1273614 - Rahul Purohit - F2 - Q 18 comment on claim management

 

QUESTION 1 : 1273614 - Rahul Purohit - F2 - Mukesh Gautam - F1

 http://youtu.be/n9f4vEGug_I

QUE2-

 INTRODUCTION

A claims management is a type of business that offers claims management services to the public. Claims management services consist of advice or services in respect of claims for compensation, restitution, repayment or any other remedy for loss or damage, or in respect of some other obligation. Claims management services cover litigation, or claims under regulation schemes or voluntary arrangements. Simply stated, it's the transactional handling of a company's insurance claims.

At INSURICA, (insurance management network) define claims management a little differently. They view their role as "a partner in a company's profitability."

The industry may have specific claims experts are able to uncover often overlooked risks and opportunities that have a direct impact on reducing and controlling our claims costs.

As a workers' compensation Third-Party Administrator (TPA), they exceed their client’s expectations through timely and professional resolution of all claims.

When it comes to managing our claims, our hands-on approach promotes prompt reporting, early intervention, aggressive investigation and timely settlements. We do this by:

·         Reviewing claims for proper coverage when reported and forwarding to the appropriate insurer.

·         Promptly paying all claims which are payable within draft authority.

·         Facilitating investigative meetings and payments of bills by the carrier.

·         Negotiating with insurer on claims where coverage is questionable.

DISCUSSION

The Claims Management Services Regulator was created by section 11 of the Compensation Act 2006. The post of Regulator if occupied by the Secretary of State for Justice to authorise and regulate claims management companies and:

·         Set and monitor standards of competence and professional conduct;

·         Promote good practice, in particular as to the provision of information about charges and other matters to users;

·         Promote practices likely to facilitate competition;

·         Ensure that arrangements are made for the protection of users, including complaints handling.

The rules and procedure for authorisation are defined in the Compensation (Claims Management Services) Regulations 2006. The Regulator may investigate unauthorised trading and seek an injunction to prevent it or bring a criminal prosecution. It is a crime to obstruct the Regulator, punishable on summary conviction by a fine of up to level 5 on the standard scale.

A person may appeal a decision of the Regulator about authorisation to the Claims Management Services Tribunal and there is a further route of appeal to the Court of Appeal.

CONCLUSION

1)      Consumers protected from CMC malpractice.

2)      Reduced false expectations of compensation and fraudulent claims and disruption of CMCs engaging in other forms of criminality.

3)      Improvements in quality and professionalism of CMCs, of confidence in compliant providers and in the system.

4)      Increased transparency of the market, particularly in relation to charges, commission payments and the provision of information.

5)      Improvement in industry practices and processes providing consumers with genuine claims with more efficient and effective routes to redress.

1272614 - Rahul purohit - F2 - Mukesh Gautam - F1