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Last Post 06/18/2008 1:57 PM by  Ray Hall
Slow Action on Claims
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cowboy26995
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06/18/2008 12:12 PM

    Regulators Top Insurer Beef: Slow Action On Claims

    BY PHIL GUSMAN
    NU Online News Service, June 17, 3:32 p.m. EDT


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    Two failures--to respond quickly to claims and to file appropriate information--are high on the list of insurer compliance misdeeds seen by regulators, according to a study.

    The finding was made by Wolters Kluwer Financial Services, which ranked the top 10 gripes of the nation’s state insurance officials.

    Wolters Kluwer—which describes itself as a provider of compliance, content, and technology solutions and services—said it reviewed last year’s market conduct exams from across the country and arranged its list based on areas receiving the most criticisms.

    The top 10 most common market conduct compliance criticisms for property-casualty insurers, according to the company, are:

    • Failure to acknowledge, pay or deny claims within specified time frames.

    • Failure to properly terminate a policy, including inadequate days’ notice and omitted required language.

    • Improper documentation of claim files.

    • Using unapproved or unfiled rates and/or rating errors.

    • Failure to provide required disclosures, such as reasons for denials and bill of rights in the claims process.

    • Failure to provide notification of producer appointments or terminations.

    • Improper documentation of underwriting and policy files.

    • Failure to communicate a delay in the settlement of claims in writing.

    • Using unapproved or unfiled forms.

    • Failure to produce requested records for an examination.

    Kathy Donovan, Wolters Kluwer manager of government relations for insurance compliance solution, said in an interview that many problems on the top 10 list could be mitigated by companies keeping better documentation of underwriting and claims files.

    She said that keeping more complete records would also help companies more easily produce the appropriate documentation during insurance department exams.

    “We’ve seen a lot of consistency across the states and across company exams where companies are unable to produce the required information,” Ms. Donovan said.

    The problem has more to do with records being incomplete, rather than inaccurate, Ms. Donovan noted. “I think a lot of what happens is that there is a claims file or an underwriting file that doesn’t have everything in there,” she said. “What’s in there is probably accurate, but it’s not complete, and it’s that piece that the examiner’s looking for that is just not there.”

     

    This article is interesting in that the obvious reasons for poor claims services are not examined. Reduced employee training and retention, poor pay and benefits, reliance on faulty metrics account for the majority of the issues raised. Time to take back the claims operations from the bean counters and reinstate claims people.

    Marc Dubois
    Executive General Adjuster
    M.G.D. Claim Services Inc.
    "Your Commercial Claims Solution"
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    katadj
    Founding Member
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    Posts:256


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    06/18/2008 1:24 PM

    Marc,

     

    AMEN, to the last statement.  Perhaps if the companies were handed significant fines for inadequate service, the bean counters would crawl back into their respective pots or cans:

    And the adjuster, who acts in good faith to assist the unfortunate victims of the loss, would be allowed to service the client properly and in turn, retain the client and close the file in the proper fashion.

     

    "Anyone who has never made a mistake has never tried anything new... Albert Einstein"
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    Ray Hall
    Senior Member
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    Posts:2443


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    06/18/2008 1:57 PM

    I have been talking about "triage adjusting" since 2004. It seems many of the catastrophe vendors and the adjusters themselves are resisting changing their ways. This has worked in all private business needing to provide emergency services to the public. Its time for the insurance carriers to switch to triage adjusting..... now....2008.

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