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12 Stages NIP Group Uses To Handle Claims

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12 Stages NIP Group Uses To Handle Claims

We understand suffering a loss is a stressful event for all parties involved, which is why we take a unique approach at NIP Group. We have a specialized and dedicated claims team in place that is knowledgeable in the unique exposures and claims that are common in your industry.

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Insured Responsibility

The insured provides accurate details of the loss, preferably by using the Acord form.

Claim Handler Responsibility

The claims handler records the details from the Acord form and enters them into the claims system, then sets up the claim.

Documents

The acknowledgement document is generated and shared with the insured, including the details of the report and the claim number.

Value

The claims intake process provides an easy, seamless, and flexible way for an insured to report new losses and allows the claims handler to begin processing the claim immediately.

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Stage 1

Intake

Claims Handling

Details of a new loss claim are recorded by email, phone, or fax. The claim number is assigned by the claim handler.

Stage 2

Setup

Claims Handling

Now that the claim handler can begin processing the claim, details of the loss are input into the claims system and an adjuster is assigned to the case.

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Insured Responsibility

The insured does not need to take any action at this time.

Claim Handler Responsibility

At this point, the claim handler conducts quick and thorough accounting of the currently known information regarding the claim.

Documents

A Notice of New Loss document is generated that includes contact information for the adjuster and the supervisor to review.

Value

The setup stage allows for consistent communication to the claims reporter with the name and contact information of the adjuster and supervisor.

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Insured Responsibility

It is the insured’s responsibility to confirm the details of the loss and provide additional information that will be useful to the adjuster.

Claim Handler Responsibility

The claim handler will reach out to the insured by phone or email and send a letter if the insured cannot be reached. This communication will confirm all details of the loss.

Documents

A contact letter will be generated and mailed to the insured if the claims handler cannot contact the insured via phone or email.

Value

A critical touchstone between the insured and the adjuster, this stage confirms all details of the claim before claims handling begins. Responsibility and expectations are established for all steps moving forward.

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Stage 3

Initial Contact

Claims Handling

Once the claim is properly setup, the adjuster will contact the insured within 24 hours of the new loss report document being generated.

Stage 4

Initial Investigation

Claims Handling

During the initial investigation, the adjuster gathers all information and speaks to all relevant parties to support a determination about the insured’s coverage and liability.

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Insured Responsibility

The insured is responsible for providing access to important documentation to answer any questions that arise from the adjuster’s investigation.

Claim Handler Responsibility

The claim handler is responsible for gathering all necessary information to make fair judgments based on the facts of the loss.

Documents

In some cases, the adjuster provides a written report.

Value

Better claims outcomes are achieved through thorough investigations and clear communication.

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Insured Responsibility

At this point, it is the insured’s responsibility to answer questions that may come up, equipping the adjuster with the right information to continue to claim handling process.

Claim Handler Responsibility

The claim hander is responsible for providing a clear determination, backed by facts and evidence obtained during the investigation. The claim handler will also be in touch with the insured to ensure that all questions are answered appropriately.

Documents

If coverage regarding the claim is denied, a disclaimer letter is generated and sent to the insured.

Value

The insured is to have a quick, clear and complete determination about coverage and liability.

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Stage 5

Coverage and Liability Determination

Claims Handling

Once the initial investigation is complete, the adjuster evaluates the insured’s coverage under the policy terms and identifies any coverage restrictions to make a determination regarding liability.

Stage 6

Appraisal and Evaluation

Claims Handling

At the appraisal/evaluation stage, the claim handler determines and calculates the cost of repairing property or otherwise compensating for a covered loss.

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Insured Responsibility

It is the Insured’s responsibility to make equipment, vehicles and information available for a timely and complete evaluation.

Claim Handler Responsibility

The claim handler will be looking for a fast and fair resolution to the claim and consider all possible sources of coverage.

Documents

An appraisal/estimate is generated based on the claim handler's resolution to repair property or compensate for loss.

Value

Trust is built between the insured and the claim handler through a thorough evaluation based on facts and experience, generating a speedy resolution.

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Insured Responsibility

The insured is required to provide title and lienholder information as requested by the claim handler. The insured also needs to make a decision on whether to retain or release the salvaged property.

Claim Handler Responsibility

The claim handler has to find the best sources for salvage value and present options to the insured.

Documents

A salvage estimate is produced based on the research conducted by the claim handler and delivered to the insured.

Value

This step is important because proper salvage reduces loss costs and lowers premiums.

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Stage 7

Salvage

Claims Handling

The claim handler obtains appropriate value for any vehicle or equipment that is not practical to repair.

Stage 8

Subrogation

Claims Handling

At this stage, the claim handler pursues third parties to pay their share of the loss cost.

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Insured Responsibility

The insured must provide contracts and contact information pertaining to potential subrogees.

Claim Handler Responsibility

The claim handler has to obtain the best possible recovery from other parties based on their liability and limits.

Documents

No documents are produced at this time.

Value

Ideally, the insured will only be liable for losses he/she caused.

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Insured Responsibility

The insured has to provide information and support to build and deliver an effective defense.

Claim Handler Responsibility

The claim handler obtains counsel when necessary and produces facts and evidence to support the position of the insured and carrier.

Documents

An engagement letter is produced by the claim handler to notify all parties of the active litigation.

Value

When necessary, the interests of the insured and carrier need to be defended to determine responsibility in a complicated matter.

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Stage 9

Litigation

Claims Handling

If needed, the claims hander acquires counsel to defend the legal positions of the insured and carrier under the policy terms and applicable law.

Stage 10

Adjudication

Claims Handling

At this point, policy terms are applied to determine the covered portion of a loss.

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Insured Responsibility

The insured pays deductibles or coinsurance related to third party losses as established in the policy.

Claim Handler Responsibility

The claim handler provides a clear and detailed computation of any claim payments.

Documents

Payment computation is completed at this stage and shared with the insured.

Value

Cost sharing is an important part of a reasonable insurance arrangement.

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Insured Responsibility

The insured needs to ask any questions regarding the full accounting of the final terms of the claim, as well as agree to or object to the settlement as presented. Signed releases are required before payments are generated.

Claim Handler Responsibility

The claim handler provides a clear and detailed accounting of all terms of the final settlement.

Documents

The claim handler generates the settlement terms and delivers them to the insured and a signed release of liability is obtained.

Value

At this stage, the entire process comes together. The terms of the settlement must be fair to all parties under the terms of the insurance policy.

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Stage 11

Settlement

Claims Handling

A full accounting is generated, including appraisals and covered costs, salvage value, subrogation and cost sharing. Payments are calculated and issued.

Stage 12

Closure

Claims Handling

The claim is finally resolved under the terms of the settlement, and the net incurred value of the loss is established.

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Insured Responsibility

No responsibilities for the insured at this stage.

Claim Handler Responsibility

The claims handler produces and collects final documents that are required to protect all parties.

Documents

No documents are produced at this time.

Value

A quick and fair resolution is the measure of effectiveness of any claims handling process. Closed claims are the best claims.

Contact Us:

900 Route 9 North, Suite 503
Woodbridge, NJ 07095-1003

Toll Free: 800.446.7647
Fax: 732.791.1630
info@nipgroup.com

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