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Claims handling costs and quality of experts

Claims handling costs and quality of experts. Feedback for group discussion. Group One - insurers. Q 1 Needed for reserves/costs/information Separate representation should remain Need to improve comms/collaboration process Change may be forced by external regulators

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Claims handling costs and quality of experts

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  1. Claims handling costs and quality of experts Feedback for group discussion

  2. Group One - insurers • Q 1 • Needed for reserves/costs/information • Separate representation should remain • Need to improve comms/collaboration process • Change may be forced by external regulators • Loss of control of claim • Q2 • Prime consideration individual and expertise • Price secondary with firm strength third (except big cases) • Relationship beneficial but claim specific • Personal recommendation rather than Yellow Pages

  3. Group One - insurers • Q3 • SLA/TOE • Prelim assessment with reserve – update/realign • Budgets rare – usually block fee reserve • Managed process driven by reporting requirement • Q4 • Continuous/qualitative assessment • Monitor accuracy of reserves v settlements • Audits of TPAs in line with SLA • Triggered by unexpected movements • Recommendations • Global SLA/TOE • Revisit adjuster/surveyor issue at future conference

  4. Group Two - insurers • Appointment of experts • Gathering facts • Coverage issues • Liability issues • Resource issues • Recovery issues • Objectivity • Selection of expert • Panels • Location • Experience • E & O • Price

  5. Group Two insurers • Management of experts • SLAs • TOE • Budget • Reporting criteria • Assessment of experts • Criteria? • Timeliness/quality/reporting/price/accuracy of reserving • Open and closed file reviews

  6. Group three - experts • Q1 • Protect own and clients interests:cause nature and extent • Skills not in house • Independent sources of information • Resistance by owners to u/w surveyor adjusting the claim • Q2 • Panels not resisted but not too narrow • Choose by personal knowledge or reference • Past record best advertising • Prompt payment in exchange for reduced rates • Location • U/W relationship with assured and types of expert dictates who chooses

  7. Group Three - experts • Q3 • Managing expectations • Good instructions vital – as is clarification if unclear • Estimates reasonable for fee • Q4 • Few audited • Positive feedback is repeat business • Questionnaires well received by clients • Difficult to evaluate – which clients have the skills?

  8. Group four - experts • Q1 • How else are u/w going to service the claims properly? • Experts who really are experts • Avoid duplication of experts • Q2 • Good experience in the past and reputation • Price – value for money and overall result than actual rates • Knowledge of clients and market procedures • Bad timing of appointment can impair expert performance and affect result

  9. Group Four - experts • Q3 • Communication • Deal direct. Talk direct • Record instructions • Give instructions to others in expert manner • Comms, comms, comms • Q4 • u/w experts in judging quality of work provided to them • Every case different – objective criteria unrealistic • Frequent dialogue between u/w and experts critical and would be profitable for recap at end of case

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