(UN) Fair Claims Practices Act

Fair claims practices represents ultimate oversight
over the claims process. Bad faith is of concern when
handling claims but of equal concern is the fair/unfair
claims practices act. So just what is it?

The Unfair Claims Practices Act, also known as the
Unfair Claims Settlement Practices Act is legislation designed
to protect consumers from inappropriate conduct of insurance
companies.

The act permits insurance regulatory authorities to take legal
action against an insurance company that engages in certain unfair
claim settlement practices with such frequency that it amounts to
a general business practice. The eight core fair claims practices
components (depending on the state in which you handle claims)
are as follows:

You must acknowledge the claim
You must process claimant/Insured claim promptly
You can't misrepresent your policy
You can't influence other policy settlements
You can't force claimant/Insured to settle for less
You can't force the claimant/Insured to travel
You can't appeal excessive amounts of claims
You Can't refuse or delay claims without a plausible reason

The phases of the typical claim are divided up into several very important categories. The initial contact, the investigative phase, coverage analysis, appraisal, documentation securing negotiations and settlement, to name a few. The most important of which is the first 24 hours following a loss. They offer a one-time opportunity to minimize the loss and direct its outcome. One thing is certain, the first 24 hours will not return. The effective adjuster will use those hours to uncover the unique hazards and opportunities in that loss, and out of a broad palette of alternatives, address the critical needs. The key areas that warrant attention during the first 24 hours of a claim consist of :

Securing the claim facts
Reviewing and confirming the coverage
Deterring the type and extent of damages
Discovering the witnesses
Securing the support documentation
Instructing the insured as to what to do, how to it and when to do it
Establish rapport with the clamant and/or insured
Get statements while the information is fresh in the minds of the involved parties
Make assignments to vendors and peripheral support people such as appraisers
Mitigate damages
Document the accident scene
Establish the claims adjusters role in the claim process

Many claims may come to conclusion during the coverage review in the first 24 hours but often times they continue because that phase was not properly addressed. This tends to be costly, creates legal exposures and diverts attention from other areas that warrant necessary attention.

When I first heard of this term, I thought it was only engaged during a court trail. As I became more experienced with EUO’s I discovered what a useful tool this is in securing relevant claim facts and how it serves as a claims investigative guide.

The examination under oath is intended to enable the insurer to obtain any and all information known to the insured or within the insured’s possession or control which may be material to the claim. The examination permits the insurer to observe the insured’s demeanor and trustworthiness, and to obtain detailed information concerning the insured’s claim.

The Examination Under Oath (EUO) is a formal proceeding taken before a court reporter and recorded in a verbatim transcript. Every question which is asked and every answer which is given is made a part of the record. Many insurance companies now videotape the Examination Under Oath, as well. It is usually conducted by an attorney hired by the insurance company for that purpose. The insured has the right to be represented by an attorney and often appears with counsel
An examination under oath (EUO) is one of many tools an insurer has at its disposal to assist it in investigating and adjusting claims which have been submitted. As such, if your clients issue insurance policies or merely purchase them, it is imperative that you understand the issues related to the conducting of an EUO.

An EUO is one of the most effective tools an insurance company has in its search for the truth. The EUO provides the company a unique contractual opportunity to gather material facts and information relevant to a claim presented. Although an EUO has some similarities to a deposition, there are some very important distinctions which, if not considered, can put you or your client at a very distinct disadvantage. These differences arise from the fact that an EUO is the product of a contractual relationship between an insured and their insurer while a deposition is generally conducted during the course of litigation.

Most commercial and personal lines insurance policies, including homeowners, auto and general liability policies, contain provisions which allow an insurer to demand that an insured and certain other parties submit to an EUO. Generally, the policy provision which provides for an EUO states as follows:

Claimstrainer Legal Terms And Concepts for Claims Professionals

This starts my series on legal terms and concepts for claims professions. I will explore and define legal content as it relates to claims handling. I start with the basics first and move on to more advanced legal claims concepts. This series will span all of about a month being presented in this blog as need warrants. That said, we will start with the term "litigation"

Litigation is the process of bringing and pursuing a lawsuit. Litigation
often proceeds much like trench warfare; initial court papers define the
parties' legal positions as trenches define battlefield positions. After
the initial activity, lawyers sit back for several months or years and
lob legal artillery at each other until they grow tired of the warfare
and begin settlement negotiations. If settlement is unsuccessful (90% of
all lawsuits are settled without trial), the case goes to trial, and may
be followed by a lengthy appeal.

Many states have enacted reforms directed at shortening the time a case
takes to get to trial and minimizing the expense traditionally
associated with litigation. Among these reforms are:

* "fast track" rules that prohibit delays and require each phase of the
case to be completed within a particular period of time * limits on how
much information can be obtained from the opposing party * requirements
that certain types of cases be arbitrated (a simpler procedure) rather
than pushed through the court system * requirements that attorneys
inform their clients of alternative dispute resolution procedures such
as mediation, and * court-sponsored techniques such as mini-trials and
early neutral evaluation that are designed to get the parties to settle
by giving them a realistic assessment of what is likely to happen if the
case goes to trial.

2010 Storm Names

The following names will be used for named storms that form in the North Atlantic in 2010. Retired names, if any, will be announced by the World

Meteorological Organization in the spring of 2011. The names not retired from this list will be used again in the 2016 season.

This is the same list used in the 2004 season with the exception of Colin, Fiona, Igor, and Julia, which replaced the names of the four major hurricanes that made landfall in Florida in the U.S. in 2004: Charley, Frances, Ivan, and Jeanne, respectively.[4]

1. Alex (unused)
2. Bonnie (unused)
3. Colin (unused)
4. Danielle (unused)
5. Earl (unused)
6. Fiona (unused)
7. Gaston (unused)
8. Hermine (unused)
9. Igor (unused)
10. Julia (unused)
11. Karl (unused)
12. Lisa (unused)
13. Matthew (unused)
14. Nicole (unused)
15. Otto (unused)
16. Paula (unused)
17. Richard (unused)
18. Shary (unused)
19. Tomas (unused)
20. Virginie (unused)
21. Walter (unused)
    
    

Xactimate Estimate Primer (Property)

Want to know how to write an Xactimate estimate? Well, I put together a brief primer on how to write one. This primer provides a step by step guide on how to write an Xactimate estimate. I will post the more detailed version at a later date. For now, this should acquaint you with the process. This is based on Version 2.5. Simply click on the navigation buttons at the bottom right.

The Reserve

With most carriers, the general reserving philosophy is the "Most Probable Outcome” payout of the claim and not necessarily the worst case scenario. In most cases, you will want to reserve an individual exposure based on what the best estimate is of its most probable outcome based on the information available at the time the reserve is being set. As the investigation advances you want to reevaluate the reserve. The reserve should factor in but not be limited to:

• Amount of estimated damages
• Anticipated / updated payout
• Depreciation expected on an ACV policy
• Deductible
• Coinsurance
• Expected payout supported by the documentation or will there be
• Other contributing coverage’s
• Probable, proper and likely negotiations to resolve the claim
• Policy limits – this obviously would place a maximum on the reserve amount
• What coverage items are involved, personal property, building, income loss, value of vehicle, loss of use, rental etc.
• Possible Supplements
And more, depending on your claims reserving best practices