Insurance Adjusters, Administrators, Investigators, Safety Consultants<br />Advanced Technology… <br />Personal Attention<...
Thank you for viewing our presentation, we plan on covering the following topics<br />Trinity Insurance Services Group – A...
Trinity Insurance Services began operation in 1997 as an Independent Adjusting and Third Party Claims administrator, and h...
Trinity presently manages claims for both local and national accounts that generate losses in all types of P/C coverage<br...
Our Independent Adjusting Service Currently Covers The following Lines of Business:<br />Workers Compensation<br />Auto Li...
Trinity’s mission is to provide a comprehensive range of innovative insurance products and expert insurance and risk manag...
Since our Founding, we have expanded the scope of our services.  Currently, Trinity has four sister organizations:<br />Al...
Practice Protection Fund<br />Became operational in 2004, PPF is an insurance carrier designed to provide a cost effective...
Catastrophe Claim Handling<br />Orientation, General Guidelines, and Company Policies<br />For Adjusters and Examiners<br />
Each examiner and adjuster must become familiar with our Claims Management System Called ClickClaims<br />To Access the sy...
You will all be issued a user name and password to gain access to our claims management system<br />Once logged in, you wi...
The Claim File Status indicator is a system for managing the progression of the claim adjustment process within CMS and pr...
When a new file is added, the status will be 0 if an adjuster is not assigned or a 1 if an adjuster was assigned when the ...
The File Status Codes are as follows:<br />0 - Open - Not Assigned<br />1 - Assigned to Adjuster<br />2 - Adjuster Receive...
The tabs displayed at the top of every claim file in CMS and provide the "navigation" for the five parts of each file, whi...
The "Claim Summary" page provides details about the loss, the client, the assigned adjuster, and the insured. Most of the ...
Log notes are entered into the "Activity and History Page" and become a part of the permanent claim file. These "logs" inc...
When the user clicks "Add New File Activity Note or Subsequent Contact", a dialog box opens, allowing the user to type in ...
File Activity Notes Section<br />
File Activity – Cont’d<br />
The CMS "Activity Log" is where the relevant dates are recorded and displayed. Dates can be entered manually by the adjust...
Activity Log Section<br />
File Created - Auto: Date new file set up and CMS record created<br />Adjuster Assigned - Auto: Date file is assigned to a...
The "Indemnity and Billing" Page is where the adjuster enters the information needed to generate a client fee bill/invoice...
Billing Information Pane<br />
The adjuster expenses pane is where the adjuster enters adjustment-related expenses, to be included in the client invoice....
Adjuster Expenses Pane<br />
If the file is billed as a "Time and Expense" fee, the box below should be checked. Also, the adjuster is required to uplo...
T&E/CWOP Pane<br />
The document manager allows users to upload documents to a claim file, where they can be viewed, downloaded, and/or printe...
Permissions for the documents and document folders are setup as follows:<br />Administrative-level users can upload/view/d...
CMS provides "folders" for managing documents:<br />Loss Notice/Policy - the original assignment documents<br />Client Upl...
When a document is uploaded to the "File Documents" folder by the assigned adjuster and the checkbox is selected, as shown...
Click the "Upload" button to open the dialog box shown below, and type a short description of the file being uploaded. Cli...
Upload Documents Pane<br />
Once the upload process is complete, the page will auto-refresh and the uploaded file(s) will appear in the document folde...
File Documents Pane<br />
The Claim Review page is used to record notes and dates relating to the review process and provides a convenient area wher...
The file reviewer can enter information relevant to the review process, including details as to the reason the file is not...
Manager Review Pane<br />
Once the file reviewer has entered the first note, the adjuster can then enter a response notes into the "Adjuster Review"...
The adjuster comments should be brief and to the point, informing the manager that the required activities have been compl...
Adjuster Review Pane<br />
When the file review approves the file, the file status can be changed to “Closed”, if there are not further closing activ...
Adjuster Guidelines<br />
These are the requirements for handling claims for Trinity Catastrophe Services.  This represents Trinity’s policies and P...
Once the claim is received: <br />Make contact with the insured within 24 hours of receiving the assignment<br />Document ...
During your Inspection: <br />Photograph the front exterior and from each angle of the risk giving an overall view.  Get a...
Inspection – Cont’d<br />Obtain an agreement with the insured and insured’s contractor (if present) “in writing” on the sc...
When Completing Your Estimates:<br />Apply depreciation according to client instructions<br />Be mindful of Recoverable vs...
At the time of Submission, All Report Packages must include the following:<br />Photos<br />Diagrams<br />Coinsurance Valu...
When Preparing Your Narrative Report<br />Be sure that your report is being addressed to the Proper Party<br />Be sure tha...
When Submitting Your Reports:<br />Order your files as follows:<br />Documentation for mileage and expenses for Service In...
Report Submission – Cont’d<br />Report Packages Must be Uploaded into ClickClaims as a Single PDF.<br />While it will alre...
Examiner Guidelines<br />
Within 48 Hours of Receiving the Assignment, The Examiner Must Determine:<br />That the Adjuster is Aware of The Assignmen...
When Reviewing Estimates: <br />Ensure that depreciation was applied per Trinity’s guideline<br />Ensure that the photos a...
When Reviewing Reports:<br />The Examiner must ensure that all the topics requested in Trinity’s adjuster guideline are be...
Files that do not meet any of these standards must be marked “Adjuster Action Required”<br />If an adjuster is consistentl...
In instances where the standards are not being met, the supervisor must then advise the adjuster of the products deficienc...
After the estimate, report and supporting documents have been uploaded into the system and the supervisor has determined t...
General Guidelines<br />
The Customer is ALWAYS Right!<br />When the client goes to the trouble of saying that they want things done a certain way,...
A Few things to keep in mind when making contact with the insureds:<br />Make sure the contacts calls are informative and ...
We will not leave the damage assessment up to the insured or anyone else. It is our job to investigate and document the lo...
If there are Multiple causes of loss: If you run on to a wind loss that has burglary, looting, fire or another cause of lo...
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Trinity Catastrophe Orientation

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Orientation presentation (cat updated)

  1. 1. Insurance Adjusters, Administrators, Investigators, Safety Consultants<br />Advanced Technology… <br />Personal Attention<br />
  2. 2. Thank you for viewing our presentation, we plan on covering the following topics<br />Trinity Insurance Services Group – A Brief History<br />File Management System Usage<br />Catastrophe Claims Handling<br />Field Adjuster Guidelines<br />Inside Examiner Guidelines<br />Trinity’s Policy and Client Relations<br />Introduction<br />
  3. 3. Trinity Insurance Services began operation in 1997 as an Independent Adjusting and Third Party Claims administrator, and has subsequently expanded to other risk management services.<br />We have Currently Expanded our Operations to Include a nationwide network of Adjusters that is geared to handle all types of Property Casualty Claims<br />About Trinity Insurance Services<br />
  4. 4. Trinity presently manages claims for both local and national accounts that generate losses in all types of P/C coverage<br />Trinity distinguishes itself from other claims firms by offering cost-effective claims management coupled with the support of a state of the art, web enabled software system, which allows loss reports to be designed and issued on a 24/7 basis<br />Trinity Cont’d<br />
  5. 5. Our Independent Adjusting Service Currently Covers The following Lines of Business:<br />Workers Compensation<br />Auto Liability<br />General Liability<br />Commercial and Personal Property<br />Environmental<br />Professional Liability<br />Medical Malpractice<br />Products Liability<br />What We Do<br />
  6. 6. Trinity’s mission is to provide a comprehensive range of innovative insurance products and expert insurance and risk management services to insurance companies, self-insured corporations and governmental entities throughout the United States.<br />Since our founding, we have prided ourselves on our ability to stay ahead of the curve through the innovative use of technology<br />We have proven ourselves by employing knowledgeable staff to handle all of our client’s needs <br />We have distinguished ourselves by completing our work, regardless of its complexity, in a timely manner; and by providing this service anywhere in the country Twenty-Four hours a day and seven days a week<br />Our Philosophy<br />
  7. 7. Since our Founding, we have expanded the scope of our services. Currently, Trinity has four sister organizations:<br />Alternative Risk Solutions<br />Founded in 2002, this organization provides the cost containment services and expertise that help our clients control medical costs for their Workers Compensation Programs<br />American Excess Underwriters<br />Also Founded in 2002, this group is a Managing General Agency that specializes in the development of insurance programs that help insurance buyers address problems associated with rising premiums and limitations due to coverage availability <br />Trinity Insurance Services Group<br />
  8. 8. Practice Protection Fund<br />Became operational in 2004, PPF is an insurance carrier designed to provide a cost effective market for medical professional liability coverage that addresses indemnity, defense and loss control considerations in today’s complex risk environment<br />Trinity Catastrophe Services<br />Founded in 2005, TCS specializes in large-scale catastrophic losses. We are currently poised to handle CAT situations across the country<br />Sister Organizations - Cont’d<br />
  9. 9. Catastrophe Claim Handling<br />Orientation, General Guidelines, and Company Policies<br />For Adjusters and Examiners<br />
  10. 10. Each examiner and adjuster must become familiar with our Claims Management System Called ClickClaims<br />To Access the system go to https://trinity.clickclaims.com/<br />On the top right corner of every page there is a link to a User Guide<br />This is a Great Tool in Understanding How the System Works.<br />Before We Get Started…<br />
  11. 11. You will all be issued a user name and password to gain access to our claims management system<br />Once logged in, you will have access to your claim files<br />Located at the top of each claim file you will find five tabs that give access to the five parts of every CMS claim file.<br />System Usage<br />
  12. 12. The Claim File Status indicator is a system for managing the progression of the claim adjustment process within CMS and providing all company users (the File Status is not displayed in the Client View) with a quick and consistent means of determining where each file stands in the claim processing cycle. Each CMS file will have a status indicator, which at all times will be 1 of 7 possible status indicators<br />Claim File Status Indicator<br />
  13. 13. When a new file is added, the status will be 0 if an adjuster is not assigned or a 1 if an adjuster was assigned when the file was added. The CMS system will auto-record the date and time that the assigned adjuster first opens each of his assigned files, and the file status will at that point change to a 2 (Adjuster Received and Working). This action and date on which it occurred will be recorded and displayed on the Claim Summary page, in the adjuster section<br />Status Indicator – Cont’d<br />
  14. 14. The File Status Codes are as follows:<br />0 - Open - Not Assigned<br />1 - Assigned to Adjuster<br />2 - Adjuster Received/Working<br />3 - Pending Manager Review<br />4 - Approved for Closure<br />5 - Adjuster Action Required<br />6 - File Closed <br />Status Indicators – Cont’d<br />
  15. 15. The tabs displayed at the top of every claim file in CMS and provide the "navigation" for the five parts of each file, which are:<br />Claims Summary - basic claim information about the insured, client, adjuster, loss, etc<br />Activity/History - activity log and date tracking<br />Indemnity/Billing –adjuster records indemnity that accounting uses to create the invoice<br />Manage Documents – upload, view, manage all claim documentation<br />Claim Review – file reviewers document the review process<br />The Claim Tabs<br />
  16. 16. The "Claim Summary" page provides details about the loss, the client, the assigned adjuster, and the insured. Most of the information found on this page will be entered when the claim file is first created in CMS, however, not all fields are required at setup details may be added edited later. <br />Claim Summary Screen<br />
  17. 17. Log notes are entered into the "Activity and History Page" and become a part of the permanent claim file. These "logs" include the Notes Log, in which all activities are entered by the adjuster, the claims, manager, clerical personnel, and any other users that have information pertinent to the claim. Log notes are also auto-recorded when certain actions are taken, such as when the claim is created, reopened/reassigned, etc.<br />Activity/History Page<br />
  18. 18. When the user clicks "Add New File Activity Note or Subsequent Contact", a dialog box opens, allowing the user to type in notes. The typed characters are counted as they are typed, and each note log allowed for 5,000 characters. There is no limit on the number of notes that can be added by any one user, nor in total.<br />When the user clicks "Submit" the typed note is recorded and cannot be edited, nor deleted by any user. The notes are displayed in chronological order (most recent added to bottom), along with the name of the person that made each note, and the time and date entered.<br />Activity/History – Cont’d<br />
  19. 19. File Activity Notes Section<br />
  20. 20. File Activity – Cont’d<br />
  21. 21. The CMS "Activity Log" is where the relevant dates are recorded and displayed. Dates can be entered manually by the adjuster when he completes certain activities, such as the loss inspection; by the administrator, when certain activities are completed, such as the date of the claim review; or automatically, such as the date the file was created in CMS, and the date the adjuster firsts opens each claim file Manual date fields will display a calendar icons for selecting the date.<br />Activity/History – Cont’d<br />
  22. 22. Activity Log Section<br />
  23. 23. File Created - Auto: Date new file set up and CMS record created<br />Adjuster Assigned - Auto: Date file is assigned to adjuster<br />Adjuster Received - Auto: Date assigned adjuster first logs into file record<br />Diary Date – Manual: Allows the adjuster to set a diary for follow up.  The diary will pop into the user’s Dashboard on the selected date.<br />Initial Contact - Manual: Date adjuster makes first contact with insured.  The adjuster should also enter the Contact Type and any appropriate notes.<br />Loss Inspected - Manual: Date adjuster physically inspects loss<br />Adjustment Completed - Auto: Date the most recent file document was uploaded<br />Pending Manager Review – Auto: Date the claim is marked Pending Manager Review<br />Approved for Closure – Auto: Date the claim is marked Approved for Closure<br />Adjuster Action Required – Auto: Date the claim is marked Adjuster Action Required<br />Manager Review – Manual: Date the manager reviews the claim<br />Adjustment Completed – Auto: Date the claim is marked Adjustment Completed (via the upload of document(s) by the adjuster)<br />File Reviewed - Manual: Date initial claim review performed<br />File Closed - Manual: Date file is approved for invoicing and client submission<br />Activity Log – Cont’d<br />
  24. 24. The "Indemnity and Billing" Page is where the adjuster enters the information needed to generate a client fee bill/invoice and where the manager creates the client invoice.<br />The adjuster should enter values into the applicable fields below, along with a description for the "Other Costs" (if a value is entered), then click the "Update Totals." The manager will use these values to determine the "Fee Schedule Amount" to be billed to the client, based on that client's applicable fee schedule.<br />Indemnity/Billing Page<br />
  25. 25. Billing Information Pane<br />
  26. 26. The adjuster expenses pane is where the adjuster enters adjustment-related expenses, to be included in the client invoice. The mileage and photos should be entered as the actual number for each, rather than the dollar value. All other fields require a dollar value entry, with the text description for each entered to the right for each value.<br />When all expenses have been entered, the adjuster will click the "Update Totals" button above, to calculate the total, which is then displayed below the value fields in the "EXPENSES TOTAL" field. <br />Indemnity/Billing – Cont’d<br />
  27. 27. Adjuster Expenses Pane<br />
  28. 28. If the file is billed as a "Time and Expense" fee, the box below should be checked. Also, the adjuster is required to upload the "T&E" Billing Sheet to the "Manage Documents" folder. The manager will use this information to create the client invoice.<br />If the file is to be closed without payment to the insured (CWOP), the adjuster must select the reason for the CWOP from the options shown on the next slide.<br />Indemnity/Billing – Cont’d<br />
  29. 29. T&E/CWOP Pane<br />
  30. 30. The document manager allows users to upload documents to a claim file, where they can be viewed, downloaded, and/or printed by any user having access to the document folder for that file.<br />Manage Documents Screen<br />
  31. 31. Permissions for the documents and document folders are setup as follows:<br />Administrative-level users can upload/view/delete file documents <br />Adjusters can upload/view file documents in files assigned to that adjuster<br />Client users can upload/view documents in files opened under a client company to which that user is associated (when a clients uploads a document, an email notification is sent to the adjuster and the support email address and that claim is displayed as a Home Page Alert (HPA) on the dashboard of the adjuster and the admins. Client view access can be denied by admins, via the Claim Review area.<br />Manage Documents – Cont’d<br />
  32. 32. CMS provides "folders" for managing documents:<br />Loss Notice/Policy - the original assignment documents<br />Client Uploads – documents uploaded by a client user<br />Zip Files – large/multiple documents that are zipped together using the WinZip tool at the top of the page.<br />Invoices – client invoices created in CMS<br />Reassignment/Reopen Records - a .pdf is created and auto-stored within CMS when a file is reassigned or reopened. This document becomes a permanent record of the claim file, as it were at the time of reassignment or reopen.<br />Manage Documents – Cont’d<br />
  33. 33. When a document is uploaded to the "File Documents" folder by the assigned adjuster and the checkbox is selected, as shown in the slide after next), this process triggers several actions in ClickClaims, including sending an auto-email to the file reviewer/claims manager, signaling that the claim file is ready for "Claim Review." It also changes the File Status from "2 - Adjuster Received and Working" to a "3 - Pending Manager Review." The file "Completed Date" will auto-fill with the current date.<br />Manage Documents – Cont’d<br />
  34. 34. Click the "Upload" button to open the dialog box shown below, and type a short description of the file being uploaded. Click "Browse" to locate the file on your local computer, highlight that file, then click "Open" in the search box to add the file path to the box to the left of the "Browse" button. You can then click "Upload" to begin the upload process. The upload time will depend on the size of the file (s) and the speed of your Internet connection<br />Upload Documents Pane<br />
  35. 35. Upload Documents Pane<br />
  36. 36. Once the upload process is complete, the page will auto-refresh and the uploaded file(s) will appear in the document folder, as shown in the next slide. ClickClaims will auto-record and display the date and time of each upload, along with the ClickClaims user name.<br />Manage Documents – Cont’d<br />
  37. 37. File Documents Pane<br />
  38. 38. The Claim Review page is used to record notes and dates relating to the review process and provides a convenient area where the adjuster and file reviewer can collaborate, exchanging details about the review process, in place of telephone calls and emails that do not get recorded into CMS for future reference by these and other parties<br />File reviewers should record the review date when the file review process commences. The page includes a “flag” that should be checked when the file review begins. This will mark the file as being under review, eliminating duplication of the file review by two or more persons. Files with the flag checked will display on the dashboard with a yellow “!” marking<br />Claim Review Tab<br />
  39. 39. The file reviewer can enter information relevant to the review process, including details as to the reason the file is not being approved, and what actions should be taken by the adjuster to bring the file into compliance. Submitting a manager review note will change the file status from “Pending Manager Review” to “Additional Action Required” and will send an email to the adjuster and place a Home Page alert on the adjuster’s dashboard.<br />Manager Review Notes<br />
  40. 40. Manager Review Pane<br />
  41. 41. Once the file reviewer has entered the first note, the adjuster can then enter a response notes into the "Adjuster Review" notes area below. Please note that the "Add New Adjuster Comment" feature is not displayed until the file reviewer has entered the first comment (in other words, the adjuster cannot enter comments until the manager enters their comment first).<br />Claim Review – Cont’d<br />
  42. 42. The adjuster comments should be brief and to the point, informing the manager that the required activities have been completed and that the file is ready for review. When the adjuster submits his comments, the manager will again receive an auto-email, letting him know that the file is ready for review. The comment will also trigger the File Status to become "3 - Pending Manager Review" and the file will appear on the admin’s dashboard under PMR.<br />This process may be repeated more than once, until the file reviewer determines that the file is meets all review criteria and can be approved for closure.<br />Claim Review – Cont’d<br />
  43. 43. Adjuster Review Pane<br />
  44. 44. When the file review approves the file, the file status can be changed to “Closed”, if there are not further closing activities required. In most cases, the procedure will be for the file reviewer to change the status to “Approved For Closure” (AFC), which prompts other users to initiate the closing activities, which may include creating the invoice. Once all required closing activities have been completed, the file should be closed in CMS by changing the status and entering the current date in the “Closed” field.<br />Closing the File<br />
  45. 45. Adjuster Guidelines<br />
  46. 46. These are the requirements for handling claims for Trinity Catastrophe Services. This represents Trinity’s policies and Procedures. These items must be adhered to, and will ensure prompt payment for the services you are rendering for us.<br />The First Rule For Handling claims for our company is to be aware of any specific instructions the particular client has.<br />These instructions will be uploaded in the click claims system.<br />Your Reports Will Be Rejected if They Do Not Follow the guidelines from Both Trinity AND the client<br />Field Adjuster Guidelines<br />
  47. 47. Once the claim is received: <br />Make contact with the insured within 24 hours of receiving the assignment<br />Document the contact in the clickclaims system<br />Arrange the inspection<br />Document the appointment date in the clickclaims system<br />Get details regarding the loss from the insured<br />Document the electronic file with notes on the conversation<br />Complete the inspection within (preferably) 48 hours of receipt of the assignment<br />If you are unable to schedule the inspection within that time frame, place notes in the electronic file detailing the conversation and that the insured understands when the inspection will take place<br />Any other conversations with the insured or other parties must be documented in the electronic file<br />Adjuster Guidelines – Cont’d<br />
  48. 48. During your Inspection: <br />Photograph the front exterior and from each angle of the risk giving an overall view. Get a Photo Of The Address As Well <br />Measure and diagram the entire risk. This must be done on every inspection, no exceptions<br />Take complete dimensions for every room where there is damage<br />Photograph all damage that you plan on including in your estimate<br />In addition to an up-close shot of the damage, and overall shot of it will be needed as well<br />Roof Photos MUST be taken from on top of the roof, with two exceptions:<br />Climbing the roof is unsafe<br />In this instance, the photos can be taken from the roof’s edge<br />The building is too high<br />In this instance, you will need to complete your inspection and prepare an initial estimate and report to include what you believe to have been damaged by the event. You will then have to arrange a re-inspection with a roofer and prepare a supplement detailing the actual damage to the roof.<br />Adjuster Guidelines – Cont’d<br />
  49. 49. Inspection – Cont’d<br />Obtain an agreement with the insured and insured’s contractor (if present) “in writing” on the scope of damage<br />Do not discuss ANY coverage issues with the insured, however, do make note of them for reporting purposes.<br />Obtain and documentation concerning repair invoices, additional living expenses, contents, etc. from the insured at the time of your inspection.<br />Obtain a Sample of the Flooring, in case lab analysis is needed<br />Obtain the information needed to complete a coinsurance valuation. This includes, but is not limited to:<br />The complete Square Footage of the Risk<br />The Age of The Risk<br />The Overall Condition of the Risk<br />The Type of Building Materials used in the Risk’s Construction<br />Special features (i.e. fireplaces, bars, patios, decks, porches, etc.)<br />The type of HVAC System Used<br />Once The Inspection is Completed, You Must Update the Reserves in Clickclaims<br />Adjuster Guidelines – Cont’d<br />
  50. 50. When Completing Your Estimates:<br />Apply depreciation according to client instructions<br />Be mindful of Recoverable vs. Non-Recoverable Depreciation<br />Detail every repair operation as a line item in your estimate <br />Do not include any line items that encompass multiple operations)<br />Prepare Diagrams of Both the Perimeter and Roof of the Risk<br />Apply Overhead and Profit when the repair operations exceed three trades and a General Contractor is involved. The trades that are not subject to O&P are:<br />Roofing, Flooring, Fencing, and<br />any operations that are contracted separately from the general contract<br />Mount and Label all Photos that you intend to receive payment for<br />Adjuster Guidelines – Cont’d<br />
  51. 51. At the time of Submission, All Report Packages must include the following:<br />Photos<br />Diagrams<br />Coinsurance Valuation – On every loss regardless of size, merit, perceived necessity, and client instructions<br />Statement of Loss<br />Bills/Invoices, Official/Expert Reports, Any and All documentation received from the insured during your inspection<br />This item MUST NOT hold up the submission of the other documentation.<br />Excuses like: “I’m waiting on the contractors estimate, to submit the report package” Will not be accepted.<br />Your Estimates and Reports Need to be able to stand on their own merit, or they are useless to us. <br />We would not be asked to tell a roofer how to nail shingles. On that same token, we should not rely on that same roofer to tell us how to handle an Insurance Claim.<br />Trust that it is easier to explain a mistake that you might or might not make, than it is to explain why you are not doing your job<br />Adjuster Guidelines – Cont’d<br />
  52. 52. When Preparing Your Narrative Report<br />Be sure that your report is being addressed to the Proper Party<br />Be sure that the Report references the proper claim<br />All reports must have captions that comment on the following:<br />Risk Identification – Covers Policy Holder Info, and Property Description<br />Coverage Verification – Detail what coverage form is being used and whether or not the loss applies, also detail the amount of the deductible<br />Insurable Interest – Detail all of the parties that would be able to collect on this claim. As well as the named insured, the most common additional insured is the mortgagee<br />Coinsurance Compliance – State the value of the dwelling and apply the coinsurance calculation<br />Facts of Loss – Detail the what, when, where, why, and how of the claim. Also detail damage that is being claimed but may not be related.<br />Scope and Estimate – In general terms, describe the damage to the dwelling. Detail the amount of the estimate (ACV and RCV)<br />Reserve – Provide an amount that allows for the amount of the estimate and and any potential supplements.<br />Recommendations – Do Not Recommend that the Client Pay based off your estimate. This is where you advise if a re-inspection is anticipated, whether a different contractor should be used, whether an engineer is needed, etc.<br />Remarks – Provide a closing Statement.<br />Adjuster Guidelines – Cont’d<br />
  53. 53. When Submitting Your Reports:<br />Order your files as follows:<br />Documentation for mileage and expenses for Service Invoice-( if necessary)<br />Adjusters log / activity notes<br />Narrative Report<br />Estimate<br />Photos,<br />Diagram, <br />Check Request Form <br />Payment letter<br />This is the General Requirement for File Order. Be Aware that this may vary from client to client. If a particular client has different instructions, the information will be uploaded in ClickClaims.<br />Adjuster Guidelines – Cont’d<br />
  54. 54. Report Submission – Cont’d<br />Report Packages Must be Uploaded into ClickClaims as a Single PDF.<br />While it will already be included in the report package, a copy of the narrative report must also be uploaded as an MS Word (.doc) document<br />In addition to the above, a copy of the claim file that was prepared in your estimating software must be uploaded. <br />This will likely be in either a .esx format for Xactimate, or a .dds format for IntegriClaim.<br />Instructions for doing this will be uploaded in the Click Claims System.<br />Adjuster Guidelines – Cont’d<br />
  55. 55. Examiner Guidelines<br />
  56. 56. Within 48 Hours of Receiving the Assignment, The Examiner Must Determine:<br />That the Adjuster is Aware of The Assignment<br />That Contact with The insured Has been Attempted<br />That The Conversations Are being documented in the system<br />It is important that the examiner ensures that the dates for: contact made, appointment made, and inspection completed are entered in the proper place.<br />It is also very important that within 24 hours of the inspection, the reserves are updated<br />Examiner Guidelines<br />
  57. 57. When Reviewing Estimates: <br />Ensure that depreciation was applied per Trinity’s guideline<br />Ensure that the photos are mounted and labeled<br />Ensure that the file includes, a perimeter diagram, a valuation, addresses co insurance and, a roof diagram.<br />Ensure that all the documents required by Trinity’s guideline are included and uploaded as a single PDF File<br />If the documents are not included in the published fashion, the adjuster must be advised to make the necessary corrections<br />Make sure that the adjuster uploads the .DDS file (for IntegriClaim) or the .ESX file (for Xactimate) in case any minor corrections to the estimate need to be made and can be done so from your desk.<br />Examiner Guidelines – Cont’d<br />
  58. 58. When Reviewing Reports:<br />The Examiner must ensure that all the topics requested in Trinity’s adjuster guideline are being included in the narrative report.<br />Above all, the reports must make sense. This means that they must be written in proper English, with correct grammar and spelling utilized.<br />If the Narrative report says what it needs to say and it makes sense to you while you are reading it, then it should be ok for release to the client.<br />Again, be sure to review and understand the adjuster guidelines on this subject as well.<br />Examiner Guidelines – Cont’d<br />
  59. 59. Files that do not meet any of these standards must be marked “Adjuster Action Required”<br />If an adjuster is consistently not following our standards, advise Harrie Wilson so that disciplinary action can be taken<br />Every Supervisor must ensure that he or she has both read and understood the applicable claim handling instructions in the Clickclaims global documents section<br />EVERY adjuster, without exception, must follow these instructions<br />Examiner Guidelines – Cont’d<br />
  60. 60. In instances where the standards are not being met, the supervisor must then advise the adjuster of the products deficiency, make a note in Clickclaims that the adjuster was so advised, and mark the file “Adjuster Action Required”<br />In order for these claims to be successfully handled in the most organized fashion as possible, the system has to be utilized to its fullest extent. Again, there will be no exceptions to this rule.<br />Examiner Guidelines – Cont’d<br />
  61. 61. After the estimate, report and supporting documents have been uploaded into the system and the supervisor has determined that the product meets Trinity’s published standard, then the invoice data must be reviewed to ensure that it is accurate and meets the guidelines set forth in the client’s fee schedule.<br />Once this is completed, the file can be marked “Approved For Closure” and sent for invoicing<br />Examiner Guidelines – Cont’d<br />
  62. 62. General Guidelines<br />
  63. 63. The Customer is ALWAYS Right!<br />When the client goes to the trouble of saying that they want things done a certain way, WE DO IT THAT WAY, whether you think it should be done that way or not.<br />It is crucial that we keep all of the information to be found within a claim file updated, as any of our clients may need to know this information at a moments notice. So please, PLEASE update your files when any contacts are made and when any work is completed.<br />Answer the phone EVERY time it rings. Someone probably needs help and we should try to help them.<br />If an insured calls looking for their adjuster and is not able to reach them, the call will go to the examiner<br />If the examiner is not available, the call will go to Harrie Wilson<br />DO EVERYTHING IN YOUR POWER TO KEEP THE INSURED FROM HAVING TO CALL THE CLIENT.<br />General Guidelines<br />
  64. 64. A Few things to keep in mind when making contact with the insureds:<br />Make sure the contacts calls are informative and the insured understands the process<br />Take that extra 90 seconds to answer the insured’s questions. The adjuster should leave their name and contact phone number or at the very least, the office phone number for contact<br />Return all phone calls the same day that they are received, no exceptions for anyone on this.<br />Explaining this on the front end will help all those involved in the claim, insured and claim representative alike.<br />If you leave a message for the insured, either leave a phone number or call back frequently.<br />General Guidelines – Cont’d<br />
  65. 65. We will not leave the damage assessment up to the insured or anyone else. It is our job to investigate and document the loss. <br />If the insured is certain or states that they DO NOT have ANY damage, we ask that you identify to whom you were speaking and document the file as clearly as possible<br />Flood / Wind issues: Adjusters must contact their supervisor immediately. This needs to be reported to the client. We need photos of any visible flood line and the adjuster should document all damage (don’t include it in the wind estimate, but make note of it - similar to working a flood file).<br />General Guidelines – Cont’d<br />
  66. 66. If there are Multiple causes of loss: If you run on to a wind loss that has burglary, looting, fire or another cause of loss, these will be consider separate events, thus a new loss must be set up. <br />The client needs to be informed of this as soon as possible<br />Accurate documentation of the ‘other’ peril loss is extremely important on these files in order to delineate damage.<br />General Guidelines – Cont’d<br />

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