Claims Reports & Applications - Additional Information
Overview
The On-line Claims System has been developed to enhance delivery of the CAR
Claim Reviews to the Servicing Carriers. Upon the completion of a Claim
Review one recipient designated by the Servicing Carrier will be notified
by e-mail from a member of the CAR Claim Department that the company's
review is available on the CAR website with a link to the website being
provided. At this time the review may be accessed by the designated
recipient. Delivery in this manner saves time and paper. In addition,
links are provided to allow for immediate access to the Summary of
Review, worksheets, Total Loss Register, and the Insurance Claim
Payment Intercept Program Results. A response to the Claim Review
is requested within 30 days.
General Information
Claims Summary of Review Table
The Claims Summary of Review table is a listing which provides a link to a
Company's Review. Information included is:
- Review Year - Each Review Year available is highlighted in blue,
which is a link to the actual Summary of Review.
- Company Number
- Company Response - The Company's response to the Summary of Review results.
- Response Due Date - The due date is 31 days after the review is made available
on the internet.
- Number of files in the Review
- Supplement Date if needed
- Contact - The Claims Auditor that may be contacted if there
are any questions regarding the review.
Cover Letter
The cover letter is addressed to an individual designated by the Servicing Carrier.
Claim handling issues and Performance Standard compliance results are presented
here. The cover letter is where warnings for non-compliance with the Performance
Standards are issued.
Summary of Review
This report is prepared for Servicing Carrier and contains the specific results
of a carrier's compliance with the Performance Standards as well as an evaluation
of the company's claim handling initiatives. The results from all of the Servicing
Carriers' Summaries of Review are combined into one Industry Result which is
then included into the Annual Report for submission to the Commissioner of Insurance.
Within each Performance Standard section several standards list the files
that did not meet the specific standard. For example, Appraisal Assignment
will list files that were not assigned within two business days upon the receipt
of the claim. Each claim id listed is highlighted in blue, which is a link to
the actual worksheet completed by the Claims Examiner while reviewing the file.
A copy of the worksheet can be printed by clicking on the printer icon located
near the page width box. To return back to the Summary of Review click on the
Back button located on the Internet toolbar.
Addendum
A response is requested of the Servicing Carrier within 30 days of the date
the e-mail notification is sent to the Servicing Carrier. Should the Servicing
Carrier feel the compliance rates should be adjusted, supporting documentation
is required. Upon receipt and review of the supporting documentation the Servicing
will be notified of any changes to the review results via an addendum letter.
Worksheets
There are three types of losses evaluated in a Claim Review:
- Bodily Injury
- Physical Damage
- Personal Injury Protection
Worksheets are completed by the Claims Examiners for each of these types of claims.
Information concerning Performance Standard compliance and claim handling
practices is developed by the entry of dates, loss amounts, claim handling
activity, fraud indicators, and cost containment measures. Time lags and
compliance results are determined as pertinent information is entered.
ICPIP
The following information is extracted and entered onto a spreadsheet which
provides each Servicing Carrier with its ICPIP compliance experience:
- Policy Number
- Claim Number
- Loss Date
- Loss Type
- Insured Name
- Claimant Name
- Claimant Social Security Number
- Settlement Amount
- Settlement Date
- DOR Notice (Y or N)
- DOR Lien (Y or N)
- Lien Satisfied (Y or N)
- Lien Amount
- Method of Lien Satisfaction
Salvage
By extracting information from the Physical Damage Worksheets the Total
Loss Register allows companies to see the expenses associated with
salvage recovery on total losses. Averages are provided for the
number of days from appraisal to pick-up, amount paid, number of
days in storage, amount of storage, tow fees, salvage charges,
total charges, gross selling price, and net selling price.
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