What is the first thing an insurer does upon notification of a claim?

Question

I took my CII - Insurance Claims Handling Process exam today, and that was one question I'm not really sure about. It was a multiple choice question with 4 possible answers, but I found it difficult to choose between 2 of them.

It was a toss-up between "Check whether the policy is valid and in force" and "Set a reserve". Eventually I selected the option for "check whether the policy is valid". Was I correct to select that option? My reasoning for choosing that answer was that it seems a bit pointless to go through the effort of calculating a claims reserve if the policy was never in force in the first place when the loss/damage occurred. So I figured that the first thing the insurer would do is check that the policy was in force. Or do insurers always have to set a reserve for every claim regardless?

Answer 1

that makes sense to me well done its correct, i thought it was sleep with the claimant ha ha

Answer 2

The first thing an adjuster does when they get a claim: check coverage.

If there is a coverage question - you will need to address this in the claim investigation.

Plus -- you need to know what coverages you have on the policy to set the reserves.

Answer 3

go through the get out clauses so they dont have to pay out

Answer 4

THEY READ IT,  READ IT TO THE STAFF,  THEY

      ALL LAUGH,   THEN SHRED IT

    THEN TELL YOU THEY NEVER  RECEIVED IT

Answer 5

Hi there,

It's definitely the first option (Checking whether the policy is valid and in force). I am doing the CII as well, and most answers do need a logical reply; the answers are not always found in the file!

Also, I work in Private Medical Insurance (PPP), and from a work view-point, that is definitely the first thing I'd do. On receipt of any application/claim, we search our system for the person's membership number, and is then passed on to the relevant department/individual for processing.

So, I am certain your choice was the right one.

Good going, and good luck with the rest of your exams!

Cheerios,

Cdj.

Answer 6

call your insurance company, they should guide. You are paying them for it. Remember, do not drink and drive. Or else you would not be in this predicament.