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Claims Management/Control

Trends and Pressures on Today’s Claims Department

“By investigating a case aggressively at the outset, it was often possible to have a developed factual matter for analysis within 90 days, maybe as long as 6 months, depending on the cooperation of any third‑party claimant and other sources of information. By having that development, one could set accurate reserves earlier. The insurer would know where it stood, and actuaries could also have access to that data and reassess a particular book of business or a particular program to see how profitable it may be over time and make adjustments, rather than canceling a program as unprofitable, should development and accurate reserve setting take longer, such as years versus months.

Another important function was the interaction between claims handlers and underwriters. The two go hand in hand. Underwriters have a certain view of the world and ways they want to approach coverage, but it’s the claims people who must handle the result and keep up to date with the latest case law affecting liability and/or coverage. Such teamwork results in tighter and more successful programs including decisions as to whether or not policy language needs to be changed or the need to add additional exclusions based on developing appellate decisions that might create new perils. That level of communication was important, especially for innovative insurance companies. Where the intent is to cover something as communicated to the applicant, the claim department might not be aware of it, resulting in a claim denial.”

Michelle Villarreal

Michelle Villarreal began her claims career over 30 years ago, with Cigna Companies while attending St. Mary’s University in San Antonio. She is the President and CEO of Occupational Accident Risk, Inc, a Third Party Administrator specializing in Texas work injury programs. They have been in the Third Party Administration industry since 2006, offering services…

Jane Marie Downey

Jane Marie Downey, ARM, M. Ed Principal Risk Consultant, Clarity Concepts, Inc.   Jane Downey is an internationally known Risk Management consultant and Insurance industry expert. Jane has a background in both Insurance brokerage and Risk Management. Her specialty industries include manufacturing, financial institutions, and technology risks.  She has made many Risk Management reports to…

Ralph Korn, CPCU

I have over fifty years’ experience in insurance and risk management.  I am a graduate of Loyola University, Chicago.  My corporate experience includes Director of Insurance for Duplan Corporation, Risk Manager for E. & J. Gallo Winery and Vice President of Insurance for Greyhound Corporation.  In addition, I have over thirty-five years’ experience as an…

Stephen Miller, CPCU, AIC

Steve is a 30+ year veteran of property and casualty insurance claims.  He holds the CPCU and AIC designations and is Past President (2006) of the National Society of Professional Insurance Investigators (NSPII). Over the course of his carrier career, Steve worked as a direct claim handler, manager, litigation examiner, senior claim specialist and director…

J. Eric Peterson, Jr.

I have been in the insurance industry for over 30 years, working as a Licensed Commercial Property and Casualty Insurance Broker, Licensed Property and Casualty Insurance Adjuster, Litigation Manager for wholly owned, Captive Insurance companies as well as handling Property and Casualty Insurance claims for two of the country’s top Third Party Administrative Companies. I…

Adjuster Safety

This article discusses some of the physical risks adjusters face in fieldwork and the emotional risks they face in an increasingly stressful claims arena. It offers tips and solutions for both adjusters and those who manage a claims team.

Amy E. Johnson

Scott S. Margraves

EXPERT WITNESS | COVERAGE ANALYSIS As the Principal Consultant of Gulf Coast Risk Management, I have over thirty years of “hands-on” experience in the insurance industry and a Certified Insurance Counselor (“CIC”) since 1999.  Nationally recognized as one of the top insurance professionals in the United States in leadership and dedication to the insurance profession,…

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