Carrier claims-practice reviews and audits.

Reviews of a claims operation as a whole: staffing, policies & procedures, reserving, controls, and settlement practices, across a book of files rather than a single claim.

Defense of TPAs, Agencies, and Counsel Carrier claims-practice reviews & audits

About this practice area

Reviewing a claims operation as a whole.

A carrier-level review looks past the individual claim to the operation that produced it: how the claims department is staffed and supervised, what its written policies and procedures require, how reserves are set and revised, what controls exist over payments, and whether settlements are fair and consistent across the book.

These reviews are commissioned by the carrier or its counsel, by a regulator during an examination, by the receiver of a failed insurer, or by a party to litigation in which the company’s practices are at issue. They usually rest on a sample of files scored against a consistent standard, so that findings can be stated for the operation as a whole.

When an insurer fails, the same questions go to the cause of the failure: whether reserving, claim handling, and communication with claimants met regulatory and industry standards.

A carrier's building with its claims floor lit, each of its files drawn out to a findings document with one finding flagged amber, closed with one solid mark

Engagements

Reviews and audits across the book.

GIC works file by file, scores the handling against the applicable standard, and ties every opinion to the record.

Testifying expert · Report, Deposition, Trial

Three-month trial over a failed insurer’s directors and outside auditor

$2Bplea in the case

265claim files scored

800+page report

Receiver’s expert

Two-year run-off plan for all claims activity

2-yearoperational plan

10,000sof claims evaluated and paid

Reinsurance and run-off

Reserve studies

Almost everyline of business

Trialtestimony in receivership proceedings

Reserve studies

Other matters

Centralizing environmental, asbestos, and toxic tort claims nationallyConsultingCarrier claims-practice reviewsRead moreShow less

Designed and operationalized a national claims operation to remove CNA’s environmental, asbestos, and toxic tort claims from the 37 field offices and centralize them. This project involved the relocating of tens of thousands of claim files, their proper and adequate reserving, and drafting claim policy & procedure manuals.

Also listed under: Claims & Reserve Auditing

Reserve review of a taxicab risk retention groupTestifyingReserve studiesRead moreShow less

Retained as an expert to review the held reserves of a taxicab risk retention group. Upon Mr. Bingham’s final report of audited claim files, the group was ordered into liquidation.

Also listed under: Reserve adequacy studies · Reserve studies for carriers

Review of a claims department’s staffing, procedures, and settlement practicesTestifyingCarrier claims-practice reviewsRead moreShow less

Completed reviews and expert reports assessing propriety of Subject Company’s claim department’s staffing, claims handling policies & procedures, and overall fairness of Company’s claim settlement practices.

Also listed under: Fair claims practices and standards of care · Reserve adequacy studies · Claim audits and file scoring

Day-to-day representative of a court-appointed supervisorConsultingSupervisionRead moreShow less

Retained by the Oklahoma Insurance Department’s Receivership Office to be the day-to-day representative of the court-appointed supervisor of an insurance company: conducting a reserve audit, analysis of the claim operation, and approval of claim payments, with responsibility for a number of other tasks including compliance, reinsurance recoveries, and financial statements, reporting to the supervisor the results of the examination of the company’s operations.

Also listed under: Claims & Reserve Auditing · Regulatory Consulting · Receivership & Insolvency Issues

Environmental claim book: reserves, coverage triggers, and allocationTestifyingCarrier claims-practice reviewsRead moreShow less

Retained by a Property and Casualty carrier to review a book of environmental claims and determine reserve adequacy, coverage triggers, and allocation, propriety of investigations and file documentation as well as apportionment of defense and remediation costs. The final report included expert opinions on claim handling and file documentation.

Also listed under: Reserve adequacy studies

Defense of TPAs, Agencies, and Counsel

The defense of claims professionals when their own handling is the allegation: third-party administrators, insurance agencies, and defense counsel.

View Defense of TPAs, Agencies, and Counsel →

Carrier claims-practice reviews and audits.

Reviewing a claims operation as a whole.

Reviews and audits across the book.

Three-month trial over a failed insurer’s directors and outside auditor

Two-year run-off plan for all claims activity

Reserve studies

Other matters

Elsewhere in Claims Handling Review.

Defense of TPAs, Agencies, and Counsel

Have a matter that involves claims handling?