Our customers are primarily insurance
companies and self-insured companies. Our focus is Personal (Auto
and Home) Lines and Commercial (Property, General Liability, Workers
Compensation, etc.) Lines of insurance.
Claims: Our Claims
Adjusters perform site inspections on
building and contents losses covered by most property insurance
policies; e.g. fire, wind, lightning, hail, sudden and accidental
water damage, burglary, theft, etc. We verify probable cause of
loss, scope and estimate to repair or replace damaged property.
We review commercial accounting records to verify or estimate loss
due to business interruption. Our estimates are computer generated by line item and include Replacement Cost, Depreciation and Actual Cash Value adjustments. Certificate of Completion in Xactimate.
Claims: Our Claims
Adjusters investigate auto, premise,
product, employer, professional, and general liability claims for
injury or wrongful death. We determine proximate and probable causes
of injury. We assess and report on first and third party liability
exposures based upon the facts that we receive. Where practicable,
we mitigate our customer’s loss by placing third party liability
exposures on notice of a potential claim, and make reason attempts
to investigate or recommend the retaining of an expert to obtain
evidence for indemnity, contribution and subrogation purposes. We
review medical records for statutory compliance, medical necessity
and possible recommendation for an independent medical examination.
Appraisals: Our Claims
estimate damage to private passenger automobiles and heavy equipment, including commercial
long-haul trucks and trailers. We use widely accepted estimating guides and software.
Total loss evaluations are based upon the results of researching
the cost of comparable vehicles in the local market. We can
extend our research beyond the local area at the customer's request. Our inspection reports and digital photographs enable salvage auction participants to bid confidently over the internet.
Appraisals: Our Claims
estimate damage to buildings through residential and commercial
construction guides such as the National Construction Estimator
modified to reflect local market material and labor rates. We appraise
residential and commercial buildings up to 50,000 square feet of
floor space for claims coinsurance purposes and underwriting valuations
for possible maximum loss. Replacement cost is calculated by valuation
guides provided by companies such as Marshall & Swift and Boeckh.
Compensation Claims: Our Claims
Adjusters and Accident Health Claims Analysts investigate the employment status
of the person making a claim for injury. We reasonably determine
as to whether or not the injury arose out of and during the course
of employment. Either we or our customer determine what benefits
are payable to an injured employee. We review medical records for
statutory compliance, medical necessity and possible recommendation
for an independent medical examination. We also meet with claimants
and their doctors periodically on claims involving extensive rehabilitation.
Health Claims: Our Accident
Health Claims Analyst
review medical records and offer an opinion on medical necessity
and appropriate CPT coding.
Arbitration: We are an authorized TPA on behalf of member clients for arbitration. Here are some advantages of arbitration: 1) Reduced Time and Expense: Arbitration usually takes less time and expense compared to litigation. There are no court costs, no legal fees and no membership fees associated with our services, just pre-negotiated service and filing fees. 2) No Hearing Attendance: There is no need for the member client to worry about attendance at hearings or presenting their case. We assist in verifying and presenting evidentiary documents. 3) Litigation Protection: Participating companies must give up litigation and use arbitration to resolve loss disputes. Participating companies are bound by the decision of one or more hearing officers. There are over 3,500 companies that cannot sue member clients for qualified insurance related losses. 4) Low Value Subrogation Claims: Many subrogation claims are forsaken as their recovery value does not justify litigation. The low cost of arbitration allows the pursuit of low value loss recovery.
Other Claims: Included in some of the above claims services and also separately, we adjust claims involving coverages of boiler and machinery insurance, builders risk insurance, construction defects insurance, inland marine insurance, GAP insurance, collateral protection insurance, vendors single interest insurance, forced placed insurance, lenders protection insurance, heavy equipment machinery insurance, fleet and cargo insurance, long haul trucking insurance, tractor-trailer insurance, Real Estate Owned (REO) claims, pollution legal liability insurance, underground storage tank insurance, directors and officers insurance, medical malpractice insurance, professional liability insurance, errors and ommissions insurance, employers liability insurance, bailee risk insurance, mechanical breakdown insurance, condominium insurance, renters insurance, business interuption insurance, additional living expenses insurance, flood insurance, earthquake insurance, FAIR Plans, mercantile and manufacturer's stocks insurance, arson investigation and detection, and subrogation and salvage recovery.
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