Categorie: Tutti - liability - negotiation - claims - investigation

da JJ Meyer mancano 14 anni

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CSA - JTA by Task

Claims Service Associates (CSAs) handle various aspects of auto and property damage claims, particularly those of low complexity and within their granted authority. They must understand the process of proper investigation, including obtaining statements from claimants, insured parties, and witnesses, and documenting evidence such as vehicle photos.

CSA - JTA by Task

Auto and Property damage claims (low complexity / within granted authority)

Complies with

Prepares & handles

Develop KSAs (basic / fundamental)

Adjusts to conclusion

Settlement
Negotiation

For out of state claims, CSA's will need to know how to arrange repairs using the Vendor department. They may information statutes or subrogation.

CSA will need to be aware of states requiring a license. Need to recognize when a state will require a license and to get assitance on those files - Brian

Evaluation

CSA may need to take recorded statements for liability disputes. They will need to be familiar with the recording system. They will also need to be comfortable with the formality of a recorded statement. Thoughts?- from Jenn

Investigation

Investigation

CSA will need to understand what a proper invest entails

-Proper statement from claimant and insured

-Witness statments

-When to record statement and how (NICE appliaction)

-PR

-Scene invest (google)

-Vehicle photos

CSA needs to recognize exposures

-difference in COMP and COL

-MP and PIP

-PD

-BI

CSA needs to understand triage model

-assign injury claim to injury unit

-assign motorcycle and busses to injury unit

Out-of-state losses
Disputed liability
Multiple property PD exposures
Low-to-high complexity liabilty w/o BI exposure

Recognize higher exposures & triages accordingly

Open claim by telephone: Performs all steps of FNOL (above), PLUS:

Obtains any additional required information from othe involved parties

Obtains any additional required information from Claimant

Obtains any additional required information from Insured

FNOL

Added By Debbie Beard 2/25/10

• Confirm coverage is in order

o If coverage issue - Advise what information needs

to be addressed

o Set clear expectations what is needed to clear

coverage question or confirm no coverage for loss

is available.

• Advise 1st party Coverage’s and time limits

• Advise 3rd party Coverage’s and time limits

• Advise insured if deductible applies or will be waived (be very clear)

o Example: Advise insured that their collision/comp

ded of $500 (or what ever their specific deductible

for this loss is confirmed to be) does apply and is

payable to the shop when the repairs are completed

(they are responsible for the deductible until

confirmed)

• Advise (verbally and in writing) intention to pursue or not to pursue subrogation provided the insured will have a deductible interest outstanding and there is a legal basis for recovery of that money.

• If possible, advise and code liability

o If liability pending set expectations on what is needed to conclude liability

o If PAF advise of liability and send PAF letter

 Advise possible rate increase

 Give Insured policy services contact number if

additional questions regarding potential rate

increase arise.

• Discuss repair options

o Advise of DRN and non-DRN conditions

o Send assignment to DRN, IA, PDA, Desk Review, or

VIP (NV)

o Advise of repair contact information

o Set detailed expectations and time frames

o Advise and send DRN participation letter (if

applicable)

• Arrange rental (if applicable)

o Advise of rental coverage’s and conditions

o Send assignment to HLE, ERAC or other rental

company

o Advise of rental contact information

o Set detailed expectations and time frames

• Advise and send Acknowledgement Letters

• Advise and send SR-1 if necessary or advise Insured they need to send SR-1

• Set detailed expectations and time frames of next steps

o Of Note: The more detailed expectations that are

set in the beginning the better CSI results you will

have and the potential of less incoming phone calls

you will receive from your customers

• Advise of OA contact information and claim number

• Ask if they have any additional questions or concerns you may help them with at this time.

Arrange rental (if applicable)
Advise of rental coverages and conditions
Discuss repair options
Advise and send DRN participation letter (if applicable)
Set detailed expectations and time frames
Advise of repair contact information
Send assignment to DRN, IA, PDA, Desk Review, or VIP (NV)
Advise of DRN and non-DRN conditions
If possible, advise and code liability*

*If liability decision is pending, set expectations on what is needed to conclude liability

o If PAF advise of liability and send PAF letter

 Advise possible rate increase

 Give Insured policy services contact number if

additional questions regarding potential rate

increase arise.

Advise (verbally and in writing) intention to pursue or not to pursue subrogation*

*Provided the insured will have a deductible interest outstanding and there is a legal basis for recovery of that money.

Advise insured if deductible applies or will be waived (be very clear)
Advise of 3rd party Coverage’s and time limits
Advise of 1st party coverages and time limits
Confirm coverage is in order
Set clear expectations as to what is needed to clear coverage question or confirm no coverage for loss is available.
If coverage issue - Advise what information needs to be addressed
Access policy language
Access Dec page