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Claims Management standards and compliance

In our role as Third Party Administrator (TPA) our minimum standards and compliance on each claim are:

  • Ensure that the terms and conditions of the insurance policy are complied with
  • Perform a coverage analysis and investigation
  • Current remedies/damage limitation concerning PD losses
  • Medical diagnosis, treatment to date, prognosis and exposure for injury claims
  • A brief recap of issues and investigation relating to liability
  • Control costs to maintain correct erosion of the underlying SIRs/deductibles/policies where applicable
  • Current legal issues and case law
  • Assess and confirm indemnity and expense reserves
  • Audit medical invoices, recommend physicians
  • Collate statements, medical records, construction expert reports, claimant’s history (as applicable)
  • Liaise with underwriters to ensure an economical resolution of the claim
  • Work with and control the defense attorney (if applicable)
  • Attend mediations as underwriters representative
  • Recommendations for future handling and strategy
  • Provide loss runs as required

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