CLAIMS MANAGEMENT

Claims Management

We like to say that “Safety is no accident”! However, no matter how much any organization works to develop a safety culture and prioritizes the safety of its employees/team members, customers, and guests, losses do happen. Property is damaged, perhaps by fire, water, or windstorm; or people are injured. Your company may have a large deductible or retention in which case the loss directly and immediately impacts your cash flow. Even if you have 1^st dollar insurance where the insurance company will pay the entire claim – your future insurance premiums can be impacted by the claims incurred.

Strategic Risk Advisors works with its clients to mitigate the impact of losses.

Loss Experience Analysis

In all lines of insurance, underwriters look at loss experience as a critical factor in underwriting future insurance coverage and the premiums they charge. With Workers’ Compensation insurance this is a particularly direct impact through the Experience Modification Factor which is based on actual claims compared to others in similar industries.

Claim Reporting/Monitoring

When a loss occurs, timely reporting to the insurance company is critical to the successful outcome of the claim. Early investigation allows for the obtaining of important information about what occurred and can help to manage the future development of the claim. However, your involvement should not stop with timely reporting to your insurance company. Monitoring and managing the claim process results in lower claim costs and more favorable results.

Claim strategy development & negotiations

Often, how a claim is managed can have a tremendous impact on a successful outcome. Additionally, no one knows your business better than you do. This means that it is only with regular involvement in helping determine an appropriate strategy in conjunction with the insurance company’s claim professional, and in some cases, direct involvement in negotiations (particularly relating to property damage and business interruption losses), allows for the most favorable claim result.

Complex Claim Evaluation

Not all claims are simple, some are quite complex. This can involve the proximate cause of property damage, or how your employees are trained and what operating policies are in place, or even how some of your contracts are worded. Complex claims require active participation on your behalf, otherwise, the most critical piece of information may be missed and what could have been a relatively small claim becomes large.

Loss Control/Prevention

While controlling claims once they occur is a vital part of Risk Management, the best claim is the one that never happens. Not all losses can be prevented, but they can be controlled. Often the prevention is through proper training and policies. This applies not only to physical activities but financial operations as well.

Insurance Coverage Dispute Resolution

We believe that most insurance companies are honorable and want to do the right thing when it claims to occur. However, there are times when differences of opinion between the insurer and the insured develop. These can result from a lack of understanding of the insurance contract, or the insurance company is simply not performing in an appropriate manner. In these cases, it may be necessary to involve other resources in order to resolve the coverage dispute. In doing so, we have had experience in negotiating on behalf of our clients, and when absolutely necessary, we have developed relationships with a number of policyholder-only representing attorneys that specialize in coverage dispute issues. In most cases, we have been successful in resolving these disputes without the full litigation process.