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Basic Casualty Claims Handling

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The course, “Basic Casualty Claims Handling,” is designed to provide adjusters with a general overview of handling a casualty claim from receipt until resolution. The module is presented by Richard A. Nouza. J.D., Senior Claims Attorney at Central Mutual Insurance Company, and Christine A. Sullivan, MBA, CPCU, AIM, President of ? CAS Consulting, LLC.

The course provides an overview of the five phases of casualty claims handling – (1) Coverage investigation, (2) Liability and damage investigation, (3) Evaluation, (4) Negotiation, and (5) Litigation. It also identifies techniques to shorten the file length of an average casualty claim.

After completing the course, the attendee will be able to understand how to conduct a coverage investigation; define the importance of the statute of limitations; explain the circumstances surrounding reservation of rights; discuss the duty to defend; define a declaratory judgment action; define waiver; define torts; know the value of interviews and statements, scene investigations, and photographs; define comparative negligence; explain principles of liability investigation such as causation and proximate cause, independent medical exams, and surveillance; describe the steps used in evaluation; understand tips and strategies for a successful negotiation; outline the steps in litigation; and explain the importance of bill/fee review.

The course is designed for insurance professionals in the liability arena.

What CE Credit is available?

Note: To qualify for credit, you must submit completion (including a passed final exam if required) within five days of completing the last quiz. No partial credits will be awarded.

State:
Adjuster General CE Hours:
Adjuster Ethics CE Hours:
Attorney General CLE Hours:
State's Course ID:
NH 2.0 482667
TX (classroom equivalent) 2.0 101389
NC 2.0 200946
FL * ( Provider Number: 364169 ) 1182361
IL 2.0 585452
WY 2.0 26002
OK 2.0 1023948

* This course has been approved by the Florida Department of Financial Services for insurance continuing education credit.

Course Content

Coverage Investigation
Expand
Lesson Content

1) Introduction
2) Outline
3) Coverage investigation
a) Covered loss
b) Statute of limitations
c) Notice of claim provision
d) Steps in coverage investigation
i) Read the policy
ii) Talk to the agent
iii) Reservation of Rights
iv) Duty to Defend
v) Declaratory Judgment Action
vi) Waiver
4) Recap

Liability Investigation
Expand
Lesson Content

1) Introduction
2) Fair Claims Practices Act
3) Initial handling
4) Tort defined
5) Interviews and statements
6) Scene investigations
7) Photographs
8) Subrogation
9) Comparative negligence
10) Damages
11) Recap

Liability Investigation (continued) and Evaluation
Expand
Lesson Content

1) Liability Investigation
a) Causation and Proximate cause
b) Independent Medical Exams
c) Surveillance
2) Evaluation
a) Dissecting the file
b) Special damages
c) General damages
d) Timeliness
e) Re-evaluations
3) Recap

Evaluation (continued) and Negotiation
Expand
Lesson Content

1) Evaluation
a) Time limit demands
b) Offsets
i) Collateral source rule
ii) Medicare Secondary Payer Mandatory Reporting
iii) Medicare lien
2) Negotiation
a) Be prepared
b) Game plan
c) Strategic thinking
d) Know they enemy
e) Aggravators and mitigators
f) Leverage
3) Recap

Negotiation (continued)
Expand
Lesson Content

1) Negotiation
a) Verbal vs. written
b) Funnel technique
2) Negotiation tips
3) Recap

Litigation
Expand
Lesson Content

1) Steps in litigation
2) Who is driving the car?
3) Own your file
4) Negotiations
5) Targeted discovery
6) Strategy, strategy, strategy
7) What is the end game?
8) Bill/fee review
9) Conclusion
10) Recap

Get CE Credit or Certificate of Completion.

Submit within 5 days to get CE Credit or Certificate of Completion.

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