Scenario A
Claimant report a collision claim. When the adjuster spoke with the insured, they claimed the vehicle and driver were unknown to them. A police report was filed and reviewed by the adjuster.
Claim was not referred to SIU. The vehicle and driver information was updated based on the police report as 3PC reported incorrectly. The police report was utilized to place the insured at the scene.
INSD reported that their vehicle was stolen, policy is 6 days old, large gap in coverage with prior carrier, application showed no prior losses and ISO shows 6 since 2016.
This claim was accepted by SIU due to DOL to policy inception, lapse in coverage and potential material misrep
INSD reported claim, no Collision. Collision/Comp added and tried to change FoL to Comp loss. Referred and accepted by SIU. Vehicle is already at the shop.
What do you do next?
Call the shop to stop repairs.
Wait for SIU investigator to complete investigation.
The insured reported a Comp loss for wind damages from debris being blown into the insured vehicle. The policy is new, the claim was reported 45 days late, and the adjuster found numerous deer hits in 2017. The insured also is claiming hail damages as additional damages.
This claim was referred to SIU, but then declined. The previous Comp claims were not for the same FoL. The hail claim needs to be filed as a separate claim.
NSD claims his car was side swiped after making a right turn. Claim reported 7 days after DOL, New policy, new vehicle, CSW notes indicated financial hardship and after speaking with a detective we confirmed that we were given the wrong DOL
SIU declined the referral as the actual DOL had been confirmed by CR's investigation and a coverage decision was just needed.
The INSD is in a rental vehicle during the investigation. The INSD ends up withdrawing the claim due to the SIU investigation.
Who handles the rental, and what should be done next?
The rental needs to be stopped her SIU investigator disposition/recommendation.
Communicate ending the rental with the customer and the rental company.
The CLMT reports that the INSD rear ends the CV. INSD claiming front end damages, CLMT claiming rear end damages. Police Report filed. You see that the DoL and the Policy Inception date are the same. Policy is new, first year, and same day as the loss. You run ISO and find no prior hits.
SIU referral! Even without prior hits, we need to ensure that the loss happened while the policy was in effect at the time of the loss, not just the date.
The INSD is reporting a hit and run on his parked vehicle. Claim reported 10 days after the DoL. After running ISO, no hits for prior claims. Vehicle Sightings had no hits either. Police Report filed and supports damage to the d/s door & window, and mirror. INSD also claims a rusty front fender at the GRN.
SIU referral! Even with damages supported by a PR, some of the damages may not be related. Rust usually takes a long time to develop.
Make sure you get the RNS involved!
A claim has been accepted to SIU. You stopped repairs. The customer calls you to ask why the repairs were stopped.
What do you say to the customer?
Advise to the customer that another adjuster is helping you with the claim.
Let the customer know to speak with the other adjuster. Provide the name and phone number.
Tell the customer that coverage is still being confirmed by the other adjuster.