The first publication is a fictional story about insurance fraud called "The Great Jewel Theft", which is the first of more than 80 true crime stories that will be published on Substack and summaries of new insurance legislation appeal decisions.
Introduction to excellent claims management
In pursuit of profit, insurance companies have decimated their professional claims personnel. They laid off experienced staff and replaced them with young, untrained, unprepared people. A virtual clerk replaced the old professional claims manager. Process and computers replaced practical human skill and judgment. Money was saved by paying lower wages. Within three months after the experienced claims were fired, people's gross profit increased. A site for insurance claims professionals and anyone who wants to know something about insurance, insurance claims, insurance coverage and insurance legislation.
Insurance claims professionals are people who:
• can read and understand the insurances issued by the insurer. that the insurance provides and their obligation, as an insurer's claims staff, to fulfill the promises made.
• are competent investigators.
• have empathy and realize the difference between empathy and sympathy.
• understand medicine related to traumatic damages and is sufficiently familiar with tort law to deal with equal lawyers.
• understand how to repair damage to real and personal property and the value of the repairs or property.
An insurer whose claim staff consists of persons less than professional will find himself t. he is the subject of several instances of expensive, counterproductive litigation ster.
Excellent injury management program requires thorough training that gives each member of the injury staff the following:
1. How to read and understand the contract underlying each adjustment, including but not limited to:
a. The formation of the insurance policy.
b. The Rules of Interpretation.
2. Damages legislation including negligence, strict liability and intentional damages.
Contract law, including the insurance contract, the commercial or residential lease, the bill of lading, non-termination agreements, proof of loss, release and other claims-related agreements.
a. The insured's obligations and obligations in the event of a personal injury.
b. The insurer's obligations and obligations in a personal injury claim.
c. The insured's obligations and obligations in a first party's property claim.
d. The insurer's obligations and obligations in a first party's property claim.
4. The Fair Claims Practices Act and the provisions that maintain it.
5. The thorough investigation:
a. Basic investigation of a car accident.
b. Investigation of claims for construction defects.
c. Investigation of a claim for non-auto negligence.
d. Investigation of a strict liability claim.
e. Investigation of first party property claims.
f. The recorded statement from the first party's property applicant.
g. The recorded statement or interview of a third party plaintiff.
h. The insured's recorded statement.
i. The Red Flags of Fraud.
j. SIU and the Ombudsman's obligation in case of suspicion of fraud.
6. Claims report writing.
7. Evaluation and regulation of the personal injury claim.
8. How to maintain coverage advice to help when a coverage problem is discovered.
a. How to check coverage advice.
b. How to instruct coverage lawyers in the issue to be resolved.
9. To deal with a plaintiff's lawyer.
10. Dealing with personal injury defenders.
11. Evaluation and regulation of the claim for damages.
12. The evaluation process.
13. Arbitration and mediation and the tort representative.
Claim handling without excellence is both dangerous and expensive. Insurance companies should develop a professional claims staff and provide excellent claims management functions, as doing so will earn them more than if they have insufficient and unprofessional claims staff.
The series of videos will soon be available for a monthly subscription. The video here is a tease to the beginning of the courses which will last about an hour each.
Barry Zalma, Esq., CFE
Barry Zalma, Esq., CFE, now limits his practice to serve as an insurance consultant specializing in insurance coverage, insurance claims management, insurance fraud and insurance fraud almost equally for insurers and policyholders. He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as a lawyer for insurance coverage and claims management and more than 54 years in the insurance industry. He is available at http://www.zalma.com and email@example.com.
Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.
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