(877) 253-9994
Property Casualty - Workers Compensation - Accident
Health - Safety and Loss Control
Claims Administration and Risk Management Services
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Claims Services 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. Property 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. Casualty 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. Vehicle Appraisals: Our Claims Adjusters 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. Building Appraisals: Our Claims Adjusters 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. Workers 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. Accident 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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