Record Keeping and Notes in Records for Claims Adjusters

Transcription

1 CLAIMS ADJUSTERS Recrd Keeping and Ntes in Recrds fr Claims Adjusters A claims adjuster s bligatin t keep prper recrds is related t the bligatin t act with cmpetence and prfessinal integrity, as required under sectin 16 f the Act respecting the distributin f financial prducts and services. Imprper recrd keeping is als cnsidered t be carrying n ne s activities negligently, under sectins 10, 15 and 58 (1) f the Cde f ethics f claims adjusters. Finally, the cntents f the recrd as such must cmply with the requirements f sectin 21 f the Regulatin respecting firms, independent representatives and independent partnerships. These legislative surces appear at the end f this dcument. Claims adjusters als have bligatins with respect t all ntes in the recrd that dcument discussins, cnversatins, actins taken and advice given t claimants. Ntes in the recrd are essential t ensuring prper fllw up. Using a cmputerized dcument management system r any ther paperless r paper-free methd f recrd keeping des nt lessen the firm s and the claims adjuster s bligatins t keep prfessinal recrds and ntes in the recrds. THE FIRM S OBLIGATIONS Keep a recrd fr each claimant r each claim. Use an rderly filing system fr recrds (ex.: claim, lss r claimant number). Keep recrds in any ne f the firm s establishments that has been declared in the register f the Autrité des marchés financiers. The individual dcuments that make up a recrd may each be kept in a different lcatin r medium (frmat), as lng as the cmplete recrd can be reassembled and made available in a timely manner. Stre client recrds safely. Prtect physical recrds frm fire r theft by having, fr instance, an alarm system, fireprf filing cabinets, and fire extinguishers. Prtect cmputerized recrds frm lss, destructin r falsificatin. Firms must therefre make back-ups f all data; cntrl access t cmputers; and pt fr infrmatin technlgy systems that make it impssible t change r erase data

2 Frbid filing ntes taken n pst-its r scraps f paper in a physical recrd. Ntes taken this way shuld be re-transcribed prperly and then placed in the recrd. Establish a system that allws the firm t identify the date at which the file was clsed r the date f the last activity carried ut in the recrd. This must be dne in rder t ensure cmpliance with the bligatins cncerning the minimum perid fr preserving recrds REMINDER: Recrds must be kept fr a minimum f five years frm the date f the last transactin.. All claim files must be kept fr a minimum f five years frm the date f ccurrence f the last f the fllwing events: the final clsing f the recrd, the date the last service was rendered t the claimant, the date the last reprt was submitted t the insurer that mandated the claims adjustment firm, the date f the final settlement f the claim, regardless f whether the insurer cmpensated the claimant r nt. Nte: If yu hear f r are ntified that further damage ccurred after the recrd was clsed, r that the claim is under litigatin, it is imprtant t repen the recrd and make sure that it is preserved beynd the nrmal perid f time and up until any further develpments have been settled. When in dubt, cnsult a superir. INSURERS COMPUTER SYSTEMS IMPORTANT INFORMATION FOR INDEPENDENT CLAIMS ADJUSTERS When an independent claims adjuster mandated by an insurer uses the insurer s electrnic prtal, the firm s recrd-keeping prcedures must include a sectin n the use f this prtal, since the infrmatin btained thrugh a prtal des nt cnstitute the independent claims adjuster s claim file, but rather the insurer s file. The claims adjuster must either print ut all the dcuments and attach them t the paper recrd r create a mirrr cpy f the recrd in the firm s cmputer system. Furthermre, the claim file must remain available even if the electrnic link n lnger functins. Thus, the insurer s cmputer system must nt be the nly place where the independent claims adjuster s ntes are kept. THE CLAIMS ADJUSTER S OBLIGATIONS Put all dcuments in the claimant s claim file, and recrd in the file all the infrmatin required under this prcedure. Ensure that recrds are cmplete and maintained in an rderly fashin s that ther claims adjuster in the firm r wrking fr the insurer may prvide fllw-up and answer clients questins, if necessary. Ensure that ntes in the client recrd are legible and in rder. Fr each nte, the representative must Specify the date n which it was written. Include sufficient details t ensure that it is understandable, even several years later. Indicate that he is the authr f the nte

3 Nte: Ntes in the client recrd include all discussins r cnversatins with the claimant r a third party; infrmatin prvided, in particular mandates and instructins given t service prviders, and fllw-up with these prviders; as well as actins carried ut, as explained in the sectin entitled Cntents f the Claim File. ON THE ROAD Much f a claims adjuster s wrk may be dne n the rad. The claims adjuster must therefre ensure that he is equipped t take accurate, cmplete ntes and abve all, that he is able t prtect the cnfidential infrmatin he has in his pssessin, n matter where he is wrking. CONTENTS OF THE CLAIM FILE The claim file shuld include, at a minimum: A. Basic Infrmatin The claimant s name and cntact infrmatin. The reference number f the claim file (r the lss file). The date f the ntice f claim. The lcatin f the lss. The plicy number and the perids f cverage, where applicable. The date and the nature f the lss as well as the circumstances surrunding it. The amunt, the bject and the nature f the insurance cverage, the deductible, and the limitatins and exclusins. Explanatins given t the claimant regarding the cllectin and cmmunicatin f persnal infrmatin and assignments f claim, where applicable. B. Dcuments (examples, depending n the circumstances) The cnsent fr the cllectin and cmmunicatin f persnal infrmatin when making a claim frm must be cmpleted and signed by the claimant. A frm designed by the ChAD is available at chad.ca, in the Tlbx sectin. The initial statement f claim and subsequent statements. Statements by third parties. Phtgraphs f the damaged site r prperty. A list f the claimant s prperty that has been lst, damaged r put int strage. This list is sent in by the claimant r any ther persn wh has prepared such a list

4 Qutes and estimatins fr the cst f wrk, assessments made by service prviders, experts reprts as well as the cntact infrmatin fr individuals representing these third parties. All ther dcuments cncerning services rendered, fr example: all dcuments the claimant has sent in t supprt his claim: a list f prperty, phts and prfs f purchase f prperty, invices fr the replacement f prperty, invices fr maintenance, etc.; a cpy f the insurance plicy; invices and receipts; a cpy f crrespndence received and sent that has any bearing n the file, including faxes and s. Nte: if a paper cpy f the s has nt been made, they must be attached t the electrnic recrd and nt simply kept in the claims adjuster s in-bx; this is required in rder t ensure that the s can be retrieved easily and reviewed by thers, if need be. Any ther infrmatin related t services rendered. C. Ntes in the Claim File Ntes in the file must be clear, cmplete, accurate, legible and understandable t the claims adjuster in charge f the recrd as well as t anyne else wh may be asked t d any wrk n the recrd, r t thse authrized under the Act t verify r cnsult the ntes. A nte that is t shrt r incmplete, such as called the insured, 10 min., des nt cmply with this bligatin. Thus, time sheets that are filled in fr the purpses f billing the insurer d nt cnstitute a nte in the file. Ntes shuld be written while the events are taking place r as quickly as pssible thereafter. Furthermre, ntes must be bjective and include facts and cncrete details. Opinins, hunches and impressins are certainly part f any adjuster s investigatin, but they cannt be cnsidered t be a nte in the file if they are nt supprted by cncrete evidence. Example: instead f writing the claimant is lying, it is preferable t write: The claimant has prvided cntradictry versins f the events and is unable t explain the cntradictins between these versins. The claimant stated that he had just bught the appliances, but he did nt keep any invices and did nt remember the stre where he bught them. On the ther hand, ntes shuld include, fr example: summaries f telephne cnversatins r meetings with the claimant; details regarding requests the claimant made r infrmatin he prvided; ntes regarding infrmatin and explanatins given t the claimant as well as decisins made (ex.: assignments f claim t service prviders, the insurer s reservatin f rights with respect t the pssible inadmissibility f a claim, etc.); - 4 -

5 summaries f telephne cnversatins r meetings with ther representatives, claims adjusters, and ther parties t the file, in particular service prviders mandated by the claims adjuster; recrdings f telephne cnversatins, where applicable; summaries f any actin r steps taken by the claims adjuster r ther emplyees r claims adjusters invlved in the file, instructins given and service prviders reprts. IMPORTANT: EXTERNAL SERVICE PROVIDERS (AFTER THE LOSS) Sectin 21 f the Cde f ethics f claims adjusters ges t the heart f the rle f the claims adjuster. It reads as fllws: Claims adjusters must prvide the insured with the explanatins necessary fr them t understand the settlement f the claim and services rendered t them. The claims adjuster must therefre recrd in the file the wrk carried ut and the services rendered fr the purpses f settling the claim in rder t be able t prvide any required explanatins and refer t infrmatin in the file as needed. Furthermre, using external service prviders must never result in the claims adjuster lsing cntrl f the file. He must always knw hw the wrk is prceeding, what the status f the claim is and what csts have been incurred. Cmplete ntes enable the adjuster t prve exactly what has been dne and said. LEGISLATIVE SOURCES The bligatin t keep client recrds prperly is related t the bligatin t act with cmpetence and prfessinal integrity, as required under sectin 16 f the Act respecting the distributin f financial prducts and services: 16. All representatives are bund t act with hnesty and lyalty in their dealings with clients. They must act with cmpetence and prfessinal integrity. Imprper recrd keeping is als cnsidered t be carrying n ne s activities negligently, pursuant t sectins 10, 15 and 58(1) f the Cde f ethics f claims adjusters: 10. Claims adjusters must nt neglect prfessinal duties relating t their prfessinal activities and must carry ut such duties with integrity. 15. The cnduct f claims adjusters must be characterized by bjectivity, discretin, mderatin and dignity. 58. Acts by claims adjusters that are cntrary t the hnur and dignity f the prfessin cnstitute a breach f the Cde f ethics, including: 1 carrying n their prfessinal activities dishnestly r negligently. Finally, the cntents f the recrd as such must cmply with the requirements f the Regulatin respecting firms, independent representatives and independent partnerships (D-9.2, r.2 n. 9)