision, advanced ded?
The department of transportation sent us a demand. What tab do you use to assign their demand for review?
Demand summary
What are all the next steps to resolving a CC99?
Verify the date of loss and verify the payment for the policy with Edge. Call all parties and handle damages.
In what situations do you need to fill out CIQ completely?
When we are investigating liability – dispute, shared negligence
Name 3 reasons why ARX is the best choice.
Repairs started same day, lifetime warranty, certifications of technicians, rental is waiting, one stop shop, priority service, etc.
You hit get next and receive an activity labeled “PRU – Arbitration Decision Published”. What are your next steps?
1.Reassign the activity to the PRU Arb Responder
1.To find who the arbitration responder is, look in Notes for an entry that starts with "*ARB" or "Your response for <Arbitration Case Number>"
2.DO NOT COMPLETE THE ACTIVITY
1.Arbitration Responders will review the arbitration decision within 21 days of the published decision date, looking for appeal opportunities. Then they will paste a decisions template into Notes.
3.Note the File
4.Review all other handling on the file:
1.Review the Navigator Task Guide, as you go, to ensure completion of tasks
2.Review TIP Guidelines to ensure appropriate Interested Parties are contacted
3.If not already set, perform a Basic Liability Investigation
4.Follow all necessary steps to resolve any outstanding Coverage Conditions
5.Verify all exposures are HC'd if possible; review When to Handle Complete
You receive the activity titled “E-sub Hub: Demand for Responder”. How do you handle it?
1.Review Liability
1.If not resolved, follow Basic Liability Investigation
2.If resolved, move on to step 2
2.Review Coverage Conditions
1.If CC exists, follow Coverage Condition Handling
2.If resolved, move on to step 3
3.Review Paycode
1.If bad paycode, review claim to resolve
2.If good paycode, move on to step 4
4.Review Demand Assignment Guide (SRT)
1.Determine if file will be auto or manually assigned and take action per guide
2.If claim does not auto-assign and ALSO doesn't meet the criteria for manual-assignment, then please go back to steps 1, 2 and 3
5.Link documents for all manually assigned claims
6.Note the claim
You have a CC33 that does affect our claim handling but there is nothing to verify the date of loss, what is your next step?
Send an SIU referral, set up a bad paycode inspection.
An insured tells you that there was damage to their vehicle caused by a shopping cart that got blown into it on a windy day. What is your liability decision?
Comprehensive
When is it ok to set up a field inspection?
When damages indicate a non-drivable vehicle and ARX/EPE/VIC are not options
We have accepted 75% liability, but A/C is on your phone asking if you can agree to 80% since they have accepted 20%. Where do you look to see if you can do that?
Claim IQ
A/C demanded 11,344.86 in their subrogation demand. SRT approved 10,767.81. What is the amount that you will be issuing in payment to A/C.
10,767.81
The named insured says their daughter, who you confirmed lives in the house, did not have permission to drive their vehicle. How do you handle the permissive use CC?
Clear the CC and advise all parties of the next steps.
You pull the activity “Unresolved Liability Pending More than 6 Days” by hitting get next. Explain what you do to handle this activity.
1.Review the Navigator Task Guide, as you go, to ensure completion of tasks
2.Review TIP Guidelines to ensure appropriate Interested Parties are contacted
3.If not already set, perform a Basic Liability Investigation
4.Follow all necessary steps to resolve any outstanding Coverage Conditions
5.Verify all exposures are HC'd if possible; review When to Handle Complete
A customer is calling about a rental extension, what do you tell them?
Let me get you in touch with your AD/PD
How do you handle an Arbitration filed activity?
Template in notes, open inter-company arb
Name 3 reasons why SRT would NOT issue a payment after their review.
Bad paycode, CC pending, arb filed, 1st party claim, not 100% liability, more than 1 PD exposure, PD limit > 5k, payment exceeds limits
Name all the documents needed to submit a CPW for a CC31/34.
PORS, CANS, Coverage RI, ROR's, Something to verify DOL, LH term if applicable
Pretend I’m a customer and explain word vs. word to me.
Both parties have different FOL that do not match, no evidence to prove liability, both parties take care of their own damages, no recovery for either
Explain to your customer what happens after you schedule their EPE.
You receive link, follow the link and the directions to take pics, you receive estimate/payment and take to BSOC.
Your supervisor just told you to tell the insured that we will file arbitration and explain what will happen. What do you tell the insured?
We need an RI and any evidence we can provide. A/C will also do this and a third-party insurance company will make a final and binding decision about liability.
You receive a call from Enterprise who wants to go over differences between their demand and what we approved. Who talks to them about that?
I do