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Introduction & Session Information
Claims 101: Best‐Practices for Pro‐Active and Efficient Claims Handling
Disclaimer
This presentation is for educational purposes only. Any materials, information, statements
etc. should not be construed as policy, insurance or legal advice.
Learning Objectives
• Analyze loss history and implement processes specific to your organization
• Learn how to develop processes and procedures for efficient claims handling
• Establish documentation guidelines based on early investigation
• Create a standard process for recovering costs
Overview
• Claims Best Practices• Investigation and Documentation• File Handling Guidelines and Metrics• Subrogation (Cost Recovery) • Case Studies• Putting this to Work!• Port Process Maps
Port of SeattleSeattle‐Tacoma International Airport
ranked as the 13th busiest U.S. airport.
Two cruise terminals and 192 ship calls in 2015.Nearly 900K visitors came to
Seattle in 2015 during the cruise season.
Newly formed Northwest Seaport Alliance plays a significant role in international trade to the region.
Best Practices: Self‐Insurance
• Supports a self‐insurance program
• Total number new of incidents in 2015 = 868• Total number of new claims in 2015 = 323• Total number new of incidents in 2016 = 909• Total number of new claims in 2016 = 391
* Does not include Worker’s Compensation**
Which Incidents Become Claims?
• Prepare all incidents for potential claims
Other Benefits
• State Audits (State Auditor’s Office)
• Third Party Administrator (TPA) Audits
• New Hire Training
Investigation: Empowering First Responders
• Tools and guidelines for gathering information
• Initial investigation, statements, and photos
File Documentation
• Early documentation, follow up statements, scene inspection and security video.
• Liability Considerations
Standard File Reporting(“Free Write” vs Template)
• “Free‐Write” Documentation • Template Documentation
Guidelines and Metrics: Contact
• Initial contact
• Return phone calls/e‐mails
• Acknowledgement of documents
Initial File Review
• Confirm adverse party insurance• Potential litigation and notice to insurance carrier• No injury/damage or minor injuries: 30 – 60 days to review for closure
• Moderate to significant injury/damage: 30 – 90 days to review for closure
“Triggering” Events(file closure)
• No response = Closed in 30 days
• Contact = Closed in 30 – 60 days
• Claim Made = 30 day review
Standard Processes for All Recoveries
• Confirm insurance
• Initial notice of intent to pursue reimbursement
90‐Day Plan
• Send Initial Notice, 30 day review
• Send Second Notice – 30 day review (60 days)
• Send Final Notice – 30 day review (90 days)
Business Decisions, Litigation and Small Claims
• Costs to recover vs. amount of recovery
• Litigation
• Small claims
Case Study 1
• Incident 1: Passenger entered a freight elevator and was hit in the head when the elevator door closed.
• Claim: Passenger alleges a Port employee pushed the button to close the door, causing the door to close on her head.
Case Study 2
• Incident 2: Port of Seattle employee collided with a 3rd party vehicle as the Port employee was changing lanes.
• Claim: “To the Port of Seattle Commission ,Would someone please investigate Martin Doyal, Risk Claims Specialist, Port of Seattle for his lack of responsibility to uphold the public trust by adhering to the highest standards of business conduct for an accident claim that I have that is now over a month old.His continual and blatant lies and deceit are getting real old. Frankly, due to his childish games, I'm very close to hiring an attorney, which I'm inclined to do simply to expose Martin's continual efforts to attempt to avoid paying a claim that is a 110% responsibility of the Port of Seattle. The end result of course would be a much higher cost to the Port of Seattle. This is a "slam dunk" case.As I read your website, I believe Martin completely abuses and violates his workplace responsibility.”
Case Study 3
• Incident 3: Third party truck driver alleges that a Port of Seattle employee changed lanes and collided with his truck.
Case Study 3
Putting this to Work!
• Analyze loss trends
• Identify processes needed to handle those incidents
• Create process maps and implement!
Analyze Loss Trends
• Review loss history
Identify Processes
• Processes used to resolve claims
Create Process Maps and Implement!
• Claims Process Maps (Visio)
• Implement!
Port Process Maps: Main Page
Basic Investigation
Basic Investigation
Basic Investigation
Port Results 2015
• Total number new of incidents = 868• Total number of new claims from those = 323• Year end open incident totals = 77• Year end open claim totals = 64• Incident closure cycle time = 44 days• Claim closure cycle time = 61 days
Port Results 2016
• Total number new of incidents = 909• Total number of new claims from those = 391• Year end open incident totals = 79• Year end open claim totals = 67• Incident closure cycle time = 45 days• Claim closure cycle time = 63 days
Summary• Establish documentation guidelines based on
early investigation• Learn how to develop processes and
procedures for efficient claims handling• Create a standard process for cost recovery• Analyze loss history and implement
processes to your organization
Summary
• Pro‐active and efficient procedures for administering claims.
