CIP C112 Practical Issues In Claims Management
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What is the definition of resolution? - Answer-Process of
bringing claims to their conclusion; may include full or
negotiated settlement, denial, litigation/Alternative Dispute
Resolution (ADR), subrogation (addressed later in this
section)
What is the definition of ethically responsible? - Answer-Ex
gratia payments or compensation without regard to legal
fault or responsibility - usually to maintain business
relationships/reputation
In what ways does the claims management process
supports the risk control program of an organization? -
Answer-1. Gathering and utilizing claims data to improve
business performance. (Look back historically on what
type of losses you have and looking for commonality)
2. Enforcing contractual obligations - insurance policy, hold
harmless, additional insured
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3. Mitigating damages after a loss event - actions taken to
minimize severity
4. Promoting equitable compromise of claims - settling for
lowest, reasonable dollar amount
5. Identifying and combatting fraud
6. Loss forecasting - setting accurate reserves, performing
trend analyses (inflation and loss development)
7. Advising and consulting with all internal and external
stakeholders - underwriting, loss control, named and
additional insureds, defense counsel, etc.
What are the steps of the claims management process? -
Answer-1. Investigation
2. Evaluation
3. Resolution
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What are the steps of an investigation in a claims
management process? - Answer-1. Reporting
2. Responding
3. Gathering information
4. Documentation
What is the definition of a loss? - Answer-a reduction in
value
What is the definition of a claim? - Answer-demand or
obligation for payment as a result of a loss
What is the definition of claims management? - Answer-
the prompt resolution of an organization's losses subject to
insurance or an active retention program including claims
by other individuals or entities to which it may be legally
bound or ethically responsible
What is the definition of prompt? - Answer-The primary
goal of claims management is to resolve claims matters
promptly and effectively to save money and preserve
relationships. As quickly as possible you are on the claim,
the more you can reduce the losses.