Claims Advocacy

Claims Advocacy is an essential element of claims mitigation.  Generally, it describes efforts to assert our client’s interests with respect to claims and claim related issues.  We view advocacy as a collaborative process between the client and insurer.

A schematic of the claims advocacy services appears below.

First Reports

We process first reports on all claims, except workers compensation claims, unless handled by a Third Party Administrator (TPA).

Claim Inquiries

A claim inquiry is any ad hoc claim related request for information.  Once the request is addressed, no further action is taken.

Referral Claims

A Referral Claim is any significant claim as defined by the client.  Once assigned, a Claim Advocate is involved until the claim is resolved.  The Advocate’s role is as follows:

  1. Collaborate with the client and adjuster on a resolution strategy;
  2. Identify and pursue non-insurance third party recoveries;
  3. Monitor reserves on a most likely outcome basis;
  4. Resolve coverage denials and reservation of rights letters; and
  5. Secure excess recoveries.

Claim Review Meetings

Claim review meetings are conducted in accordance with client’s service plan.  We treat each claim reviewed at a claim review meeting as a point-in-time Referral Claim and advocate accordingly.

TPA Management

Third Party Administrator (TPA) management is described in the schematic below.