Wolters Kluwer Financial Services recently released its annual list of the top 10 reasons insurance companies are found to be out of compliance during market conduct examinations, and many of the issues were related to claims. To find out why, Claims' Eric Gilkey spoke with the report's author, Kathy Donovan, who serves as senior compliance counsel for Wolters Kluwer's Insurance Compliance Solutions group.
Specifically, how do claim issues factor into your list?
Claim issues certainly appear to be a group of related and very frequent criticisms, with issues ranging from timely claim-handling issues to the remitting of the proper amount to the claimant. Providing required reasons for claim denials and specific notices, such as the bill of rights in an automobile claims process, also appear to be problematic for insurers. Apart from these timeframe and complete claim issues, insurers are also frequently cited for using unlicensed claim adjusters or appraisers.
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