Claims

Insurance Claims Adjusting

Our experts have extensive experience as Claims Adjusters, Claims Supervisors and Claims Managers, both with third-party administrators (TPAs) and with insurance companies. In addition, they have experience in negotiating large contracts with TPAs both locally and nationally.

Insurance Claims Bad Faith

The Insurance Archaeologist™ experts have claims experience gained by working for insurance companies, as third-party claims administrators, and as Risk Managers for several corporations. The potential for bad faith arises when an insurance company has an opportunity to settle a claim against its insured within the policy limits but tries to save a few dollars by offering less than policy limits. Under these circumstances, an insured may have a bad faith claim against the insurance company. Our experts have consulted on many claims when extra-contractual damages are an issue because of the bad faith claims handling on the part of an insurance company.

Insurance Claims Duties of the Insurance Company

The insurance company has a duty to complete a diligent investigation of the claim of its insured in a timely manner, whether it is a first party (property) claim or a third-party liability claim. The insurance company has a duty to inform its insured of the status of the claim in a reasonable and timely manner. The insurance company has a duty to settle claims against its insured within the policy limits whenever reasonably possible. In addition, the insurance company must comply with the applicable state Unfair Claims Practices statutes.

Insurance Claims Duties of the Insured

The insured has a duty to promptly report any claims they are involved in, to their insurance company. In addition, the insured has an obligation to cooperate with the insurance company in investigating any claim against the insured.

Insurance Claims Management

As Risk Managers our experts have managed self-insured programs for both workers’ compensation claims and liability claims, with a large volume of vehicle liability and medical malpractice claims, together with the management of claims supervisors.

Insurance Claims Reserve Setting

With backgrounds as Claims Managers and Risk Managers, The Insurance Archaeologist™ experts have a great deal of experience setting claims reserves. They understand the different theories regarding reserve setting and appreciate the various approaches to reserve setting, such as reserving for the ultimate incurred loss as opposed to reserving for the maximum expected loss based on actuarial projections.

Extra-Contractual Claims

Experienced in the area of extra-contractual claims as Risk Managers and Expert Witnesses, our experts have experience dealing with insurance companies that refuse to settle claims within the policy limits, thus putting the insured at financial risk. In addition, our experts have testified in cases involving extra-contractual claims, including cases specifically with minimum limits policies where the bad faith rights have been assigned to the Plaintiff.

Subrogation

Experienced in the area of subrogation from both the insurance company side and the insured’s side, The Insurance Archaeologist™ experts have been responsible for hundreds of files. As Risk Managers, our experts experience was obtained in the setting up of an “in-house” subrogation program (technically a “recovery” program for a self-insured entity). One corporate recovery program resulted in over $300,000 being recovered in the second year of operation. Enrolling employers in the inter-company arbitration forum enabled the corporate risk management departments to participate in the inter-company arbitration with insurance carriers to increase recovery while expediting claims processing.

Third Party Claims Administrators

Years of experience as Claims Adjusters, Claims Supervisors and Claims Managers for Third-Party Administrators (TPAs) our experts have handled a variety of claims all across the United States. As Risk Managers, TPA contracts were negotiated with several of the largest TPAs for services for local claims administration (claims adjusting) and nationwide services.

Tort Litigation Management

As former Insurance Adjusters, our experts have worked closely with the attorneys selected by insurance company clients and, as Claims Managers, were responsible for supervising litigated files. As Risk Managers our experts have experience in supervising outside legal counsel on all corporate litigation.

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