Case track limits and the claims process for personal injury claims
Lecture 2 - The Claims Process
Transcript of Lecture 2 - The Claims Process
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THE CLAIMS FUNCTION
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INSURANCE COMPANY VALUECHAIN
INBOUND
LOGISTICSOPERATIONS OUTBOUND
LOGISTICS
MARKETING
& SALES SERVICES
Reinsurance
Loss
Adjusting
Underwriting
Surveying
InvestmentClaims Broker services
Risk management
Repairs
FIRM INFRASTRUCTURE
HUMAN RESOURCE MANAGEMENT
TECHNOLOGY
PROCUREMENT
SUPPORT ACTIVITIES
PRIMARY ACTIVITIES
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INSURANCE COMPANYORGANISATION
Claims
Manager
Underwriting manager Reinsurance
Tehnical general
manager
Investment General
Manager
Marketing General Manager Administrative General manager
Chief Executor Officer
Board of directors
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AN IRISH COMPANY
Reinsurance
Director
Underwriting
Director
Claims Director Personnel
Director
Managing
Director
CHAIR OF
THE BOARD
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BRANCH ORGANISATION
Claims
Handlers
Claims
Inspectors
Engineers
CLAIMS
SUPERINTENDENT
UNDERWRITING
SUPERINTENDENT
REINSURANCE
Type title here
PERSONNEL
BRANCH
MANAGER
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INSURANCE INTERMEDIARIES
Governed by Insurance Act 1989
Brokers
Hold themselves out as experts ininsurance
Must deal with at least five life and five
non-life companies Must be a member of the Irish Brokers
association (IBA)
Must have a separate guarantee fund
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WHOSE AGENT IS THEBROKER
Agents of the insured
May be times when agents of insurer Collection of premium
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INSURANCE INTERMEDIARIESAGENTS
Work with less than five insurers
Agents of the insured
Act now provides agent of insurer whencompleting proposal forms
Tied agents
Work with only one company
Agents of insurer
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LOSS ADJUSTERS
Specialists in claims investigation andnegotiation
Only appointed by insurers
May specialise in a particular class ofloss
Normally members of the CharteredInstitute of Loss Adjusters
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LOSS ADJUSTERS
There task is to:
Investigate cover
Investigate quantum
Report to their principles
They have no authority outside that given
by their principles
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LOSS ASSESSORS
Appointed by insured
Investigate and negotiate on behalf of
the insured
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THE CLAIMS PROCESS
How are claims made?
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Developmentaltheoryoflitigation
Accident
Perception of the injury
Grievance
Claim
Litigation
Recognition Barrier
Attribution Barrier
Abandonment
Confrontation
AbandonmentBarrier
Litigation Barrier
Kritzer, 1991
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HOW INSUREDS MAKE THEIR DECISIONS
Realisation of loss
Causation
Attribution to peril
Claim under policy
Policy provides
cover
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Broker advised Insurer advisedBroker advised
Insured reports Loss
Check coverCover
No cover
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Claim reported to
insurer
Insurer
Checks cover
Appoints loss
adjusterChecks
Quantum
Investigates and
reportsSettles
Estimate
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CHECKING COVER
Check name of insured
Check policy in force
Check that the circumstances of theloss fall within the four walls of thepolicy
Check all conditions complied with.
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LOSS ADJUSTER
Appointed by
Insurer
Checks facts
Checks cover
Checks Quantum
Reports to
Insurer
Negotiates with
Insured
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