Creating the claims file

• Author: David Frangiamore
• Pages: 121-144

CREATING THE

CLAIMS FILE

3-1

CHAPTER 3

CREATING THE CLAIMS FILE

§300 IN GENERAL

§301 How the Claims File Is Created

§302 Real and “Dummy” Files Created

§302.1 Claim Filed With an Administrative Date of Loss

§303 Coverage Documentation

§304 Duties of Primary Insurers Owed to Excess Insurers

§305 Excess Insurer’s Duties When Notif‌ied of Claim Being Handled by Primary or Umbrella Insurers

§310 FACT FINDING TEAM ASSIGNMENTS

§320 LOCAL AND COMPANYWIDE CLAIM NUMBERS

§320.1 Making an Insurance Claim Over the Internet

§321 Multiple Claims Off‌ices

§330 LATE REPORTING PROBLEMSLIABILITY CLAIMS

§331 By the lnsured

§332 By the Agent

§333 By the Broker

§340 CHECKLIST FOR COVERAGE INVESTIGATIONS

AUTOMOBILE, ENVIRONMENTAL, CONSTRUCTION, AND JOB SITE INJURY CLAIMS

§350 CHECKLIST FOR FACTUAL INVESTIGATIONS

§360 “FIRST CALL” SETTLEMENTS

§361 Diary Dates

§362 Non-Waiver Guidelines—When Are They Valid?

§363 Reservation of Rights Guidelines—What Is a Proper Reservation?

Sample: Reservation of Rights Letter

§364 Advice of Counsel Defense Through Use of Independent Attorney Letter

§365 Carbon Copy Notice—May Be Evidence of a “Home Off‌ice” Claim File

§366 Claim Reserves and Dates of Loss and Why They Are Important

§366.1 Individual Reserves Are Made for Each Line of Coverage

§366.2 Reserves for Legal Costs

§366.3 Claim File Reserves on “Wasting” Policies

CREATING THE

CLAIMS FILE

How Insurance Companies Settle Cases 3-2

§370 ATTORNEYS INVOLVEMENT IN THE CLAIM PROCESS: IS THE ATTORNEY PLAYING ADJUSTER?

§380 PROOFS OF LOSS (POL) AND EXAMINATIONS UNDER OATH (EUO)

§380.1 Insurance Company’s Policy

Sample: Proof of Loss (Homeowner)

Sample: Proof of Loss (Automobile)

§380.2 Waivers

§380.2.1 Money Limits

§380.2.2 No Fraud Suspected

§390 VERIFYING THE TIMELY HANDLING OF THE CLAIMS FILE

§391 Date/Name Stamping

§392 Contact Rules With the Claimant and Insured

§393 Agent Contact and Status Reports

KEY POINTS TO REMEMBER