02 — Capability · BC-1750.20
Claim Investigation & Adjustment
Establish the facts, cause and value of each loss and who is liable, and hold a case reserve that reflects what the claim is expected to cost. IBNR and portfolio reserving sit in Actuarial Valuation & Reserving.
- Loss Adjusting
- Claims Adjustment
- Claim Investigation
In scope
- Loss inspection, estimating and appraisal
- Liability and coverage determination
- Case reserve setting and review
- Independent adjusters, experts and life and disability benefit assessment
Out of scope
- IBNR and actuarial reserves across the portfolio (see BC-1740.60)
- Special investigation of suspected fraud (see BC-1750.50)
Realized by · 0
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Used in · 1
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Decomposes into · 5
- BC-1750.20.10Loss Inspection & AppraisalInspect damaged property or vehicles in person or from images and produce an estimate of repair or replacement cost.
- BC-1750.20.20Liability & Coverage DecisionDecide whether the loss is covered and who is at fault, recording the reasons for acceptance, partial acceptance or denial.
- BC-1750.20.30Case Reserve SettingSet and revise the expected cost of each open claim as facts emerge, within reserving authority and guidelines; IBNR and portfolio reserves built on these sit in Loss Reserve Estimation.
- BC-1750.20.40Adjuster & Expert PanelAppoint and oversee independent loss adjusters, engineers, medical examiners and other experts, and measure their cost and turnaround.
- BC-1750.20.50Life & Disability Claim AssessmentVerify death, disability or critical illness evidence against policy terms and decide benefit eligibility and amount.