American Association of Insurance Management Consultants

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Claims Handling

Podcast: Claim Ramifications of Keodalah v. Allstate Decision in Washington State

THE CLAIMS JOURNAL interviewed AAIMCo member Kevin Quinley on claim ramifications of the 2018 Keodalah v. Allstate decision, allowing adjusters to be added as individual defendants in bad faith lawsuits.

Chantal M. Roberts

My career spans 20 years in the insurance claims industry with specialization in commercial general liability, special investigations/fraud investigations, commercial auto insurance, homeowner’s insurance, and cargo insurance.  I spent the majority of that time working claims for syndicates of Lloyd’s of London.  I published How Can Cannabis Claims be Covered and Adjusted? in the CPCU Insights…

TECHNICAL ASPECTS OF PROFESSIONAL LIABILITY CLAIMS

“To the uninformed, “a claim is a claim is a claim.” To some extent this is true. Any type of liability claim requires proof that the insured owed a duty to another person or entity, that the insured breached this duty, and that the breach was the proximate cause of quantitatively measurable damages suffered by the person or entity to whom the duty was owed. Thereafter, it becomes a matter of determining whether or not there are any defenses such as comparative or contributory negligence on the part of the claimant. Finally, there is the question of coverage—the issue of whether or not the policy will respond to the claim. ….

There are significant differences between managing professional liability claims, compared to those arising out of more standardized coverages. …”

THE RISKS INHERENT IN DIMINISHING LIMIT POLICIES

“Diminishing limits policies create a host of potential problems for insurance company claim departments. As is well known the insurance industry has long been plagued with “nuisance” claims. While in some instances insurance companies make quick settlements of nuisance claims to avoid defense cost expenditures, in others, insurers will attempt to resist such claims to avoid setting a precedent, thereby sending a message to the plaintiff’s bar that nuisance claims will not be honored. Considering that defense costs are deducted from the policy’s aggregate limits, either course of action places an insurance company in a difficult position. … “

CLAIM AUDITING

The claims audit is the anathema of day-to-day claim operations. Nothing is more disruptive. Yet, if properly defined, nothing is more informative and helpful in improving a claim management program. This article will examine the need for a regular auditing program and provide a recipe for a three-dimensional approach to the process in order to maximize the accuracy of the audit results.

The need to conduct regular claims audits has already been widely discussed. With the magnitude of self-insured claims programs (including self-funded programs) and the millions of dollars spent on claim administration fees, what better way to verify whether the money spent has been justified or wasted? In essence, an audit of closed and open claims should accomplish several things.

The World Trade Center Property Insurance Trial: Lessons Learned?

All should use greater care handling underwriting information

Insurers: To Rescind or Not to Rescind?

“Ten Claim-Handling Lessons from `The Game of Thrones'”

Kevin extracts insights from HBO’s popular series and sees implications for how claim professionals approach the challenges in their work.

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