claims management


HW3 Group, LLC (HW3) is a leader in the claim management arena. Our approach to claim preparation and claim processing is a truly positive experience. We are innovators by educating our clients, fully explaining the claim process and walking you through every step. Our experience and collaborative philosophy ensures a process that is thoroughly documented and well managed.

An insurance claim involves many materially interested parties. There is an unspoken “dance” that should take place among everyone in order to reach a successful claim settlement. This requires understanding everyone’s roles and expectations. Also, requires establishing protocols to ensure proper communication and flow of documentation. It is critical to understand the Insurer (insurance company) requirements, timelines and how to properly present a formal Property Damage and/or Business Interruption insurance claim.

If you have never experienced a loss before, this can be overwhelming. Where to begin? HW3 can assist by providing you with Property Owner Representation and Claim Preparation services.  We are your eyes and ears every step of the way. We will help you prepare your claim and develop strategies to get your business back to normal operations as quickly as possible. We will work with your insurance company to expedite payments to assist with your cash flow needs. We can also assist with auditing your vendor invoices prior to payment and clerking the job to ensure that you are only being invoiced for the appropriate work/equipment. If you are a company that has multiple locations and you experience multiple losses in a policy year (both above and below the deductible), we can assist in developing and implementing an Emergency Response & Recovery Program. It includes pre-selection of vendors and insurer representatives, pre-approved rate sheets by the insurance companies and written protocols on how all interested parties will respond before the loss occurs. We help you create a program that is proactive versus reactive and removes the guessing.

What is Claim Preparation?

It is a common misconception that when a policyholder experiences a loss, that the insurance company will assign an adjuster and that the adjuster will prepare the claim. This is incorrect. The role of the adjuster is to respond and adjust the claim after it has been prepared by the policyholder. It is the obligation of the policyholder to prepare and present its claim to the insurer (adjuster, insurance companies and other representatives), then the insurer will respond with an insurer measurement (the undisputed amount of the claim) and claim payments.

Insurance companies often recognize that the policyholder may need assistance in quantifying, preparing and presenting the claim. Therefore, they offer Professional Fees / Claim Preparation Fees coverages that if not already included, can be added to your policy. The policyholder then engages an expert claim preparer to assist with gathering information necessary to prepare the Property Damage and Business Interruption (if applicable) claims. This includes, but is not limited to estimates, invoices, reports, photos, maps, financial documents associated with emergency services, building reconstruction, personal property (contents/equipment/fixtures), extra expenses, loss of inventory, loss of revenue, etc.

Hiring a claims preparer helps maximize the policyholder’s insurance claim recovery by ensuring that no items were missed and that all items are properly allocated within the coverages allowed in the policy. A claims preparer understands the claims process and the insurer’s requirements. This expedites the claims process, ensures the accuracy and completeness of the information provided, minimizes disputes, and accelerates the payment and settlement process.

Why do adjusters often take control and package the claim? Policyholders may not know they can hire their own representation and if they have never experienced a loss, they will not know where to begin. If no one begins the process, the claim will not be prepared, the adjuster cannot respond and the insurance carriers will not issue payments. Therefore, in the absence of someone taking the lead, the adjuster will do so. Is this a good idea? Let’s keep in perspective that the adjuster is hired and paid by the insurance carrier. Is their interest and loyalty to you or the insurance carrier? Will they want to maximize your recovery or save the insurance carrier money?

Gathering the necessary documents for a claim can be quite the undertaking and adjusters will not want to go above and beyond to assist you . Especially, since their role is to respond, not prepare your claim. Therefore, they may suggest you hire a Third Party Administrator (TPA). A TPA can serve many roles, including providing claim management services. But, keep in mind that most TPAs work for the insurance carriers (like an adjuster) and often are staffed by former insurance adjusters. Will they have your interest in mind?

Another option is to hire a licensed public adjuster. Their role is to appraise the damage, prepare an estimate and other claim documentation, read the policy, determine coverages and negotiate the claim on behalf of the policyholder. Public adjusters typically get paid a percentage of the settlement (percentage varies). Therefore, it is in their interest to maximize the claim and they often settle the claim on an aggregate number (total claim amount) versus reviewing each line item and ensuring maximum recovery for each item. You will notice below that public adjusters are excluded from policy coverage.

When experiencing a loss, it would be wise to engage a claims preparer to assist you similar to how a plaintiff and defendant both hire an attorney. This is the “hat on a hat” principle. If the insurance carriers have representation, shouldn’t you? Below is sample policy language for Professional Fees / Claim Preparation Fees.If you do not have this coverage, speak to your broker about the option to add this to your policy at renewal.

This policy covers the actual costs incurred by the Insured, of reasonable fees payable to the Insured’s accountants, architects, auditors, engineers, or other professionals and the cost of using the Insured’s employees, for producing and certifying any particulars or details contained in the Insured’s books or documents, or such other proofs, information or evidence required by the Underwriters from insured loss payable under this Policy for which Underwriters have accepted liability.

This Additional Coverage will not include fees and costs of attorneys, public adjusters, all including any of their subsidiary, related or associated entities either partially or wholly owned by them or retained by them for the purpose of assisting them nor the fees and costs of loss consultants who provide consultation on coverage or negotiate claims. This coverage is limited to an amount of $_______ per occurrence.

 




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