Top 5 Pet Claims

The most wonderful time of the year is also one of the most dangerous for pets. In order to assess the impact of the holidays on pet health, Veterinary Pet Insurance Co. (VPI), the nation's oldest and largest provider of pet health insurance The company found that last year more than 200 policyholders spent Christmas Day at the veterinarian's office—most with pets receiving treatment for accidental injuries or dietary indiscretion.

The top five Christmas Day claims of 2008:
1. Gastritis/Enteritis
2. Lacerations or Bite Wounds
3. Soft Tissue Trauma
4. Foreign Body Ingestion
5. Chocolate Poisoning”

Christmas Day is the last day most pet owners want to spend at an emergency clinic with a sick or injured pet," said Dr. Carol McConnell, vice president and chief veterinary medical officer for VPI. "Fortunately, many of the claims we receive for conditions treated on Christmas Day can be prevented.

The data, mined from more than 475,000 VPI-insured pets nationwide, reveals that claims treated on Christmas Day skew towards accidents requiring emergency treatment, perhaps because most regular veterinary clinics are closed on December 25. The other 364 days of the year, claims for medical conditions such as skin allergies, ear infections and urinary tract infections prove far more common than claims for the majority of conditions treated on Christmas Day. Only gastritis/enteritis ranked among the top 10 medical claims received by VPI in the full year of 2008. Other claims submitted with a December 25 treatment date included claims for broken bones, gastric torsion, gastric ulcers, torn nails, allergic reactions and cruciate ruptures.

PROPERTY CLAIMS TIP: ARSON

A property claims professional should always be aware of the indicators of an arson fire. The main elements of an arson fire investigation revolve around motive, opportunity, and an incendiary fire.

These indicators should help isolate those claims which necessitate further investigation. No single indicator by itself is necessarily suspicious. Even the presence of several indicators, while suggestive of possible arson, does not mean that arson or fire related fraud has been committed. Indicators of possible arson are not evidence that arson has occurred.

General indicators of arson or fire-related fraud include:

• Building and/or contents were up for sale at the time of the losss
• Suspiciously coincidental absence of family pet at the time of the fire
• The insured had a fire loss at the same site within the preceding year; the initial loss, though small, may have been a failed attempt to liquidate contents
• Building and/or business was recently purchased
• Commercial losses include old or nonsaleable inventory or illegal chemicals/materials
• Insured or insured's business is experiencing financial difficulties
• Fire site is claimed by multiple mortgageesbuilding is in deteriorating condition and/or lacks proper maintenance
• Fire scene investigation suggests that property/contents were heavily overinsured
• Fire scene investigation reveals absence of items of sentimental value
• Fire scene investigation reveals absence of remains of items normally found in a home or business (television, clothes, personal items, business records)
• Fire occurs at night, especially after 11 p.m.
• Commercial fire occurs on holiday, weekend, or when business is closed
• Fire department reports fire is incendiary, suspicious or unknown
  
  

AUTO CLAIMS TIP: INTERSECTION ACCIDENTS

When intersection accidents happen, there is usually a clear reason why. The seasoned auto investigator will often engage in a series of questions to help guide them to the proper conclusion. Most often in intersection accidents the culprit is the result of some very basic breaches of traffic rules. This is not an absolute but the following checklist of investigative items will serve as a good start to investigating an intersection accident. My experience leads me to start with these questions and from there, I will usually probe deeper to get the deciding facts. The list:





Speed
Management of the vehicle
Adherence to traffic signals
Visibility
Obstructions
Weather conditions
Road conditions
Proper Vehicle signaling used
Point of impact
Skid marks
Who had the right of way?
What color was the traffic light for each driver
How big of an intersection
Any drinking or drugs involved
Was any of the drivers sited and if so, why?

Property claims estimating is a challenging and exacting task. Those who have mastered the proprietary software tools are few and specialized. Have you ever wondered what exactly is involved in property estimating software? Well, you are in luck. Claimstrainer has put together several brief training videos to highlight the software features. We also provide a visual introduction to these unique programs. Simply Click on the Link below:

Take me to the software Demonstration

THE 50 STATE INSURANCE DEPARTMENT LINKS

The state department of insurance is a destination that offers consumers, agents and other insurance professionals excellent insurance information. The following list offers links to all 50 departments of insurance.

Alabama Department of Insurance
Alaska Division of Insurance
Arizona Department of Insurance
Arkansas Insurance Department
California Department of Insurance
Colorado Division of Insurance
Connecticut Insurance Department
Delaware Insurance Department
District of Columbia Department of Securities and Insurance Regulation
Florida Department of Insurance
Georgia Insurance and Fire Safety Commissioner
Hawaii Division of Insurance
Idaho Department of Insurance
Illinois Department of Insurance
Indiana Department of Insurance
Iowa Insurance Division
Kansas Insurance Department
Kentucky Department of Insurance
Louisiana Department of Insurance
Maine Bureau of Insurance
Maryland Insurance Administration
Massachusetts Division of Insurance
Michigan Office of Financial and Insurance Services
Minnesota Department of Commerce
Mississippi Department of Insurance
Missouri Department of Insurance
Montana State Insurance Dept
Nebraska Department of Insurance
Nevada Division of Insurance
New Hampshire Insurance Department
New Jersey Department of Banking and Insurance
New Mexico Insurance Division
New York State Insurance Department
North Carolina Department of Insurance
North Dakota Department of Insurance
Ohio Department of Insurance
Oklahoma Department of Insurance
Oregon Insurance Division
Pennsylvania Insurance Department
Rhode Island Department of Business Regulation
South Carolina Department of Insurance
South Dakota Division of Insurance
Tennessee Commerce and Insurance Administration
Texas Department of Insurance
Utah Insurance Department
Vermont Department of Banking, Insurance, Securities and Health Care Administration
Virginia Bureau of Insurance
Washington State Insurance Commissioner
West Virginia Board of Risk & Insurance Management
Wisconsin Office of the Commissioner of Insurance
Wyoming Insurance Department

Auto Liability Claims Tip - Part 2: Vertebrae?

This is part two of the on the injury most often incurred in auto accidents. In this segment, we look closer at the components of the vertebrae. The main weight of the body is carried by the vertebral bodies and disks. The lamina, facets and spinous process are major parts of the posterior elements that help guide the movement of the vertebrae and protect the spinal cord.

Auto Liability Claims Tip - Part 1: Vertebrae?
The most common injury sustained in auto accidents is the Neck/Back injury. Often times this occurs because of a sudden jolt from the rear causing the neck to flex. The muscles surrounding the neck and spine sustain injury because they are strained. More serious Neck/Back injuries involve vertebrae. A vertebrae (plural: vertebrae) is an individual bone in the flexible column that defines vertebrate animals, e.g. humans. The vertebral column encases and protects the spinal cord, which runs from the base of the cranium down the dorsal side of the animal until reaching the pelvis. From there, vertebrae continue into the tail bone. The attached video explains what vertebrae is. This is helpful in handling auto liability claims

Social Media And Insurance Claims

You have doubtless heard of it. You probably have used it. Aside from the chattering
Class, you probably think that social media has little utilitarian value to claims professions. I agree with you. Wait, I just got off of twitter. I changed my mind, I don’t agree with you, here is why – This new social media world of communicating and information sharing is so effective in that it can’t be ignored by the insurance industry, particularly as it relates to the insurance claims business. Think about it, we deal in information and communication. The strong suit of the medium (social Media) is information and communication. What is social media? It is: Twitter, Facebook, MySpace, YouTube and much more. Currently, I am finalizing an eBook on this topic. Thus far, during my research, I have concluded that social media helps us in the following ways:

It allows us to see what our customers are thinking. What do they like and want and don’t want.

It allows us to answer customer questions for customers in a general nature. Note: claims are a litigious business and it would not be wise to share legal-sensitive information that would expose us to unwanted legal exposure.

It helps establish are brand as an exceptional claims organization.

It makes for a positive responsive presence with our customers

It allows claims professional to share information and thoughts on common claims topics

And so much more.

In my eBook, I will go into detail as to how to accomplish the above and provide plausible examples. I will complete the list. I will introduce you to my insurance claims social media vision which will help everyone who services insurance customers.

Thanks – Robert Carper

What is "Combined Ratio" and why should claims people care?

The combined Ratio is important to claims people because it is a measure of success. The lower the better. We contribute to this metric with efficent claims handling. This results in possible financial rewards given the company will make more money with an impressive combine ratio.

The combined ratio in insurance, combination of the loss ration and the expense ratio:
1. Loss Ratio
= Incurred Losses + Loss Adjustment ExpenseEarned Premiums

2. Expenses Ratio
=Incurred ExpensesWritten Premiums

The combined ratio is important to an insurance company since it indicates whether or not the company is earning a profit on the business it is writing, not taking into account investment returns on the premiums received. The property and casualty insurance business sometimes goes through cycles. During the 1980s, for instance, it was not unusual to have a combined ratio of over 120%. Obviously, the difference has to be made up from the company's surplus, which in some instances even put the major companies under severe financial strain.

This metric is useful to determine and compare the profitability between insurance companies. A combined ratio of less than 100% means that the company is profitable, as its premiums earned are greater than its total expenses. For example, an insurer with $800 in expenses and $1,000 in premiums earned has a combined ratio of 80% (800/1000). However, companies with combined ratios over 100% may still earn a profit because the ratio does not account for Investment Income.

Lower combined ratios signal that the company is more profitable than competitors with higher combined ratios.

9 Car Safety Features That Help Minimize Auto Claims
From National Highway Transportation Safety Administration
Whether you're shopping for a used or new car, it's important to spend time making sure it's safe. First off, you should take a test drive and try on the seat belt to make sure it fits well and is comfortable. Check that head restraints, roof structures, and windshield designs don't interfere with your ability to see clearly. And try to conduct your test drive in the evening so you can check the visibility provided by the headlights.

To help you better understand what to look for, click on the following links for descriptions of features:

Seat Belts In the event of a crash, seat belts are designed to keep you inside the vehicle. They also reduce the risk that you will collide with the steering wheel, dashboard, or windshield. New seat belt designs have the following additional features that improve seat belt performance:

Adjustable upper belts. An adjustable upper belt lets you change the position of the shoulder strap to accommodate a person's size. This feature may encourage passengers to wear their belts, since it increases shoulder belt comfort. Seat belt pretensioner.

Pretensioners retract the seat belt to remove excess slack, almost instantly, in a crash. However, you still need to adjust your seat belt so that it fits as snugly as possible, since pretensioners are not powerful enough to pull you back into your seat in the event of an impact.

Energy management features. Energy management features allow seat belts to "give" or yield during a severe crash to prevent forces on the shoulder belt from concentrating too much energy on your chest. These features include "load limiters" built into the shoulder belt retractor and/or "tear stitching" in the webbing that causes the seat belt to extend gradually.

Rear center seat lap/shoulder belts. Some manufacturers provide a rear center lap/shoulder belt. This added feature is especially beneficial to older children and children in booster seats who are often seated in the rear center position.

Air Bags Depending on the speed at impact and the stiffness of the object struck, front air bags inflate to prevent occupants from hitting the dashboard, steering wheel, and windshield. Side air bags reduce the risk that occupants will hit the door or objects that crash through it. Although air bags provide life-saving benefits for the vast majority of people, there are situations in which air bag deployment can have adverse effects, such as when occupants are unbelted. Front air bags do not eliminate the need for seat belts and are not designed to offer protection in rollovers, rear, or side impacts. In fact, maximum air bag effectiveness depends upon seat belts, which help keep you in place should a collision occur. You can significantly reduce the risk of injury from an air bag by buckling your seat belt and keeping about 10 inches or more between your breastbone and the air bag. Children can be killed or seriously injured by an air bag, so you should always put children age 12 and under in the rear seat. You should never use a rear-facing child seat in the front seat of a vehicle equipped with a front passenger air bag unless the air bag is off.

Head Injury Protection Head injury protection consists of foam or other energy absorbing material under the trim of the vehicle interior and is likely to be invisible to vehicle occupants. Some vehicles have head air bags. While all head air bags are designed to deploy in side impacts, some are also designed to deploy during rollovers. Both types of air bags are designed to help protect occupants from injuries caused when their head strikes the upper interior of a vehicle.

Head Restraints Head restraints are extensions of the vehicle's seats that limit head movement during a rear-impact crash, thus, reducing the probability of neck injury. Head restraints meeting specific size and strength requirements are required in front seats, but not in rear seats. While you must adjust most head restraints manually, some adjust automatically with changes in seat position or dynamically in a crash. In general, dynamic head restraints provide the best protection.

Antilock Brake System An antilock brake system (ABS) prevents a vehicle's wheels from locking during "panic" braking, which allows the driver to maintain greater steering control -- a key factor in avoiding a collision. However, an ABS does not guarantee your ability to avoid a crash. Furthermore, you still may lose control when driving at excessive speeds or when using extreme steering maneuvers. Learning to use the ABS correctly will provide you with the greatest benefit from the system. All passenger cars equipped with ABS have four-wheel ABS. Sport utility vehicles, trucks, and vans equipped with ABS can have either four-wheel or two-wheel ABS. Four-wheel ABS monitor and control all the wheels of the vehicle, while two-wheel ABS only monitor and control the rear wheels of a vehicle. Some ABS's also include brake assist, which senses emergency braking by detecting the speed or force at which the driver presses the brake pedal and boosts the power as needed. Under certain conditions, brake assist may reach the braking force needed to activate the ABS more quickly and easily compared with vehicles without brake assist, and can potentially reduce overall stopping distance by eliminating the delay caused by not braking hard enough or soon enough.

Traction Control Traction control systems improve vehicle stability by controlling the amount the drive wheels can slip when you apply excess power. The system automatically adjusts the engine power output and, in some systems, applies braking force to selected wheels during acceleration. Traction control is mainly found in vehicles with four-wheel antilock brake systems.

All-Wheel DriveAll-wheel drive distributes power to both front and rear wheels to maximize traction. Unless combined with traction control, all-wheel drive systems do not prevent the drive wheels from slipping when you apply excess power during acceleration.

Electronic Stability ControlElectronic stability control (which is offered under various trade names) is designed to assist drivers in maintaining control of their vehicles during extreme steering maneuvers. Electronic stability control senses when a vehicle is starting to spin out (oversteer) or plow out (understeer), and it automatically applies the brake to a single wheel. It is intended to reduce the occurrence of crashes in which vehicles veer off the road and strike curbs, soft shoulders, guard rails and other objects that initiate rollovers. However, it can't keep a vehicle on the road if its speed is simply too great for the curve and the available traction.
Weight Crash data show that heavy vehicles offer more protection than light vehicles with the same safety equipment, particularly in two-vehicle crashes.

Nine Claims Speed Reading Tips

Much of our day is spent reading all sorts of claims material. It makes sense to increase our ability to grasp, digest and comprehend the claims material in the most effcient way possible. The following tips will help to achieve this objective.

1. Choose your claims reading material intelligently, efficient reading is the goal


2. Browse the material from back to front as often you will find that you have read it before


3. Read Early in the Day before the phones and emails start


4. Prioritize Your Reading - important claims material should take priority


5. Skim Material First for Main Ideas and preview Topics


6. Consider the digital version (If available) insurance policies are often in PDF format


7. Read in the Proper Environment (Comfort, Lighting, quiet etc.) if available


8. Decide what you want to accomplish by reading this material


9. Enroll in a Speed Reading Class if you have not achieved "The Read Speed" Claimstrainer is currently contructing a online claims speed reading module. Due out 2/12/10

INSURANCE FRAUD PRIMER(Part -1-)
When reviewing a claim, one or more of these indicators may suggest a potential fraud. Indeed, the more you find, the higher the prospect of fraud and the more important it is to investigate thoroughly. Most policyholders are honest, a claim must be given every opportunity to prove itself genuine, inconsistencies naturally surface in a properly conducted investigation.

This series is broken down into the important claims fraud components. I will address each component on a weekly basis. This week I will start with the policy. What does it cover? what does it not cover? Is the person and property covered? Does it fall within the policy period? Have the exclusions and conditions been addressed? and more. The following areas should be addressed (at a minimum) as they relate to the insurance (policy) contract.


Loss within first year (or sooner) of purchase of coverage
Loss shortly before renewal/expiry of cover
Loss shortly after increase in coverage
Notification of claim after policy lapse/cancellation
Existence of multiple policies covering same loss
Premium payment abnormalities
Pre-loss enquiry re cover/claims circumstances
Non-disclosure/misrepresentation
Frequent changes of insurer
Gaps in previous insurance history
Evidence of significant over insurance/under insurance
Policy arranged via agent far away from insured's home
Poor claims history
Claimant appears to be different from policyholder
Questionable use of property/occupation at time of loss
Very knowledgeable about the policy

Time Management Tips For
The Claims Professional
Here are 10 practical claims time management tips by Robert Carper

1. Write things down
A common claims time management mistake is to try to use your memory to keep track of too many details leading to information overload. Using a to-do list to write things down is a great way to take control of your projects and tasks and keep yourself organized. Keep a claims “to-do” list and you will be amazed by the results.

2. Prioritize your list
Prioritizing your “to-do” list helps you focus and spend more of your time on the things that really matter to help you resolve claims. Rate your tasks into categories using the ABCD prioritization system. Areas such as 1st contact, telephone calls, file review/recall, follow-up, email mail replies, paperwork, new claim file reviews etc. are usually at the top of the list.

3. Plan your day, week and month
Spend some time at the beginning of each day to plan your schedule. What are the things you need to do to accomplish your claims closings goals? Taking the extra time to do this will help increase your productivity and balance your important long-term claims objectives with your more urgent tasks. All you need is fifteen to thirty minutes each day for your planning session.

4. Make notes
Have you ever thought about a claims issue (while away from your desk) and thought I will implement this. If so, carry a small notebook with you wherever you go so you can capture your thoughts. If you wait too long to write them down you could forget. Another option is to use a digital device.

5. Learn to say no
The “superman syndrome” dictates that we think we can do it all, when in reality, we simply can’t. Many people become overloaded with too much work because they over commit; they say yes when they really should be saying no. Learn to say no to low priority requests and you will free up time to spend on things that are more important like serving customers and settling claims. Let’s face it, you can’t say no to your claims job responsibilities but you can focus only on the items that contribute to successful claims outcomes.

6. Think before acting
How best to approach the claim to resolve it in a customer service focused and efficient manner, is a question you will want to ask yourself. How many times have you committed to something you later decided was not the most efficient approach? Before committing to a new task, stop to think about it before you commit. Simply ask yourself “can I do this in a effective manner”. This will help with timely claims resolution.

7. Continuously improve yourself
Make time in your schedule to learn new things and develop your natural talents and abilities. For example, you could take a class, attend a training program, or read a book. Continuously improving your knowledge and skills increases your effectiveness, can help boost your claims career..

8. Stop the Claims productively killers!
Claims productively killers warrant recognition and elimination. It is a good idea to evaluate regularly how you are spending your time. In some cases, the best thing you can do is to stop doing an activity that is no longer serving you so you can spend the time doing something more valuable. Consider what you are giving up in order to maintain your current activities.

9. Use a claims time management system
Using a time management system can help you keep track of everything that you need to do, organize and prioritize your work, and develop sound plans to complete it. An integrated system is like Microsoft outlook or in some cases, you can use a company provided proprietary time management system that offers claims time management solutions.

10. Identify bad habits
Make a list of bad habits that are stealing your time, sabotaging your goals, and blocking your success. After you do, work on them one at a time and systematically eliminate them from your claims work model. Remember that the easiest way to eliminate a bad habit, it to replace it with a better habit.

Useful Insurance Links Part -1-
This is part one of the Claimstrainer useful insurance links series. This five part series will unfold in the next five weeks providing you with the most comprehensive insurance links available.

Property Casualty Insurers Association of Americahttp://www.pciaa.net/sitehome.nsf/main/
American Institute for CPCU and Insurance Institute of Americahttp://www.aicpcu.org/
CPCU Societyhttp://www.cpcusociety.org/
CIC Societyhttp://www.scic.com/
National Association of Insurance Women - Local Chaptershttp://www.naiw.net/
National Association of Insurance Womenhttp://www.naiw.org/
National Alliancehttp://www.thenationalalliance.com/
Risk Insurance Managers Societyhttp://www.rims.org/
Society of Insurance Researchhttp://www.sirnet.org/
Insurance Journalhttp://www.insurancejournal.com/Business Insurancehttp://www.businessinsurance.com/
Insurance news links http://www.insurancejournal.com/
All 50 departments of insurance http://www.ican2000.com/state.html
AM Best http://www.ambest.com/
Natl assc. of insurance commissioners http://www.naic.org/
National Highway Traffic Safety Administration http://www.nhtsa.dot.gov/
U.S. Consumer Product Safety Commission http://www.cpsc.gov/
Officer.com http://www.officer.com/links/Agency_Search/
Fire departments USA http://home.flash.net/~jturner/map.htm

More Cars On Road, But Fewer Get Stolen

Experts Credit Anti-Theft Technology

The number of vehicle thefts reported in the United States has fallen to a 20-year low even as the number of vehicles on the road has doubled.
Experts with the Highway Loss Data Institute point to more sophisticated anti-theft technology in cars and increased efforts by police to target organized car-theft rings for the decline.
The FBI estimates that 956,846 motor vehicles were stolen in 2008. That's less than half the rate in 1991, when a high of 1.66 million vehicles were stolen. Complete data for 2009 are not yet available.
The Alliance of Automobile Manufacturers estimates there are more than 245 million vehicles on the road today, up from 122 million in 1989.
Cars these days routinely include such things as ignition immobilizers, which makes it hard to start a car without the owner's key. Whereas only 5 percent of new cars included the device in 1989, today more than 86 percent have them, according to research from the Highway Loss Data Institute.
The institute also credits other anti-theft technology, such as alarms and GPS tracking devices, for helping cut down on auto thefts.

Adjusters tip # 14

Adjusters Need To Read And Digest
by Robert Carper
Information is the life blood of successful adjusting. We obtain this valuable commodity via a variety of ways. Most often it is from voracious reading. Reading what? Well, there’s the policy, claims best practices, case law, company provided data, repair estimates and accompanying reports, email, industry publications and the list goes on. The ability to read and comprehend is of paramount importance. Reading seems so simple but very few do it effectively and efficiently. If we don’t read and grasp the necessary facts properly then bad decisions and bad results will likely follow. An effective adjuster must not only be able to read and understand an insurance policy, forms, endorsements etc., he or she must also actually intelligently read many documents. This sounds simple, but many adjusters simply don't take the time. They will say” oops, I missed that on the report”, or “oh no, I glanced at the case law and missed that supporting documentation” etc. With good intent but with huge demands on our time the aforementioned has happened to all of us. Effective reading goes a long way in addressing these potential shortcomings.

Aside from the huge amount of information on the internet that will help resolve claims, there’s the claims technical material that has to be read and digested. Moreover, just as a mechanic from twenty years ago can’t knowledgably work on a new model car without reading and self educating, the adjuster will need to read and learn from a variety of sources to remain effective. Reading is important. Digesting what you read is all the more important.

Next up – Adjuster listening skills

Thoughts on "CAUSE & ORIGIN"

The development of NFPA 921, Guide for Fire and Explosion Investigation, and recent court decisions pertaining to the reliability of scientific evidence and expert opinions such as Kumho Tire Co. v. Carmichael and Daubert v. Merrell Dow Pharmaceuticals, Inc., continue to change the rules of fire investigation. These changes have advanced the profession by requiring that investigators use the scientific method and base their opinions and conclusions on science and not on experience alone.

Fire cause & origin determination is the applied science of finding out where, how, and why a fire has started. By carefully observing and accurately interpreting smoke, heat, and fire effects on combustibles and other materials like metals, an investigator is guided to what is known as the "area of origin" of a fire.

So what should ask to get the investigation started right?

• What caused the fire in this case?
• Could the fire be the result of a manufacturer’s defect or improper service/repair work? What was the condition of the engine and transmission prior to the fire?
• Is there a likelihood of arson?
• Can subrogation be successfully pursued in this case?
  Typically, we need to determine the area where the fire began, and the investigator then sorts through it in search of potential ignition sources, examining each closely.
  

Once all the potential ignition sources are found, the weeding out process begins, and an ignition source which best fits the fire's circumstances is finally identified as the others are ruled out. This methodology applies to just about any fire scene, whether it be at a car, a boat, a house, or a factory.

Questions typically asked:

Isn't investigating a fire the fire department's job?

The fire department has a lot of jobs, and determining a general fire cause is usually one of them. But although firefighters are trained in fighting fires, few fire departments have investigators specifically trained in chemistry, electricity, and other technical aspects of fire causation investigation.
Mainly for statistical purposes, fire department reports typically list the suspected fire cause in more or less general terms (i.e., electrical, smoking, etc.) if the cause was accidental. If the fire was intentional, the fire marshal must prove a crime was committed, but only rarely are criminal charges actually filed - mainly because 84% of arson cases remain unsolved.

Who else investigates fires?

Forensic engineers (and some private investigators who typically have law enforcement or fire service backgrounds) also determine the origin and cause of fires.
These investigators are usually independent contractors who mainly work for insurance companies, but sometimes also investigate fires or a fire's affects for attorneys, private individuals and companies. Origin and cause investigations are usually conducted with the cooperation of the local fire department and municipal investigators.
The forensic engineers' investigations are typically more technical in nature and more detailed, and are especially useful for potential "subrogation" cases and fires of a technical nature (electrical failures, for example).

What's a "forensic" engineer?

Just about any type of occupation can become a "forensic" one. There are forensic pathologists ("Quincy"), forensic engineers, even forensic accountants. "Forensics" deals with arguing your case, whatever your expertise may be, in court.
Engineers are technically trained in physical sciences, and many also become qualified through further experience and training to argue about fires and accidents.
What's "subrogation"?If an appliance fails and causes a fire, or if a repairman does shoddy work and a fire results, insurance companies will occasionally demand reparation for the ensuing damages in an action known as subrogation, and many times they'll use an independent forensic engineer's report to convince the other insurance company that their insured was responsible for the fire.

If a hair dryer catches fire, such as the one pictured at left, the forensic engineer must determine not only that the dryer caused the fire, but he must also be able to explain the technical details of how the hair dryer failed and why. Based on the report, the manufacturer's insurance company will then be asked by the homeowner's insurance company to pay for the damages.
The manufacturer's insurance company will typically retain its own fire expert to review the other's report, and the case is then settled or argued later in court.

What about intentionally-set fires?After an intentionally-set fire (popularly known as "arson") is investigated by the fire department or fire marshal, the case may or may not get the support of the district or state attorney, depending on the strength of the evidence.

If it does go to criminal trial, the evidence presented to a jury must be able to overcome the "reasonable doubt" concept which applies to innocence or guilt. This isn't always possible with a clever fire-setter who starts a fire to collect insurance money. The conviction rate nationwide remains consistently at a paltry 2%.

If such a fire was intentionally-set but no charges are filed or the arsonist walks, forensic engineers can often provide the insurance company with an extra safety net. Based on the investigator's report and the background information their own internal SIU (Special Investigations Unit) provides, an insurance company can deny the insurance claim of losses resulting from the fire.

In such a case, though, a civil trial can result and the insurance company must prove that it had reason to believe that the fire was intentionally-set for insurance fraud - and the independent fire investigator is then called upon to argue his position.

THE CLAIMS FIRST CONTACT

The successful claim outcome is dependent upon how the claims professional starts the process. Paramount is the “first contact” with those involved in the claim. In order to guide the claim process to a proper resolution you will want to begin with the following steps:

Review of the initial claim facts
Review and assessment of all parties involved
Retrieval of support documentation
Initial determination of cause or at fault party
(This may change as facts reveal themselves)
Formulate an interview guide (questions to ask) to secure the facts

Secure the following:
What happened?
When did it happen?
Where did it happen?
Who was involved?
Why did it happened
Who witnessed it
Review contributing factors etc.

Once the aforementioned has been secured, then you should have your core content to move forward with the first contact process. Depending on the claim type, (property or casualty) you will move your investigation in the direction that extracts the facts you seek and need. Important questions like “why” mean a lot. Opened ended questions that encourage discussion will lead to more claim information. Effective probing offers many opportunities. Know how to probe comes with experience and the proverbial “gut feeling”. I will write a blog update on this topic in the coming weeks. Think of the aforementioned on your next first contact. Seeya

Robert Carper

What is Proof of Loss?

Why do we ask our insureds to provide a Proof of loss? Well, a a Proof of loss is documentation that your insurance company requires to support your claim.

The property insurance proof of loss usually is for the purpose of providing the insurer with the formal claim including:

•The amount

•The parties claiming under the policy

•Those with an interest

•The date and cause of loss

• Some supporting documents of the amount of the loss

Typically, the policy usually requires that the proof of loss be sworn to as truthful and a notarized signature by the insured The insurer will look at this documentation to determine its liability under your policy. Depending on the type of policy, proof of loss might consist of a claim form, written estimates, receipts, sworn statements, police reports, and other evidence.

Proof of loss details the insured losses such as the property involved, what caused the damage, the extent of the damage, and the estimated dollar amount of the damage. For example, if your home is destroyed by fire, your proof of loss is your official communication with the insurance detailing the damaged property. This form will be extensive due to the nature of the loss.
For exAMPLE, An auto collision claim’s proof of loss will likely contain information about where the accident occurred, the parties involved, a copy of the police report, and written estimates.
On the other hand, if you are dealing with a life insurance policy, the proof of loss will be less extensive. You’ll need to provide the insurance company with a death certificate proving that the insured has passed away before the death benefit is paid to the beneficiary.

WHAT IS BAD FAITH?
Often we adjusters are threatened with "Bad Faith". In order to avoid and prevent bad faith exposure, we must train ourselves on what exactly it is. In keeping with our "to the point" knowledge tools approach, coveragejet has put together the following "quick learn"on bad faith. Example: When an insured/claimant files an insurance claim with an insurance company, by law, in any state, that company owes you a duty to act in good faith. Simply put, this means that the insurance company must not look for ways to escape its obligation to investigate the claim or to pay you. Doing so would constitute bad faith. Bad faith claims and lawsuits may stem from one or more of a number of actions or inactions by the insurance company from denial of coverage to failure to negotiate a settlement. Here are some of the typical reasons insurance companies get sued for bad faith:

Unwarranted denial of coverage
Failure to communicate pertinent information to the claimant
Failure to conduct a reasonable investigation of the claim
Refusal to pay the claim without investigating
Failure to deny or pay the claim within a reasonable period of time
Failure to confirm or deny coverage within a reasonable period of time
Failure to attempt to come to a fair and reasonable settlement when liability is clear
Offering substantially less money to settle than the true value of the claim
Failure to promptly provide a reasonable explanation for denial of a claim
Failure to enter into any negotiations for settlement of the claim
Failure to respond to a time-limit demand
Failure to disclose policy limits

Unfair Claims Settlement Practices Acts apply mainly to claims for personal injury, property damage (home or car), medical bills and disability but they vary from state to state. In some states, the acts may not apply to surety, malpractice or workers compensation claims.
Claims practices that are prohibited will be similar from state to state because they are based on a model act developed by the National Association of Insurance Commissioners (NAIC). Most states use the NAIC model as a basis for their individual state acts but many tweak it. To find out more about how the law works in your state, contact your state's insurance department.

When it comes to car insurance claims, most state laws make a distinction between a car insurance company's own customers and a third-party claimant. For example, if you cause an accident, you would file a claim with your own insurance company. But if another driver damages your car, you would file a claim with their insurance company — and in that case, you are the third-party claimant. Generally, an insurance company has more of an obligation to its own customers.









Can't misrepresent your policy
Under most Unfair Claims Settlement Practices Acts, an insurance company may not knowingly misrepresent material facts or relevant policy provisions in connection with a claim. It may not attempt to enforce policy provisions that were altered by the company without notice to you or without your knowledge or consent.


Can't influence other policy settlements
Typically, the company may not drag out the settlement of a claim under one portion of your policy where liability and the amount of the loss are reasonably clear, so as to influence settlements under a different portion of your policy. For example, your auto insurer can't refuse to pay your bills under the medical coverage in your policy so that you'll settle your uninsured motorist claim. Usually, this prohibition only applies if you're filing a claim under your own policy, not if you're pursuing a third-party action against someone.


Must acknowledge your claim
An insurance company must acknowledge and act promptly in response to your communications about your claims. In some states, the insurance company must respond within a certain time frame, such as 15 days.


Must process your claim promptly
Insurers must implement standards for promptly investigating and processing claims. Otherwise, an unethical insurance company could endlessly stonewall you by saying it is still investigating your claim.


No delays for extra forms
An insurer may not delay an investigation or payment of claims by requiring unnecessary or repetitive reports and proof-of-loss forms.


Can't force you to sue

A company may not force you to go to court in order to recover amounts due under an insurance policy by offering substantially less than the money ultimately recovered. Otherwise, an insurance company with lots of lawyers on the payroll could just say, "Sue us!" and make you go to court. Obviously, that would discourage many individuals with small claims.



Can't appeal lots of claims

Similarly, an insurance company may not exploit the legal system by appealing almost all of the arbitration awards in favor of policyholders as a way to force a settlement or compromise of claims. The insurance company is allowed to appeal, but appeals can't be a standard business practice aimed at forcing you to take less than you're owed on a claim.



Can't refuse or delay claims without a good reason
An insurance company may not refuse to pay your claim or delay payment without a valid reason. It must promptly provide you with a reasonable explanation why your claim was denied or why a compromise settlement was offered. The insurer is required to make a good faith attempt to process a prompt, fair, and equitable settlement of claims in which liability is reasonably clear.

HOW CLAIMS PEOPLE CAN SAY NO NICELY

1. "No." Sometimes, the best way to refuse is politely, but directly. If someone in your life is constantly asking you to do things they could easily handle themselves, a firm "no" is the only way to get them to stop. Another approach to problematic people with frequent requests is to tell them, "I know you'll do a great job handling it on your own."

2. "I'm in the middle of several other projects/commitments right now." Don't be afraid to tell people when you're busy. Most will respect your schedule and find another way to fulfill their requests for help. You shouldn't be expected to drop tasks you've already committed to in order to complete new ones.

3. "I need to focus on [my career, my family, my personal life] at the moment." If you're going through a difficult time in another area of your life that requires your attention, don't hesitate to refuse taking on extra requests. You don't necessarily have to explain your specific reasoning for taking a pass; just indicate that you

4. "I don't feel I'm the best person to handle that task." When you don't feel qualified to handle something requested of you, say so. Explain that you don't want to do a poor job, because you know this task is important to the person asking you to do it. Chances are, they want the task done well, too.

5. "I can't do it, but I know someone else who can." Only use this "no" form if you truly know someone who can not only handle the task, but has the time to do it. It's nice to be able to offer alternative help, but only if you can follow through on your offer. Referring people to someone else who won't be able to help either will be viewed as a brush-off; the person who originally came to you will think you never actually wanted to help them in the first place.

Steps To Follow After An Auto Accident

1- 6 Steps To Follow After An Auto Accident

TIP: Take a picture of the other drivers license plates in case they decide to drive off. In most cases this can be done with your cell phone.

1. Stop your car, no matter how minor the accident.

Most states law requires that the driver of a vehicle involved in an accident resulting in personal injury, death, or property damage must stop his or her vehicle at the scene of the accident.

2. Assist any injured persons.

Your first duty, after stopping your car, is to assist any injured persons. Most states law requires that you render reasonable assistance to any injured person. If someone is seriously injured, call an ambulance. Make the injured person comfortable, but do not move them unless you know what you are doing.

3. Protect the scene.

If it is safe to do so, you are best off to not move the vehicles until after law enforcement has arrived. If the car poses a safety threat to other traffic if not moved, however, you should move it. Use common sense.

4. Call the police or highway patrol.

Most states law requires that drivers of vehicles involved in auto accidents resulting in personal injury, death, or total property damage of $500 or more, must immediately contact the local police department, highway patrol, sheriff’s department or other appropriate law enforcement agency by the quickest means available.

5. Identify the other drivers.

Be certain that you get the other driver’s address, telephone number and insurance information. Also be sure to write down the license plate number of the other vehicle.

6. Identify witnesses.

As soon as possible, get the names, addresses and telephone numbers from all witnesses. Although they should stay around until the police arrive, surprisingly often they leave beforehand. These witnesses may be critical to your claim, so get this information as soon as possible.

(Steps 7-13 next)

The State Department of Insurance

The State Department of Insurance isn't only for people who need to files claims against companies. You can find a lot of valuable information there, and on each state's Department website. It's a good idea to check in every once in a while to find out about the newest traffic laws, or changes made to laws. You can even read news stories about car insurance companies who are in trouble, or those who are doing a good job by their customers. Through some states' websites, you can even do things like renew your license! The State Department of Insurance website for your home state should be your first stop for anything related to your car insurance.

Insurance Departments ForAll 50 States

Insurance Claims - Some Basic Principles...
Introduction - insurance is purchased to provided us with cover against a financial loss should an unforeseen occurrence happen to cause damage or destructions to our possessions. Of course, we all hope this will never to us but each year insurers are faced with large payouts following Accidents, Fires & Floods. Claims totally many thousand of pound are now reasonably common. How will your claim be handled and the procedures to follow are laid down in your policy document and details of how to make a claim are presented to you when you accept policy cover. It is a good idea to tell your insurers as soon as possible and they will want to discuss matters with you at the earliest opportunity. Before confirming that a claim is valid under your policy document, your insurers will need to check that cover is actually in force for the loss that has occurred. The insurers will want to know when and how the loss happened, for claims involving

Theft or a Loss; they will want the incident reported to the police and an appropriate reference number obtained

Policy Wording - every loss is the effect of some cause, and this is the starting point to discover if your claim will be valid. Most modern policies cover a wide range of eventualities and your loss may be the result of a single cause or a chain of events. However a loss occurs, it is essential that the cause falls within the scope of your policy wording. The basic principle which governs this is caused Proximate Cause. Proximate cause is the active efficient cause that sets in motion a chain of event that brings about a result without the intervention of any force started and working actively from a new and independent source. Well that statement may be a little difficult to grasp, so consider this scenario.

If you have a building insurance policy which covers Fire but excludes Water Damage and a Fire occurs at the property. The Fire Brigade turn up and the bulk of the damage to your property is caused by the Fireman saturating your property with water then the insurers will pay the claim as the proximate cause will be deemed to be Fire. Establishing proximate cause can be a complicated task but insurers are very fair when deciding if a peril is insured or not.

Paying Your Claim - when deciding to pay your claim, your insurers will want to know if you have any other policies in force under which you may possibly be able to submit a similar claim. Where it can be established that more than one insurer is involved in a loss, then a principle known as contribution comes in to play. Under the contribution clause, your insurer can call on another insurer to pay part of the claim but necessarily an equal amount. An example would be a claim for loss or damage caused to your possessions whilst on Holiday, it is fairly common for a Holiday Insurer to enquire if you have an All Risks section under your Home insurance policy. If you have, your Holiday Insurer may wish to ask them for a contribution.

Subrogation - the insurance principle of Subrogation, prevents an insured person from “making a profit” from a claim. Subrogation can be defined as the right of one person (in this case your insurer) to stand in place of another and to avail themselves of your rights and remedies. Therefore, if your insurance company has paid your claim, they will then have the right to recover their loss from any party that they can prove is responsible for the occurrence.
Insuring your property for the correct value is of paramount importance and you should spend time in making sure that your sums insured are up to date an accurate. Under most Property insurance policies, the insurers will have a clause Known as Average. This condition has the effect of reducing any claim that you may make under your policy in direct proportion to the amount of under insurance. It is thus vitally important to make sure your sums insured are accurate