Insurance buyers deserve certainty regarding the performance of the policy at critical times. However, a high percentage of the main commercial claims are disputed. Such a situation is bad for clients, the business community in general, and the insurance industry. Nevertheless, there are approaches that can facilitate better claims results.

Bellow, the dedicated professionals from SDC CPA, a global investigation and forensic accounting company, explains the key steps that can help make a claim straightforward and quick.

Types of Claims

In general, claims are divided into three categories:

• Small and direct complaints, resolved efficiently and generally with a good customer experience. This represents the majority of claims.
• Simple big claims, resolved quickly. This, unfortunately, is quite rare.
• Large and complex claims where insurers can be slow, cumbersome, and sometimes adverse.

Increasingly, we see a lawyer- and expert-led approach to handling large claims, characterized in part by experts who weigh in on what should have been done to minimize the loss, along with their views on the extent of the loss. This approach can invade the traditional space of the licensed loss adjuster, whose job it is to manage the claim and oversee a fair and equitable settlement.

The accounting professionals from SDC CPA bring focused and specialized experience and expertise in claims investigation and evaluation as well as risk evaluation and loss control to employee dishonesty, liability, professional liability, and commercial surety coverages at a reasonable cost. Their experience and expertise enable the insurer to achieve its goals of prompt, fair claims investigation and resolution while also effectively managing costs.

More Efficient Claims

There are two areas that can help larger and more complex claims run more efficiently:

Ensure the effectiveness of the policy. One step towards more effective and less hassle claims management is ensuring that policies are free of terms that cannot be met or, worse, that the insurance buyer is not aware of. Policies must be free of ambiguity, explained by SDC CPA. This is a constantly evolving process. As jurisprudence changes and clarifies the meaning of words, policy writers should incorporate the changes into the statements.

Buyers should regularly review their “stress test” policies to make sure they will work as expected. A well-run test involves brokers, underwriters, and, when necessary, outside experts. Testing can identify gaps in the roof, allowing for clarification or amendment before an incident occurs. Such tests can also help buyers establish expert procedures and understand what to expect in the event of a claim.

Manage claims effectively. Another key to the claims process is understanding that successful claims do not happen by accident; They are managed professionally and proactively from start to finish. As claims become more complex and insured by experts, brokers are investing in more claims defense services to help their clients and differentiate their services.

A well-managed claim, through the lens of the customer, offers quick claim of coverage, interim payments before expenses, quick identification and socialization of issues with all stakeholders, and proper avenues for resolution. The insurance buyer should have no surprises and be able to keep their leadership team fully informed as they focus on the recovery of the business.

SDC CPA provides focused expertise for consistent and efficient claims assistance. By utilizing a targeted approach, SDC CPA reduces the learning curve and costs for claim adjusters and attorneys. This allows insurance companies to provide efficient and consistently high-quality services to their clients.