Details of a new loss claim are recorded by email, phone, or fax. The claim number is assigned by the claim handler.
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.
Once the claim is properly setup, the adjuster will contact the insured within 24 hours of the new loss report document being generated.
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.
Coverage and Liability Determination
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.
Appraisal and Evaluation
At the appraisal/evaluation stage, the claim handler determines and calculates the cost of repairing property or otherwise compensating for a covered loss.
The claim handler obtains appropriate value for any vehicle or equipment that is not practical to repair.
At this stage, the claim handler pursues third parties to pay their share of the loss cost.
If needed, the claims hander acquires counsel to defend the legal positions of the insured and carrier under the policy terms and applicable law.
At this point, policy terms are applied to determine the covered portion of a loss.
A full accounting is generated, including appraisals and covered costs, salvage value, subrogation and cost sharing. Payments are calculated and issued.
The claim is finally resolved under the terms of the settlement, and the net incurred value of the loss is established.