Casualty Claim Handling

Casualty claims professionals face the double whammy of a litigious society and potentially volatile claim outcomes, making it more important than ever for them to hone their skills and improve the techniques they use to achieve favorable outcomes. Focusing on optimal claim handling techniques will set the stage for success.

Casualty claims require that the claims professional consider three major areas: coverage, liability, and damages. Each of these issues requires investigation, evaluation of the findings, and negotiation to a fair and equitable outcome. 

Examination

Investigation is a skill that will set the adjuster down the correct path toward claim resolution. Starting with a review of the policy for coverage confirmation, the claims professional will first want to understand what is covered, the extent of the coverage, and to identify the insured person or entity. Coverage review will also reveal any lapses in coverage that could prove problematic later as the investigation into liability and damages progresses. Investigation of the facts is conducted to determine the extent of the liability of the insured and other parties to the occurrence. Similar to a journalist, a claims professional will want to determine the “who,” “what” “where,” “when,” “how,” and “why” of the situation. The claims practitioner can uncover this information in a number of ways, such as: