Industry Magazine Grand General Agency Fall 2016 | Page 7

YOU HAVE FILLED A CL AIM

YOU HAVE FILED A CLAIM
Now What?

ALTHOUGH most insurers’ claims departments prefer to
interact directly with a policyholder during a claim, it’s important
for agents to understand the process. Certainly, not being familiar
with how a claim is handled makes it difficult for the agent to set
the client’s expectations. In fact, setting realistic expectations
for the claims process contributes to a policyholder’s peace of
mind throughout the claim event.
Becoming familiar with your carrier’s claim process is simple to do
since most carriers have claim processes that are very similar and,
therefore, are easy to communicate to your clients. The only major
difference is when the claim is considered catastrophic.

Claims 101
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Reporting - Most carriers will have some sort of
communication portal so the policyholder can report
the claim directly to the carrier. The portal is typically
monitored 24/7, and claims can be reported via fax, email,
or telephone. Some clients prefer to report to their agent
during business hours, and this can easily be accomplished
by completing a First Notice of Loss (FNOL) form. Agents
should complete the form accurately, make certain the
appropriate contact information is provided, and note
whether the claim represents an emergency situation.
File Setup - When the claim is received by the carrier, a file
is immediately created and a claim number is assigned. This
claim number is critical since it is the reference point for
all future documentation and communications concerning
the claim. The policy information is immediately pulled
from the carrier’s system, and an examiner is assigned to
the case.
Adjuster Assigned - Once the examiner verifies that
coverage applies, the loss is reserved (i.e., assigned a value
based on the limit of risk plus administrative fees), and
an adjuster is assigned to make contact with the insured
within twenty-four hours to set an appropriate time to
visit for an inspection. The adjuster is dispatched to the
location of the loss and completes an inspection report.
The report is then sent electronically to the examiner
for processing so that the policyholder can make the
necessary arrangements for repairs or replacement.

Catastrophic Event

adjusters that form a CAT Team to expedite the claims
process in case of a catastrophic event. According to
Anthony Buglio at Aegis Security Insurance Company,
“Our Aegis CAT Team is made up of a group of preferred
independent adjusters. The CAT Team was created after
Hurricane Andrew and has been in place ever since. The
CAT Team will deploy to a storm area and then mobilize a
CAT office and begin handling claims immediately. Our CAT
Team has check-writing authority so that claims can be
evaluated, appraised, and settled at the site of the event.”
Most of the major insurers have developed a Catastrophic
Event Response team so that those affected policyholders can
receive an immediate response and relief for a covered peril.

Agent Support and Follow-Up

The agent of record should always schedule a followup call or visit with a client after the claim process is
completed. The client is likely to have questions about the
claim and any resulting payments, and it’s better if the
agent makes contact sooner rather than later to prevent
any issues from festering.
Many policyholders are going to have questions about
deductibles, co-insurance, and claim payments. The agent
should be prepared to discuss these issues with the client.
Agents should understand that the insurance policy is simply
a promise on paper until a loss occurs. To retain long-term
relationships with clients, communication is paramount and
cannot be understated. In general, the process stays the same
whether the claim is for personal lines or commercial lines,
and whether the adjuster is independent or employed by the
insurance company.
Let your customers know how much you care about their
needs. Do everything possible to make certain their claims
are handled promptly and to their satisfaction and that
their needs have been met.

By: The Grand General Team and
Anthony Buglio, Aegis Security

Most carriers today have developed a group of specialized

FALL 2016

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