The adjuster or the claim representative has the following responsibilities in the processing of a claim which are as under: -
· To respond promptly to the submitted claim
· To obtain adequate information
· To properly evaluate the claim
· To treat all parties fairly.
Respond Promptly to the Submitted Claim
When a claim is reported, the claim representative need to respond to the claimant and guide him in a manner which shall facilitate claims process. He should empathically, that in the event of a claim, the loss experience might have been painful, frustrating, agonizing, or even embarrassing.
Obtain Adequate Information
Next in the process is to obtain adequate information pertaining to the claim to enable its processing. A claim representative must verify whether the claim is covered under the insured’s policy. If a question of coverage exists and insurer wishes to investigate, then a reservation of rights letter might be sent to the insured.
A reservation of rights letter is a notice sent by the insurer to an insured advising that the insurer is proceeding with investigation of a claim but that the insurer retains its right to deny coverage later.
A reservation of rights letter serves two purposes:
· To inform the insured that a coverage problem might exist
· To protect the insurer so that it can deny coverage later, if necessary.
Properly Evaluate the Claim
Valid and accurate information enables the claim representative to evaluate the claim. This evaluation hinges on two critical elements of the claim handling process:
· Whether the claim is covered according to policy provisions
· If the claim is covered, the dollar amount payable under the policy.
Treat All Parties Fairly
Throughout the claim handling process, the claim representative must remember that a loss often produces strong emotions. Hence, he should ensure that those losses which are covered as per the policy provisions are promptly and quickly paid and vice versa.
CHAPTER: 6 CLAIMS
