Hi Chris
Great article , the focus on the fubndamentals is on the money and sometimes this can be forgotten or lost in the “noise” associated with the claim.
Back in the day when I worked in Construction Contract Management we had a mantra for evaluatiing Construction Contractual claims ticking each element to ensure that all was covered
C = Cause- what was the cause of the incident that has led to instigation of a claim .Detailed and contemporaeneous investigatiobn is required here.Is there anything associated with the “cause ” that may ring bells.
E = Effect – What is the effect on the contract .In insurance does the policy respond , are there any clauses that may effect indemnity one way or the other.
E = Entitlement – What is the claimants entitlement under the contract /policy once it responds . Monetary ,are there Limits of Indemnity etc.
S= Substatiation – Where is the back up ,documents ,evidence ,statements , CCTV , Locus Reports, bill of cost associated with mmedical expenses etc. Have they been reconciled and checked properly.
Each of the elements combined make up the whole ,back to fundamentals ,it may take time ,it can be frustrating sometimes but if its not done properly and comprehensively then you run the risk of exposure to leakage ,fraud and bad habits.
Hello Chris, this is article was very helpful! I appreciate the simplicity with which you explained the components/mechanics of exactly what a BI adjuster is looking for. It certainly addressed my question! Thanks again :-)
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Hi Chris
Great article , the focus on the fubndamentals is on the money and sometimes this can be forgotten or lost in the “noise” associated with the claim.
Back in the day when I worked in Construction Contract Management we had a mantra for evaluatiing Construction Contractual claims ticking each element to ensure that all was covered
C = Cause- what was the cause of the incident that has led to instigation of a claim .Detailed and contemporaeneous investigatiobn is required here.Is there anything associated with the “cause ” that may ring bells.
E = Effect – What is the effect on the contract .In insurance does the policy respond , are there any clauses that may effect indemnity one way or the other.
E = Entitlement – What is the claimants entitlement under the contract /policy once it responds . Monetary ,are there Limits of Indemnity etc.
S= Substatiation – Where is the back up ,documents ,evidence ,statements , CCTV , Locus Reports, bill of cost associated with mmedical expenses etc. Have they been reconciled and checked properly.
Each of the elements combined make up the whole ,back to fundamentals ,it may take time ,it can be frustrating sometimes but if its not done properly and comprehensively then you run the risk of exposure to leakage ,fraud and bad habits.
Hello Chris, this is article was very helpful! I appreciate the simplicity with which you explained the components/mechanics of exactly what a BI adjuster is looking for. It certainly addressed my question! Thanks again :-)