Claims AdjustingClaims EnvironmentOrganization of Claims Function Physical OrganizationOrganization of Claims Function Management StructureClaim Adjusting ProcessClaims Adjusting Process LiabilityClaims Adjusting Process DamagesLoss ReservingClaim SettlementSettlement DocumentsLitigationMeasuring Claim PerformanceClaims AdjustingObjectivesComplying with contractual promiseAchieving profit objectiveCollection of informationMarketingUnderwritingActuarialDefinitionsFirst party = claims by policyholderThird party = claims against policyholderClaims EnvironmentExternalGeneral publicPlaintiffs’ attorneysDefense attorneysState regulatorsLicensingConsumer complaintsMarket conduct auditsUnfair claim settlement practices legislationDocumentationCommunicationsSettlement standardsInternalMarketingUnderwritingLegalTrainingOrganization of Claims FunctionPhysical OrganizationCentralized/decentralizedBy product or line of businessPersonal/commercialProperty/liabilityOrganization of Claims Function Management StructureClaims managersExaminersSupervisorsAdjustersIndependent adjustersProducer claim servicesPublic adjustersOther claim personnelCause and origin expertsAppraisersReconstruction expertsPrivate investigatorsRehabilitation expertsClaim Adjusting ProcessQuestionsIs the loss covered?Is the policyholder or insurer legally liable?What are the damages?CoverageInsuring agreementExclusionsConditionsResponse to coverage issuesReservation of rights letterFiling for declaratory judgment actionClaims Adjusting ProcessLiabilitySources of liabilityStatutesContractsTortsIntentionalNegligenceStrict or absolute liabilityInvestigation of liabilityStatementsInspectionsDocument reviewClaims Adjusting ProcessDamagesProperty damageBodily injury damagesMedicalLoss of earningsPain and sufferingConsortium(Sex, society and services)Future damagesPunitive damagesSurvival and wrongful deathExtra-contractual damagesLoss ReservingCase reservesJudgmentAverage valueTabularIBNR (Incurred But Not Reported)Reserving problemsStair-steppingInconsistencyClaim SettlementPre-settlement negotiationPersons involvedAgentPolicyholderClaimantWitnessesAttorneysNegotiation of settlementDenial of claimsSettlement DocumentsProof of lossGeneral releaseJoint tortfeasor releaseCovenant not to sueHigh/low agreementsRelease for injury to a minorParent’s release and indemnity agreementNominal releasesRelease draftTelephone recorded releasesLitigationAlternatives to litigationArbitrationMediationRent-a-judgeSettlement conferencesSummary jury trialsSelection and direction of outside attorneysDecisions relating to defenseDefend or settleNuisance settlementsSubrogationMeasuring Claim PerformanceFinancial measuresLoss ratioAccuracyConsistencyClaim-handling performanceTurnover of claimsAverage cost of settlementLitigation ratesAverage caseloadStaff
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