Claims Advocacy is an essential element of claims mitigation. Generally, it describes efforts to assert our client’s interests with respect to claims and claim related issues. We view advocacy as a collaborative process between the client and insurer.
A schematic of the claims advocacy services appears below.
We process first reports on all claims, except workers compensation claims, unless handled by a Third Party Administrator (TPA).
A claim inquiry is any ad hoc claim related request for information. Once the request is addressed, no further action is taken.
A Referral Claim is any significant claim as defined by the client. Once assigned, a Claim Advocate is involved until the claim is resolved. The Advocate’s role is as follows:
- Collaborate with the client and adjuster on a resolution strategy;
- Identify and pursue non-insurance third party recoveries;
- Monitor reserves on a most likely outcome basis;
- Resolve coverage denials and reservation of rights letters; and
- Secure excess recoveries.
Claim Review Meetings
Claim review meetings are conducted in accordance with client's service plan. We treat each claim reviewed at a claim review meeting as a point-in-time Referral Claim and advocate accordingly.
Third Party Administrator (TPA) management is described in the schematic below.