The policyholder, broker, claims preparer, insurer and loss adjuster are all parties to an insurance claim for Property Damage and Business Interruption. The Policyholder is the key party. He/she is the reason the others exist.
In the event of a loss the Policyholder’s first telephone call is usually to their insurance broker. Often the broker will notify two parties, first the insurer and then the claims preparer. The insurer normally instructs a loss adjuster to act on its behalf.
The roles of the various parties differ from one claim to the next but the following roles are often taken to facilitate an efficient claims settlement.
The Policyholder
Works co-operatively with the claims preparer and loss adjuster. Provides full description of the property damage and detailed explanations of the impact of the loss on production, stocks, sales and customers. Provides documentation to the claims preparer in the format requested. Remains actively involved in all discussions and gains a thorough understanding of the insurance policy.
The Broker
Oversees the functions being performed by the loss adjuster and claims preparer. Ensures the documentation flow between the insured, claims preparer, loss adjuster and broker proceeds in a timely manner. Remains actively involved in the claim. Co-ordinates meetings between the various parties if necessary.
The Claims Preparer
Obtains a clear understanding of the nature of the Policyholder’s business, the extent of the property loss and the impact on production, stocks and sales. Reviews the insurance policy and provides the insured with a precise understanding of how the policy is likely to respond to the loss. Gathers the appropriate information, prepares the claim and presents this to the insured and then the loss adjuster and insurer. Remains actively involved in the claim process.
The Insurer
Reviews reports from the loss adjuster in a timely manner. Processes progress payments promptly. Attends claim meetings on key issues.
The Loss Adjuster
Gains an understanding of the business, extent of loss and insurance cover. Prepares an estimate of the likely loss for the insurer, reviews claims on a timely basis and recommends the insurer makes progress payments at the earliest opportunity.
Author
Published with permission of Claim Solutions Pty Ltd.
Insurance Policy
Country: - Australia
Policy Description: - Mark IV Industrial Special Risks (ISR) policy
Insurer: - Various
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