Most people have no common knowledge as to what an insurance claim representative is or what a claim representative does. The only time that we may come into contact with one is when our life has met some catastrophic incident. It can be an automobile accident, a slip or fall on a business property, or it could be because a doctor left a sponge inside the patient while performing surgery. So where does the insurance claim representative come in?
When an incident occurs, a claim representative will first look at the insured’s policy to determine if coverage is applicable for the particular incident. Once the coverage has been cleared, the claim representative begins the task of investigation. This process is done by gathering information that is pertinent to the facts of loss. It may include interviewing all of the parties involved such as the witnesses in the incident, and gathering records such as police reports, medical records, and wage loss records.
In the meantime, the party who has brought the claim against the insured may be treated by a physician for an extended period of time in order to resolve the injuries he or she received. If the claim representative determines that the insured is the culpable party and is liable, it will be up to the insurance company to pay for any damages. These may include damages to the vehicle or rental expenses of another vehicle while the other party’s car is being repaired. Other expenses may include medical fees the injured has incurred as a result of the accident. Payment for the inconvenience due to the accident should also be considered. When the claimant is paid for all damages, which are inclusive of both property and bodily injury, the claim is considered settled, and the claimant signs a release stating that they cannot pursue any further claims against the insured for the same incident.
What happens when the claim is litigated? Should the claimant party elect representation by an attorney, all communication between the representative from the insurance company and the claimant ceases. The lawyer representing the claimant will now communicate with the insurance claim representative and/or defense counsel who is hired by the insurance company to represent and defend the insured. When a lawsuit is served upon the insured, it is the responsibility of the insurance company to hire a defense counsel who can well respond in their behalf. Once this takes place, the discovery stage then begins. Discovery is very much like the investigative stage of the claim file prior to litigation. The only difference is that it is now dictated under the guidelines and procedures of the courts.
Most often than not, cases are usually resolved prior to trial. However, some may not be resolved through settlement because the parties reach an impasse, in which the evaluation of the exposure differs and so trial is inevitable. When a case is tried before a jury, the jury decides as to whether the plaintiff will be awarded for their damages. It is also upon them to discuss the amount that should be awarded.