LexisNexis Claims Discovery

Transcription

1 How to Read L e x i snexis Claims Discovery

2 LexisNexis shall not be liable for technical or editorial errors or omissions contained herein The information in this publication is subject to change without notice and is provided as-is without a warranty of any kind Nothing herein should be construed as constituting a warranty, as any applicable warranty is exclusively contained in your signed agreement with LexisNexis All names in the text, or on the sample reports and screens shown in this document, are of fictitious persons and entities Any similarity to the name of any real person, address, school, business or other entity is purely coincidental Due to the nature of the origin of public record information, the public records and commercially available data sources used in reports may contain errors Source data is sometimes reported or entered inaccurately, processed poorly or incorrectly, and is generally not free from defect This product or service aggregates and reports data, as provided by the public records and commercially available data sources, and is not the source of the data, nor is it a comprehensive compilation of the data Before relying on any data, it should be independently verified The LexisNexis Claims Discovery service is not provided by consumer reporting agencies, as that term is defined in the Fair Credit Reporting Act (15 USC 1681, et seq) (FCRA), and does not constitute consumer reports, as that term is defined in the FCRA Accordingly, the Claims Discovery service may not be used in whole or in part as a factor in determining eligibility for credit, insurance, employment or for any other eligibility purpose that would qualify it as a consumer report under the FCRA LexisNexis and the Knowledge Burst logo are registered trademarks of RELX Inc Claims Discovery is a trademark of LexisNexis Risk Solutions Inc Other products and services may be trademarks or registered trademarks of their respective companies Copyright 2018 LexisNexis 2

3 C o ntents Introduction 4 Report Header Section 4 Recap Section 5 Search Request Section 6 Vehicles Section 6 Reported Claim History Section 7 Possible Related Claims Section 10 Possible Additional Drivers Section 12 Inquiry History Section 12 Auto Claim Type Codes 14 Property Claim Type Codes 15 3

4 I n t r oduction LexisNexis Claims Discovery is a contributory database of industry-provided historic claim data that facilitates the claims administration and investigation process This document is designed to help you understand the report produced by Claims Discovery Each section of the report provides essential definitions and tables R e p ort Header Section The Report Header section contains general information related to the transaction, including the date and time the report order was placed and completed, the order ID, account, and requester information, among other data Report Header The following table lists all the fields that appear in the header of a Claims Discovery report It also provides a description of each field, as well as the information that can be returned Report Header Field Descriptions Field Claim # Date of Order Order ID Date of Receipt Account Claims Discovery Auto Ref # / Claims Discovery Prop Ref # Requestor Description Insurance company claim number that was entered on the request form Date the order was placed Unique identifier for the request / order Date the order was returned Requestor's account number Internal reference numbers used to identify the data that was returned from both auto and property systems Adjuster ID of the individual who requested the report 4

5 R e c a p Section The Recap section provides a summary of losses reported for the subject, vehicle, and risk address for this Claims Discovery report This section also contains the processing status of the additional report types ordered Recap The following table lists all the messages that return in the Recap section of a Claims Discovery report It also provides a description of each message Message Descriptions Message Insufficient data for request Search not requested No additional driver(s) reported Processing delayed State not available Description Insufficient data was entered to conduct search; request not processed A search was not requested for LexisNexis Driver Discovery on the Subject or Vehicle; however, the data was used as corroboration The Driver Discovery search did not find any additional drivers The Driver Discovery database (for a particular state) was temporarily unavailable for processing The Driver Discovery request was for a state not yet available on the database 5

6 S e a r ch Request Section The Search Request section provides a summary of the information submitted with the request Search Request V e h i cles Section The Vehicle section of the report contains any vehicle submitted with the request Vehicles Section 6

7 R e p orted Claim History Section The Claim History sections include loss information found in the Auto and Property Claims Discovery systems that sufficiently match the search criteria The loss information that does not exactly match the search criteria is underlined Fields may be blank if they were not contributed by the insurance company Reported Claim History Section 7

8 The following table lists all the fields that appear in the Reported Claim History section of a Claims Discovery report It also provides a description of each field, as well as the information that can be returned Reported Claim History Section Field Descriptions Field Clms Disc File # Policy Type & Company Claim # Policy # Description The Claims Discovery file number assigned to the claim The type of insurance policy and the name of the insurance company that contributed the claim Possible values: B = Boat Owners C = Condominium CY = Motorcycle D = Flood F = Fire H = Homeowners I = Inland Marine J = Personal Umbrella MH = Motor Home PA = Personal Auto Q = Earthquake R = Ranch/Farm T = Tenant X = Other Contributing insurance company's claim identification number Insurance policy number that covered this claim 8

9 Reported Claim History Section Field Descriptions (Continued) Field Date/Age Subjects Fault Indicator First Payment Date Vehicle & VIN Vehicle Disposition Description The date the claim occurred and the age of the claim The item lists the individuals in the claim along with other identifiable information Possible codes: (P/H) = indicates that the listed individual was the insurance policy holder (V/O) = indicates that the listed individual was operating the vehicle at the time the incident occurred (INSRD) = indicates that the listed individual is the Insured Party (CLMNT) = indicates that the listed individual is the Claimant (Alias) = indicates an alias name for the individual listed An asterisk (*) indicates that the personal information (DOB (date of birth), SSN (Social Security number), or License #) applies to the subsequently listed subject The code provided by the insurance company that indicates whether the vehicle operator was responsible for the incident Codes that may appear in this field are: (AF) = At Fault (NF) = No Fault (UN) = Undetermined (PF) = Partial Fault () = Unknown or Unreported Date of the first payment on the loss Includes the vehicle description and VIN (vehicle identification number) for the loss listed The status of the vehicle for the loss listed Descriptions that may appear in this field are: Repaired Stolen Totaled Damaged Other No Compensation 9

10 Reported Claim History Section Field Descriptions (Continued) Claim Type Field Description Indicates two pieces of information The Claim Type is shown on the left side of the slash The code in this column represents the type of loss incurred as a result of the incident Auto Claim Type Codes: BI = Bodily Injury CO = Collision CP = Comprehensive GL = Glass ME = Medical Expense MP = Medical Payment OT = Other PD = Property Damage PI = Personal Injury Protection RR = Rental Reimbursement SL = Spousal Liability TL = Towing and Labor UM = Uninsured Motorist UN = Underinsured Motorist Refer to "Auto Claim Type Codes" on page 14 for a complete list codes and examples Refer to "Property Claim Type Codes" on page 15 for a complete list of codes and examples Claim Disposition Codes The claim disposition (when provided by the contributing company) is shown on the right side of the slash and indicates the status of the claim Codes that may appear in this field are: C = Closed D = Under Deductible O = Open P = Peril not Covered S = Subrogation W = Withdrawn Subrogation claim disposition status remains throughout the life of the claim Amt Paid AM Best # The amount paid on each claim type listed The contributing insurance company's AM Best Number P o s s ible Related Claims Section The PRC (possible related claims) section includes claims information found on individuals whose address matches the subject's address, and a match to at least one other identical element in the inquiry (last name, driver license number, SSN, or policy number) Claims Discovery encourages the insurance company to determine if these claims relate to the subject on whom the search was requested The claims information that does not match the search criteria is underlined 10

11 Possible Related Claims > + This symbol may appear prior to the address listed It indicates that the subsequently listed address is part of the claims record, but not necessarily the address of the vehicle operator in this incident The address is shown on the claim number, but is not necessarily the vehicle operator's address This symbol may appear prior to the city name line of the address to distinguish those claims that resulted from an address that LexisNexis Risk Solutions developed rather than the address originally provided The address is shown with the claim number, but is not necessarily the vehicle operator's address 11

12 P o s s ible Additional Drivers Section The Possible Additional Drivers section lists information about individuals that may be additional drivers in the subject's household Claims Discovery encourages the insurance company to verify this information prior to making business decisions Possible Additional Drivers Possible Additional Drivers Section Field Descriptions Name DOB Sex Type Restrict Field Description These items include information about the possible additional driver listed The driver license number, expiration date, issue date, and partial SSN are listed as shown if the state in which the subject resides permits disclosure The last four digits of the SSN in this section will be returned as zeros (0s) Represents the type of driver license issued to the possible additional driver These codes and definitions vary according to state Represents the type of driving restrictions placed on the possible additional driver These codes and definitions vary according to state I n q u iry History Section The Inquiry History section lists information from the Auto and Property systems about each insurance company that has requested a Claims Discovery report on the subjects, vehicle, or risk address in this report within the last six months or longer In addition, it lists the date the report was produced and the reference number of the request The National Accident History database allows the user to order additional reports for each section of the Auto Inquiry History To order a report, click the View Report hyperlink in the section of the report for which you are requesting additional information An additional fee will be billed for each additional order that is requested 12

13 Inquiry History 13

14 A u t o Claim Type Codes The Reported Claims History section returns the following auto claim codes The description is not returned Auto Claim Type Codes Code Description Explanation BI Bodily Injury Coverage for the loss resulting in bodily injury CO Collision Coverage for the loss resulting from the striking of another object by a moving vehicle CP Comprehensive All-risk physical damage protection for automobiles except for loss by collision May also be displayed on an automobile insurance policy as Other Than Collision GL Glass Losses resulting in damage to a vehicle s windshield or other windows ME Medical Expense Insurance providing for payment of medical, surgical, and hospital expenses MP Medical Payments Protection to pay the cost of medical care to injured parties PD Property Damage Protection covering the insured's legal liability for damage to property of others caused by insured's negligence PI Personal Injury Protection Also known as no-fault insurance, providing insurance for medical costs, loss of earnings, additional living expenses, and funeral costs for occupants of the insured automobile and pedestrians other than those insured under other policies RR Rental Reimbursement Insurance which reimburses an automobile owner for the cost of renting a replacement automobile if the insured vehicle is rendered unusable by an insured peril SL Spousal Liability Provides bodily injury coverage under a private passenger automobile policy to cover the liability of an insured spouse because of the death of or injury to his or her spouse where the insured spouse is culpable for the injury or death TL Towing/Labor Charges An extension of an automobile physical damage policy that covers the cost of towing the insured car or providing emergency road service UM Uninsured Motorist Coverage Protection for the insured against bodily injury or property damage caused by the negligence of an uninsured motorist UN Underinsured Motorist Protection for the insured against bodily injury damage caused by the negligence of an underinsured motorist OT Other Claim types that are not described in any of the other defined categories Examples: Miscellaneous, Stolen Articles, and Accidental Death and Dismemberment 14

15 P r o p erty Claim Type Codes The Reported Claims History section returns the following property claim codes The description is not returned Property Claim Type Codes Code Description Explanation ACCDL Accidental Discharge/ Leakage Losses caused by water discharged from plumbing systems, including burst pipes Pipe bursts resulting from frozen pipes should be reported as FREEZ APPL Appliance Related Water Losses caused by water from appliances, such as washer machines, refrigerators, humidifiers, etc Coll Collision, Upset, Overturn Losses caused by a collision, an upset, or an overturn of a vehicle as provided under a ranch/farm owners policy CONTA Contamination/Pollution Losses caused by contaminants or pollutants in the atmosphere or surface environment CRAFT Watercraft Property damage or bodily injury liability amounts paid on behalf of the insured, as a result of the negligent operation of the insured's watercraft This is intended for when the coverage is attached to the homeowners policy or other policy This is not intended for boat policies CREDT Credit Card Damages paid to the insured as a result of theft and subsequent unauthorized use of credit cards DAMAG DISAP DISSC Damage to Property of Others Mysterious Disappearance Mysterious Disappearance Involving Scheduled Property Damages paid on behalf of the insured to another party for losses to property of the other party, caused by the negligent and unintentional acts of the insured Losses that result from the vanishing of an insured's property in an unexplained manner Differs from theft/burglary in that no evidence of theft is present Losses of property scheduled on a homeowners policy that cannot be explained, with no evidence of theft DOG Dog Bite (Liability) Damages paid on behalf of the insured as a result of any animal owned by the insured biting or injuring another individual EXTEN Extended Coverage Perils Includes losses that occur as a result of the extended coverage perils not listed elsewhere in this section: explosion, riot, civil commotion, damage from vehicles, and damage from aircraft FIRE Fire Losses caused by the combustion of an unfriendly fire (one that escapes the purpose or use from which it is intended, or one that is unintended) Although light, flame, and heat are generally required to constitute an unfriendly fire, a fire loss can occur without the presence of all three Subsequent losses (such as water damage and smoke) that result due to a fire should be included in this category FLOOD Flood Losses that result from rising water and its effects from the overflow of lakes, rivers, or streams Flooding within a dwelling due to burst pipes is not flood damage (see FREEZ) 15

16 Property Claim Type Codes (Continued) Code Description Explanation FOROB Intake of Foreign Objects Damage caused to farm related machinery resulting from the intake of foreign objects as provided under a ranch/farm owner's policy FREEZ Freezing Water Damage caused by the freezing of water and subsequent consequence The most common loss is water damage from water pipes rupturing and overflowing HAIL Hail Losses that result from damage caused directly by hail, or any form of falling frozen precipitation LAE Loss Adjustment Expense All claims costs and/or expenses specifically associated with the loss These costs include the investigation, appraisal, adjustment, settlement, litigation, defense, or appeal of a specific loss filing It does not include salaries and expenses of employees and other office overhead expenses LIAB Liability (All Other) Damages paid on behalf of the insured for any reasons other than SLIP and DOG, where the insured has been deemed negligent and liable for loss incurred LIGHT Lightning Losses caused by lightning, or any large-scale high-tension natural electric discharge in the atmosphere, including resulting losses from fire LIVES Livestock Losses associated with livestock as provided under a ranch/farm owners policy MEDIC Medical Payment Damages paid on behalf of the insured for medical care or expenses to an injured party, typically occurring while the injured party occupies the insured's property, but without regard to fault MOLD Mold Losses that result from the effects of mold MOVE Earth Movement Damages resulting from movement of the earth along established fault lines Differentiated from earthquake in that earth movement does not necessarily involve vibration or trembling of the earth's surface OTHER Other All other losses not described above, including but not limited to collapse, falling objects, weight of snow/ice PHYDA All Other Physical Damage Losses to real or personal property of the insured due to any reason not listed above, or in the section titled EXTEN - Extended Coverage Perils QUAKE Earthquake Losses resulting from vibrations of the earth or earth's crust caused by seismic activity from under the earth's surface SINK Sinkhole Losses resulting from a collapsing sinkhole SLIP Slip/Fall Liability Damages paid on behalf of the insured as a result of a visitor to the insured property becoming injured due to a slip or fall SMOKE Smoke Losses caused by smoke damage, other than those paid under the peril of fire THEFT Theft Losses experienced due to the theft or burglary of unscheduled personal property; for example, property not specifically listed or insured under the homeowners policy or any other policy THFSC Theft Involving Scheduled Property Losses from theft or burglary that involve scheduled personal property 16

17 Property Claim Type Codes (Continued) Code Description Explanation VMM Vandalism and Malicious Mischief Losses resulting from the willful destruction of the insured's real or personal property WATER Water Losses caused by the accidental presence of water (but not including flood or surface water) in a place where it is unintended, other than ACCDL, APPL, and WEATH WC Workers Compensation Benefits paid on behalf of the insured to personally hired employees of the insured, as a result of injury suffered while the employee is in the course of his or her employment WEATH Weather Related Water Losses caused by wind driven rain WIND Wind Damages caused directly by high winds, cyclones, tornadoes, or hurricanes 17