claims management4

8/9/2019 Claims Management4

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ClaimsManagement


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REASONS FOR DELAY IN CLAIMSSETTLEMENT

Late submission of claim form along wit su!cient"roof or su""orting #ocuments

Innocence an# illiterac$ of te assure#

Not submitting te claims forms in full Lac% of moti&ation or %nowle#ge about te im"ortance

of te claims settlement

Lac% of awareness among te sta' of te

organi(ations or #efecti&e su"er&ision Te #ela$ on te "art of te insurer ma$ be intentional

or #ue to te "ressure of wor%)


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ROLE OF S*R+EYORS ANDLOSS ASSESSORS


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Maintaining confdentiality and neutrality witout ,eo"ar#i(ing te liabilit$ of te insurer an# claim of teinsure#-

Examining, inquiring, investigating, veriying andchecking u"on te causes an# te circumstances of te lossin .uestion inclu#ing e/tent of loss0 nature of ownersi" an#insurable interest-

Conducting spot and fnal surveys an# comment u"on

e/cess1un#er insurance etc Surveying and assessing the loss on bealf of insurer or

insure#-

Assessing liability un#er te contract of insurance-

ointing out discrepancy0 if an$0 in te "olic$ wor#ings-

Satisying queries of te insure#1insurer an# of "ersonsconnecte# tereto in res"ect of te claim1loss-

!iving reasons or repudiation o claim0 in case teclaim is not co&ere# b$ "olic$ terms an# con#itions-

"aking expert opinion0 were&er re.uire#-

A sur&e$or or loss assessor sall submit his report to te


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NDER4RITIN5


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Insurance un#erwriting is te "rocess of classi6cation0rating0 an# selection of ris%s)

Tus te un#erwriter 6/es te "remium of te"ro#uct consi#ering &arious factors suc as cost of

ris%0 a#ministration e/"enses0 bro%erage or mar%etinge/"en#iture0 claims settlement e/"enses an#bu#gete# "ro6t) Te "remium is te "resent &alue ofte future ris%sources inclu#e7 Te "olic$ a""lication-Me#ical istor$ an# e/aminations-Ins"ection re"orts- Te Me#ical Information 8ureau 9MI8:- an#

Te "ro#ucer or insurance agent)

*NDER4RITIN5 IN INS*RANCE


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Claims settlement as a #irect im"act u"onun#erwriting) If te claims of certain insurance"ro#ucts are fre.uentl$ recei&e# te$ a&e an

im"act u"on te claims reser&es an# warrantre&iew of te "ro#uct an# ta%e #ecision eiterto mo#if$ te terms or continue)

;ACT OF CLAIMS ON *NDER4RITIN


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FRA*DS IN CLAIM

SETTLEMENT


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Insurance frau# is an$ #eliberate#ece"tion1#isonest$ committe# against or b$ aninsurance com"an$0 insurance agent0 or consumer forun,usti6e# 6nancial gain)

ma$ be committe# at #i'erent "oints in tetransaction b$ #i'erent "arties suc as "olic$ owners0tir#


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FOR E?AM;LE 7

Creating forge# #ocuments suc as wills0 legal eir

certi6cates0 assignments of te "olicies an# oter"a"ers to su""ort teir claim

#eliberate #estruction of te insure# sub,ect wit anintention to get te "olic$ amount

=O4 IS IT DEALT 4IT= >>>

As suc an$ frau# ma#e b$ te insure# or te insurer inconclu#ing te insurance contract or te claimssettlement0 ma%es te entire contract &iocable at teo"tion of te "erson on wom te frau# is "la$e#)

Te frau#ulent claim b$ te assure# will #e"ri&e im te

rigt to claim as te insurer as te rigt to re,ect it)


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Te success of claim management #e"en#s onte satisfaction of te customers) Te customersare attracte# to an insurance com"an$ b$ its

state of art claim ser&ice)

CONCL*SION


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An e/"erience#0 com"etent claims team can@ton it@s own ma%e $our CI business "ro6table

8*T

An ine/"erience#0 claims team can ma%e$our business un"ro6table e&en if $ou a&e got

te "ricing an# un#erwriting rigt)

9an# #amage $our bran# at te same time:

One Final Tougt


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T=ANB YO*

FOR YO*R TIMEAND ;ATIENCE

claims management4

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