WPS 30/60
Which Lifecycle should we be utilizing in our CHIP when working our 30/60?
COL Lifecycle
Investigation- Within what time frame should New Claims be worked? (SLO)
1 Day- 24 Hours
How can we identify damages/exposures early to resolve claims?
In the Injury Segment- which line has the opportunity to recover the most money through Subrogation? First party or third party and why?
First Party due to the negligence being solely on the Tortfeasor, depending on the Negligence Standard of the venue- First party has the opportunity to recover money that we did not owe from the Uninsured/Underinsured Tortfeasor's.
Which 3 buckets should we be reviewing in our CHIP COL Lifecycle?
Evaluation, Negotiation, and Other
What should be completed in a QFC? What is explained etc.?
Same day verbal contact, Explanation of benefits, set expectations, gather injury information, evaluate for prompt resolution, update IED, OBC/QFC category FN)
In your IED, where should your Benchmark total be reflected?
Specials/Treatments Tab
What is in alternative dispute resolution in Subrogation?
Arbitration
How many days should our Evaluation bucket be within?
60 Days
If a direct Insured does not answer on the contact attempt for a QFC, what letter should we send?
FC0010198 - BODILY INJURY REQUEST FOR INFORMATION STATUTE OF LIMITATIONS
What is the goal for our DID and what commitment is this keeping to our Policyholders?
At or above 50%-
Our Commitment states that we will:
Communicate with and be responsive to inquiries from insureds and their attorneys by promptly responding to communications
You receive a notification from E-Subro Hub or Arbitration Forums- what team do you assign to address?
DSA- Defensive Subrogation and Arbitration
How many days should our Negotiation bucket be within?
30 days
When you receive a New Claim re-assignment, what are the first things to confirm in first party?
Liability and Coverage Analysis
What letters should go out in our TM's name?
Denials/Disclaimers, IAL's, and ROR's
If a supplement(second) payment has been made on a claim, what template should we be sending to the Sub Claim handler?
Additional Subrogation- File Note Template 152
When following up on claims- what should we be doing?(Not a specific answer)
Reviewing what is needed to move the claim forward. Status letter, follow up call, missing a MB?
When you receive a Demand, what are the expectations?
Acknowledge the demand timely, Input into Demand Management accurately, Run your Demand through the UM/UIM Launcher, Set a follow up date prior to the due date or 30 days, and if time permits- begin your evaluation.
Why is an ISO search important when completing your IED?
W/C claims, Priors, potential fraud
What information is needed for the Tortfeasor/Claimant prior to sending to Subrogation?
Full Name and Address. If there is a phone number and the claimant is not represented, attempt contact to obtain.