SAIF Claims Division Philosophies, Communication Expectations, and Adjuster Certiciation Flashcards
What two questions should adjusters ask themselves every time they review a claim?
- What do I need to do to bring this claim to resolution?
2. Are my reserves adequate?
Claims Tenet One
Claims adjusters will:
determine compensability
use available resources
pay benefits timely and appropriately
Claims Tenet Two
Claims adjusters will:
manage to appropriate conclusion
facilitate early return to work
Claims Tenet Three
Claims employees will promptly communicate with:
EAI, IW and providers
Claims Tenet Four
Claims employees will:
manage reserves
pay benefits
manage litigation
Claims Tenet Five
Claims employees will be mindful of the future
Settlement Tenet One
Settlements should reduce uncertainty for the worker, the employer, and SAIF.
Settlement Tenet Two
Parties affected by settlements must be fully informed.
Settlement Tenet Three
The settlement value of a claim is the probably cost factored by uncertainty.
Settlement Tenet Four
Claims employees will anticipate and prepare for litigation
Settlement Tenet Five
Disputed claim settlements cannot be used where responsibility is the only issue in the claim.
Reserving Tenet One
Set reserves for ultimate probable cost. Not best or worst case scenarios.
Reserving Tenet Two
Periodic reassessment, documentation and management review.
Reserving Tenet Three
Communicate with policy holders.
The Claims Division communication standards indicate contact with an injured worker to be:
▪A verbal dialogue with the injured worker, which includes an explanation of the claims process, and asking and answering questions.
▪Two reasonable attempts by phone, at varying times, to reach the injured worker.
▪If no response is received following the attempts by phone, an interactive email that is a business-style communication of letter-quality or a personalized letter should be sent.
