American Association of Insurance Management Consultants

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Claims Management/Control

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.

“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.

Olie R. Jolstad

Olie Jolstad is an insurance expert with over 40 years of professional insurance experience in commercial and personal lines insurance claims handling, coverage analysis, managing general agent, and agent/broker procurement of insurance. Mr. Jolstad holds the Senior Claims Law Associate (SCLA) designation, as well as being a Fellow in the American College of Forensic Examiners…

Charles C Hewitt

Chuck Hewitt is a veteran insurance claims executive with 45+ years of multi-line claim department experience and leadership at national and regional carriers. Particular strengths in coverage analysis, creation, and teaching; bad faith defense; technical and management training; claims management; cyber liability; employment practices liability; litigation management; customer relations; reinsurance; and runoff operations. Multiple appearances…

Shinning A Light On Insurer Misconduct

A uniform law proposed by the National Association of Insurance Commissioners (NAIC) is currently working its way through state legislatures. The Corporate Governance Annual Disclosure Model Act[i] would require American insurers to disclose a wide range of information relating to their governance, performance evaluation systems, compensation and incentive plans, Enterprise Risk Management (“ERM”) plans and codes of ethics and conduct. This article will highlight some of the important features of the NAIC’s model act and illuminate how they are designed to cloak insurer disclosures in secrecy, but at the same time provide compelling evidence of information whose existence insurers have long denied. Discarding the secrecy mandated by the model act and allowing access to the disclosed information will help discourage insurer misconduct long hidden from the insuring public.

[i] http://www.naic.org/store/free/MDL-305.pdf.

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