Quality Insurance Claims Documentation Guidelines

By James DeRosa | February 20, 2014

“If it’s not documented in the file, it doesn’t exist” is a very well-known saying in the insurance claims world. Documentation is important to every insurance claim file to ensure a proper outcome. A well-documented claim not only tells a full story but also allows claim managers to make the right decisions with ease.

employee working on computerA claims system that supports adjusters in proper documentation is critical to insurers to have hard facts on damages, coverage, liability, etc. This allows efficient time management, especially if a claim is moved to a new adjuster.

Claim documentation should be approached with care. Several claim adjusters weighed in with their thoughts of a few tips adjusters should keep in mind when documenting claims.

  • Log all notes! Every call, meeting, inspection, etc. should be noted on the claim.
  • Date stamp all photos. This gives a backup record outside of the entry date of when a photo was taken. In addition take advantage of the video option on cameras for sound recordings that can be included in the file.
  • Make documentation training high priority and continuous. As claims get more complex adjusters should always be aware of the latest and greatest claim documentation techniques.
  • When looking to upgrade a claims management system real time documentation should be a key feature on your checklist. Make sure that your claims system will trigger a prompt to save all records, including phone calls, emails, and messages.
  • Implement audits before files are moved to a new department. A checklist of standard documents that should be in each file before moving to a new department is a great training tool for new adjusters, and interns.
  • Spell Check! Spelling errors can easily change the meaning of a note. Re-reading and spell checking notes keeps files accurate.
  • Notes should be kept factual and not emotion based. For example statements like “the client was very upset” should not be added into notes unless it was directly quoted by the client. If it was not actually said by the client it is an assumption and opinion based not factual information.

Documentation guidelines should be clear and concise for everyone to understand. The end goal for every claims adjuster is to resolve claims in a timely fashion. Keeping updated diary notes and documentation in a claims system will allow adjusters to create a well-planned strategy to resolve a claim. This reduces the risk of loss, fraud, and provides a permanent storage of each claims data.

What additional tips would you add to this checklist?

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About James DeRosa

James DeRosa the founder/CEO of JDi Data Corporation, has successfully developed innovative technology software solutions for company growth and client satisfaction in the insurance industry for carriers, risk managers, third party administrators and public entities. Learn more at www.jdidata.com. More from James DeRosa

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