Documents matter. More to the point, Documentation really matter




This is part 1 of this post. Part 2 will post May of 2015. Documents matter. More to the point, Documentation really matters. A properly documented claim file should "speak for itself." Anyone reading the file should be able to understand the basic facts of the claim, the outstanding issues, and what is being done to bring the claim to resolution. A good rule of thumb is the saying "If it's not in the file, it did not happen." A well documented file is the key to making the proper decision on that particular file. These suggestions are just that, suggestions.

Your company guides is the best source to lead you collecting proper documentation. The investigative needs will also serve to help in these endeavors. Every claim file is different.

 

It is important that information related to claim decision  making be documented in the file. Decision support is best documented in clear, concise, relevant, professional (civil) statements that summarize in accurate fashion what was said, who said it and when as well on what information a decision is based and the explanation of the direction the claim is going - who, where, when, how and why.

In theory, the documentation should be to the level that anyone can look at it and clearly know what was discussed, what was resolved and whether or not there are open issues. If it does not meet this level, it is probably inadequate.

Why is this level of documentation so important? When looking at some claim files, is it evident there was a misunderstanding between what the customer told you and what you heard? What if a claim develops and the misunderstanding now surfaces? The goal must be to try to resolve any misunderstandings before the claim occurs. What is the best way to do this? Further, the legal ramifications of poor claim file documentation is staggering.

Things to document include, but are not limited to: 

·      Phone calls  (made and received)

·      Letters, memos & reports ( contact, status, denial, specific request etc)

·      Photos

·      Estimates - receipts - proof of ownership documentation

·      Diagrams or property or accident scene

·      Any legal documents - releases. suit papers, subpoenas, letters, opinions issued etc.

·      Conversations with anyone related to and of relevance to the claim

·      Explanations provided to insured, claimants, vendors, agents staff etc.

·      Coverage confirmation

·      Negligence

·      Exposure

·      Damages

·      Supervisor/Manager input

·      1^st & 3^rd party discussions and claim decisions

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Claims Best Practices (Part 1)
by Robert Carper

I spent years in property and casualty claims. Claims professionals are often referred to claims Best Practices as a guide on how to handle claims. What is "Best Practices"? Best Practices often serve a roadmap to achieving Quality Claims Outcomes.

The Best Practices may vary from carrier to carrier but the core intent is much similar. This is a two part series, after which, I will elaborate in detail on each Best Practice item in up-coming post. My background and experience affords me the opportunity to offer both property and casualty Best Practices assessment. Claims (property & Casualty) Best Practices typically consist of the following areas:

 

• Prompt, Meaningful Contact
• Special Handling Compliance
• Communication with all parties as needed
• File documentation
• Photos and estimates if needed in the file
• Policy Confirmed for property/car etc. on date of loss
• Coverage Analysis review
• Regulatory Requirements compliance
• Damage Evaluation assessment
• Claim file reporting requirements
• Reserves properly addressed for claim file exposures
• Assigned Authority (personal) with assigned position profile
• All necessary parties contacted
• Efficient claim handling utilized
• Negligence assessment determined and explained