Insurance Consultant

---

 An independent and unbiased review of a claims file and the handling of the claim are vital in identifying any risks that may exist within a claim or a grouping of claims. Thorough and methodical review of a claim is critical to ensure all requirements have been met, both from an internal and external compliance standpoint, as well as a reasonableness test. 

The first question to be asked when reviewing a claim - “Is this a covered claim?”. This can be a complicated answer depending on the facts of the claim as well as the differences within each policy. Every property insurance claim is different and a proper and thorough investigation of the damages and the complete policy is the first step toward answering that question.

• What caused the damage?
• What language in the policy is applicable to this claim in order to determine what is and is not covered?
• If there are two or more causes of loss, is there anti-concurrent language that could impact this claim?
• Was the claim properly and thoroughly investigated? 
• Were experts utilized when needed?
• Did the insured provide all information necessary to complete the investigation? 
• Did the insurer reach a correct coverage decision being fully informed?

This is, of course, not meant to be a full and complete list, however it does illuminate some of the more basic questions that need to be addressed in every claim.

If coverage is to be afforded, one must identify the proper repair/replacement of the damages followed by the necessary and reasonable valuation of those damages. Application of the state’s regulations must be reviewed and considered. If there is a difference of opinion, what steps were taken to remedy those differences and were those steps reasonable? Were payments, if applicable, issued timely given the information from the investigation and the coverage determination?

Ms. Strong has an extensive history of handling claims in both personal and commercial lines of insurance which has provided the real-life experience to understand each claim is different and contains unique issues and complications. 

Ms. Strong is happy to discuss any claim with you.