How Claims Teams Benefit From Automated Capture Solutions

October 2, 2016

Managing Agents are required to meet the Principles and Minimum Standards set by Lloyd’s and this applies equally when ensuring that there is an appropriately detailed, regular file review process. According to Lloyd’s the process for claims file review shall be documented and allow for the results to be reviewed with the relevant claims handler.

Under the current system, when a handler adjusts a claim, a percentage of their claims under Lloyd’s Minimum Standards MS2 Claims Management have to be reviewed by a peer internally. Indeed a number of MAs use external reviewers/review firms for their ‘internal’ Peer Review required under the Minimum Standards. It might be someone in their team, their manager, or someone in another team that understands their class of business but they will essentially check over work, record what they’ve checked, and flag any errors they think may have been made.

Internal peer review will continue but under the new system set to go live in October 2016, Lloyd’s requires a ‘quota’ of files to be reviewed by an external independent reviewer against a consistent, market-wide question set. Lloyd’s Claims Minimum Standards does not specify the number and/or percentage of files to be peer reviewed. However, it does refer to the fact that a written rationale for the sampling methodology should be in place and take into account; the frequency of review, the open claim count, the mix of business and the claims portfolio. The sample size should be representative.

MAs should take a proactive approach, achieving prompt resolution of the claim under the circumstances presented. A new Lloyd’s initiative, Claims File Review – whose principal aim is to obtain a view of market themes and trends in claims handling via a consistent review of external independent reviewers – starts from 1st October this year following a pilot conducted by the Corporation in 2015.

Large or small, carriers will need to have reviewed a number of claims – whatever Lloyd’s specifies – in the 12 months from October to September. Lloyd’s is currently refining the question set they are asking these external reviewers to answer every time they are reviewing a claim. The message for specialist London market technology companies is that they will need to consider aligning their peer review checklist with their current fields so that MAs can complete their own internal and external reviews on the same lines that Lloyd’s wants.

Where the previous file review might have had 20 fields of questions, the new one might have 45-50 fields. The process is being managed through the LMACC and is effective 1st October this year. When it comes to consuming claims content whether it is photos, emails or peer review files arriving from a plethora of devices and in different formats, this places responsibility on handlers to put the correct content in the correct location.

This method of manual content ingestion often results in content being lost or misplaced. To avoid this scenario, it makes sense to employ the services of a specialist insurance software company like DOCOsoft to incorporate technological functionality that allows claims teams to receive and organize claims content within automated capture solutions.

DOCOsoft are also working with one of its clients to build a brand new full Peer Review workflow process enhancing current functionality and replacing as many as seventeen previous manual processes to provide full claims Peer Review MI across the entire company.

Such solutions assign specific metadata to pieces of content according to predefined rules that automate content availability, resulting in time savings as well as error minimisation.