Do you need to satisfy FSA or Lloyds Coverholder audit requirements? Have your Delegated Authority Scheme terms been complied with? Are your adjusters/outsourcers complying with the agreed technical standards and best market practice?
As a Reinsurer are you satisfied that the primary/captive claims have been properly handled?
In all these situations it may be that a simple “tick and bash” audit approach is all that is needed.
However at the other end of the scale you may be involved in a possible breach of contract situation where liability reverts to you. Action is needed to establish the extent of ultra-vires activity if any and whether fraudulent. The financial repercussions would require extraction and quantification. Risk management procedures would need to be examined and both technical and financial audits undertaken. Thereafter a commercial or legal resolution may have to be sought with investigation and presentation of the necessary evidence combined with a quantum analysis that would stand up to court scrutiny.
At Adjusting Solutions we have the necessary skills and experience to help you beyond a standard “tick and bash” claims audit. With claims, underwriting, adjusting, financial audit, IT, risk management and litigation support experience we can provide a tailored team with the right skill sets to examine and report on any outsourced claims or underwriting arrangement that is giving you concern. We can also review captive or primary layer claims handling.
Our involvement is on a confidential basis and without risk of business competition or partiality. We are guided by the terms of the contract between you and your outsourcer but do seek to discuss and advise risk improvements that may bring benefits to the continuation of business if appropriate. All claim and underwriting decisions have an element of personal judgement and we therefore seek to examine whether the proper steps of evaluation have been considered on a technical basis rather than merely making a pronouncement of being right or wrong.
In all situations we will document our findings, report to you in an appropriate format and advise on risk improvement aspects to enable you to set your strategy going forward.
The potential benefits to you are:
- A tailored team with skill sets to cover financial and technical issues
- Audit of compliance with standards and agreed procedures including technical, financial and regulatory aspects
- An in-depth technical investigation where there are concerns of ultra-vires activity or breach of contract
- Review of technical claims handling in respect of primary layer and captive claims
- Risk management evaluation and review with best market practice
