Why do you need to be well-versed with the Claims Settlement Process?
If you’re an insurance carrier, you know clients who’ve been in vehicle accidents will be rattled after the experience. The last thing they need is delays from their insurer. But as we’ve all experienced, the claims settlement process can sometimes become a drag.
As a representative of the insurers, your USP is the turn-around time you offer. Swift assessments and decisions will earn you the appreciation of your clients.
What is Claim Settlement?
Claim settlement is the process by which an insurer pays money to the policyholder as compensation for an accident or vehicle injury.
Tools exist that allow you to automate the entire process. Claim Genius too has a wide array of AI-based tech for automating the claims settlement process. But to provide the best claims services, you need to have your eye on several balls at once.
The 4 stages of the claims settlement process
Right after the accident – The Carrier Steps In
At the accident site, immediately after the accident has taken place, the victim contacts the insurer directly or through the insurance broker agency.
Your job as a carrier at this stage is to take down all the facts as an unbiased third party. A carrier takes detailed notes, either in a notebook or through dictations on a smartphone. Photographs of the scene prove to be helpful, as they are obvious visual proof.
Meticulous records are kept, including the date and time of accident, contact details, licence plate and registration numbers of the other person’s vehicle.
Depending on whether the police are involved, the carrier notes down the contact details of the officer on scene, for later reference. Similar key details are recorded if medical staff is present on the accident site.
The claim is filed
The carrier then takes the case to the insurance agency. The accident claim is filed in the victim’s name after the details of the victim have been verified. While filing this claim, the person’s policy is reviewed against physical injuries and vehicle damage incurred by both parties.
If there are serious medical complications, the vehicle insurer will coordinate with the medical insurance company who’ll look after settling the medical coverage.
An adjuster is assigned
The adjuster is the person who becomes the single point of contact between the accident client and the insurance company.
Adjusters handle the many groups that branch out to study medical reports, investigate the accident scene, talk to witnesses if present, assess the vehicle damage, and start off the process of vehicle repairs and medical recuperations (known in the claims settlement process as ‘indemnification’).
Parallelly, the claim adjuster checks the client’s claim policy coverage which determines how much the person is liable to receive from their insurance.
Whose fault was it?
The last thing on your client’s mind after being in an accident is playing the blame game. They just want to recover from the accident and be reimbursed for any costs they had to bear as a result.
So, it becomes the insurer’s responsibility to see the claim settlement process through to its end. And part of it is determining who was at fault. This is crucial because the later stages of paying the claims policy depend on how liable each party is.
Typically, there are two broad criteria for determining fault. If both parties share an equal blame (50-50) or nobody was to blame, then the insurance agencies of both parties pay their respective clients. If one party was more at fault (say 60-40), then the policy pay-out is in proportion, with the larger share shouldered by the driver more at fault.
If the accident was caused wholly by just one driver, the claim settlement becomes much simpler, as that driver’s insurance agency pays in full.
What if the other party does not have an insurance policy?
Your insurance policy will give you coverage for such scenarios. It will be your insurer who becomes liable to pay the damages in full. However, the terms and conditions of such a policy differs from insurer to insurer. Your insurer may have specific clauses against collision cases, or up to specific amounts.
Beyond that, the insurer will approach the other party to seek damage reimbursement.
Claims payment disputes are settled
Until now, thorough investigations into each aspect of the accident claim are completed. Now the claims settlement process arrives at its final stage: settling the claims payment.
Armed with data from claim investigation stages, each insurance agency puts forth its demand of payment liabilities. Sometimes, if the figures and facts match, the settlement is made quickly and without hiccups.
If there are disputes about the claim liabilities, the insurers approach Arbitration Forums, a not-for-profit organization that specifically handles insurance disputes. Arbitration Forums appoints a panel which hears arguments from both parties, and ultimately has final say in the matter.
Can we help you?
These were the 4 primary stages of a typical claim settlement process. Depending on the insurance agency, there maybe additional intermediate steps.
But keep these broad-level steps in mind to have an overview of how the claims settlement is progressing.
Claim Genius has tools and mobile-based apps that can fast-track the claims settlement process. Our AI can speed up damage detection turn-arounds and give accurate vehicle inspection reports. If you want to know more about how we can help you further, write to us.
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Great informative blog.