There are various external services which are available to an internal claims team which can assist then in the functions as follows:
a. Outsourcing Companies
b. Loss Adjusters
e. Loss Assessors
f. Authorised Repairers
g. Risk Managers
Outsourcing is using a skilled resource from outside the company to handle work traditionally performed by
inhouse staff. Essentially, a function (or part of a function) is a delegated to a third party. This can be done
by either sending work out or by bringing work in the company.
The Reason behind outsourcing are:
a. The perceived costs benefits. (the belief that work will be done more cheaply than if carried out inhouse.)
b. To manage a specific issue for example a surge event.
c. To gain access to a wider skills base.
At the turn of the 21st century, many insurance companies were using overseas call centers. This is called ‘offshoring’ or ‘near
shoring’. The perceived costs benefits were the main reason, cheap labour but allegation of exploitation and questions of language
and service levels tended to arise. As a result, customer satisfaction fell remarkedly. Customers did not appreciate the service. Now,
most of these services particularly where there is interaction with customers have now been returned to the UK call centers. This is
now used as a marketing benefit to customers.
Any, or all of the claims functions can be outsourced. If a company chose to outsource the whole process along with the financial reporting and management of the operations, then there would be no need for a claims department. However internal responsible for claims would be retained by the insurance company for compliance purposes. Regular audits fulfills this requirement.
The outsourcing could be provided by:
a. Third party administrators
b. Insurance company claims departments
a. Strategy – Concentration on CORE activities and better capacity to cope with an increase in workload
b. Costs – This often results in cost savings.
c. Service –Through access to a wider skills base or to improved technology etc.
d. Staff – Reduces the requirement for staff and avoids the peaks and troughs of workflow and the loss of expertise.
a. Strategy – Loss of control and dependence on provider.
b. Costs – Unforeseen problems plus extra co-ordination and audit costs.
c. Service – Maybe a problem especially is respect of customer retention.
d. Staff – Loss of the opportunity to retain, and develop in-house expertise
Because of the above, both options need to be analysed before any decision is made.
These are experts in processing claims from start to finish. Small claims are usually negotiated and settled
inhouse while larger and more complex claims are given to the loss adjuster. They will investigate and
recommend settlement to the insurer who if in agreement will settle via the loss adjuster. The insurer pay
their fees. In some cases, some adjusters are delegated to settle claims on behalf of the insurer without
any need for prior approval on a case-by-case basis. Finally, they are independent and professional,
therefore, must be fair to both parties with settlement terms within the policy contract.
Disaster Recovery Companies (DRC):
A DRC is an organization that specializes in ensuring business continuity for a company in the event to an interruption to
the normal flow of business. It is concerned both with the implementation of the plans in the event of an interruption
and the analysis before the event of a company’s requirements. Its functions may overlap with the company’s risk
1. DCR offers management analysis of the effect and impact of losing resources, plus the followings
2. Identifying and evaluating operational risks that may impact operations
3. Compiling recovery strategies
4. Addressing specific emergency situations eg: terrorist attacks, fire, significant escape of water, etc
5. The actual work done to return business operations to normal or as close as possible to normal
6. Trials to assess the effectiveness of the plans
A DRC company will address the complete scenarios of disasters:-
a. from backing up and retrieval of Information Technology
b. To cleaning and restoration of individual pieces of paper from a file which was affected from soot from a fire.
Surveyors act as the eyes and ears of the underwriter and can also be used by the claims department post loss.
Their report of a risk will include:
1. A full description of the risk
2. An assessment of the level of the risk
3. A measure of the Maximum Probable Loss (MPL)
4. Recommendation on Loss Prevention
5. The adequacy of the insurance being requested.
6. They can be asked to conduct a “post loss” survey and report on aspects and cause of the loss and,
7. Give their view as to compliance or otherwise with policy conditions and warranties etc.
i. A firm of solicitors can be used as a pre- litigation advice facility.
ii. The supply of specialist services such as the negotiation of complex injury claims.
iii. To bring court proceeding where negotiations have reached an impasse and or in defense matters.
iv: For legal advice services, policy wordings interpretations and reinsurance disputes.
v. Some insurers employ inhouse solicitors and barristers or have a financial interest in that firm for cost reasons.
vi. External solicitors are used where they may be a conflict of interest or matter the inhouse team cant handle.
These are also professionals in the insurance industry who are appointed by a client to seek their interest in
the settlement of a claims. They pay the fees charged by the client; this is NEVER part of the claims settlement.
The represent the insured to ensure maximum recovery from the insurer after a claim.
Insurers will always use the services of the authorized repairer to repair to the client’s property, be it insured under any product
where damage is covered, and repair is an option for indemnity to be provided. They are sometimes contracted to an insurer or
are sourced from part of a network used by many insurers. Insurers can obtain a discount off costs thus keeping the claims cost
low. In addition, there will usually be a service agreement , guaranteeing a high level of service to the insurer’s customers . Some
authorized repairer even offer the claimant a curtesy car.
Insurance Risk Managers are utilized by policyholders(usually commercial customers) to scrutinize insurance
claims and factors that can contribute to claims. There objective is to find ways to reduce the likelihood of an
. ii. The supply of specialist services such as the negotiation of complex injury claims
Experts used in the Valuation of Third-Party Claims:
Medical reporting experts:
1. Care Experts – Typically former nurses commenting on hours and nature of care requirements.
2. Medical Experts – Specific to the type of injury and include
3. Life expectancy Experts
4. Accountants – to review lost wages
5. Accommodation Experts – to comment on suitability of housing needs for claimants requiring alternative or
6. Surveillance – to verify claimants’ injuries and claims concerning wage loss are genuine