American Association of Insurance Management Consultants

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Customs, Standards, Practices & Duties - P&C

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…

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.

CONTINUITY AND PRIOR/PENDING LITIGATION EXCLUSIONS IN THE CLAIMS-MADE POLICY FORM

“Directors and officers liability policies have long been issued on a “pure claims-made” basis (a
phrase this writer first coined in 1990). That is, they were written with no prior act date (also
known as a retroactive date). As a result, wrongful acts of the directors and officers dating
back to corporate formation were covered as long as the claim was first made against the insured
during the policy term. To minimize the singular risk D&O insurers were taking (i.e.,
“what probability exists that a claim will be first made against the insured during the policy
term?”), they began using a “continuity date” and/or a “prior/pending litigation exclusionary”
date that was the same as the inception date of the first policy issued. The date the insured
first obtained coverage thus became known as the “first coverage date” so the “continuity
date” could be honored at renewal. This was reinforced by a warranty within the application
for coverage stating that the insured was or was not aware of facts, incidents, or circumstances
that could give rise to a claim in the future.”

The World Trade Center Property Insurance Trial: Lessons Learned?

All should use greater care handling underwriting information

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…

Vincent “Chip” Boylan

Property and Casualty Insurance Expert Witness with a 42 Year background as an Insurance Broker.  Expert witness since 1989 with a primary focus on 1) agent and broker standard of care; and 2) coverage issues. Topics addressed have included: Property/Crime; Business Interruption; General Liability; Executive & Professional Liability; Workers’ Compensation; Umbrella Liability; Automobile; and Homeowners.…

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Craig Andrews

Craig Andrews is a Senior Consultant with Malecki Deimling Nielander & Associates, LLC.  Craig entered the property-casualty industry as a producer in an independent insurance agency in Defiance, Ohio in 1977.  A few months later, he established his own independent agency “from scratch”.  He operated the agency successfully until selling it in 1996 to join…

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