Surveyors/Accountants/Consultative Experts:  Not all loss surveyors and forensic accountants are the same.  These are the data gatherers on behalf of the insurers.  Their expertise can vary greatly from little experience to being an authority in the field.  Because of this, the content of their reports varies greatly but shapes the outcome of the loss payment or whether a claim will be paid at all.  CRC’s claim staff devotes a great deal of coordinating and collaborative effort to ensure that the report content is unbiased, accurate, and truly reflective of the loss conditions.  Many claims are made or broken at this stage, because of how report information influences an insurance company adjuster’s judgment..

Company Adjusters:  Insurance company adjusters are not the same as surveyors and the two should never be confused.  The adjusters receive survey reports, financial data from accountants and technical reports from expert consultants.  The adjuster, on behalf of the insurance company, reviews all the data and makes a determination as to whether the loss is covered, whether the claim will be paid and how much will be paid.  It is a fact.  Not all adjusters have the same knowledge and expertise.  It takes a lot of training and experience to handle claims effectively and efficiently.  

Again, CRC’s claim staff devotes a great deal of coordinating and collaborative effort to ensure that policy language is properly interpreted by adjusters, that surveys and other reports are accurately interpreted, and that the adjuster has effectively coordinated with the underwriter.  Misinterpretation by the adjuster can be disastrous, primarily because the wrong decision leads to intractable face saving, when a reinterpretation of the facts is requested.

Underwriter:  Most insurance companies do not want underwriters involved in claim-settling activity.  Those insurers who do allow underwriter involvement produce a much higher degree of policyholder satisfaction.  Adjusters are almost never involved in the underwriting side.  However, adjusters interpret the intent and meaning of insurance contracts.  The one sure way to avoid disputes over intent and meaning is to engage the underwriter to find out what was intended when the policy was underwritten.  CRC is not shy about getting underwriters involved and many coverage disputes have been avoided at an early stage as a result.

Client:  Yes.  Clients need to be involved in the claim process.  CRC’s long experience in handling claims has shown that a client’s expertise is vital and invaluable in ensuring an effective and efficient process, especially in providing expert input on losses involving income-producing goods.  Some policyholders take a hands-off approach.  This is wrong and counter-productive.  CRC’s claim staff can not emphasize enough the benefits of client involvement in the claim process.