The THiNK Blog

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5 Phases of Moving Claims Through to Completion

Apr 5, 2017 9:00:00 AM / by Robert Bouchard posted in Reinsurance, Claims

The first part of this series explained the importance of moving a claim through to completion within a 90-day period. To help you strive for this, I shared barriers that could prevent it from happening and key components to aid the process. To recap, the three components are:

  1. Streamline your process for submitting claims
  2. Identify & address any retention/ceding issues as soon as possible
  3. Initiate dialogue between the ceding assumed entities on any discrepancies or concerns early in the process

The first component, streamlining your process for claims submission, can be accomplished by using electronic reinsurance claims. The second and third components can be accomplished by developing a consistent stream of communication with your business partners. Throughout my experience, I've found the following five phases can contribute to strong communication, resulting in timely payments under 90 days. 

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[How to] Keep Unpaid Reinsurance Claims Under 90 Days Old

Mar 31, 2017 11:29:34 AM / by Robert Bouchard posted in Reinsurance, Claims

As part of the re/insurance eco-system you are likely aware that insurance companies are expected to pay claims in a timely manner.  And rightly so as all parties involved can benefit from this. Direct writers and assumed reinsurance deals get their expenses paid, ceding reinsurers receive their income/assets and claimants get their coverage. The expected 'timely manner' is a 90-day period. Unfortunately this doesn't always happen which can have consequences. So how can you strive to keep outstanding claims under the 90-day old threshold? Read on to find out!

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Challenges of Critical Illness from a Claims Perspective

Nov 2, 2016 4:52:47 PM / by Mervyn Gillson posted in Claims, Underwriting

In the first installment of this blog, we broke down the basics of Critical Illness (CI) insurance and what you need to know to successfully write CI business. Knowing the basics of CI is also the starting point for a claims professional. It is important to understand the challenges you might come across when dealing with Critical Illness. This principal is something that is beneficial to any role – know the barriers so that you have a plan to overcome them.

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What do I need to know about Critical Illness Insurance?

Jul 19, 2016 11:11:37 AM / by Fernanda Rodriguez posted in Underwriting, Claims, Critical Illness

As a claims professional, I come across critical illness cases regularly. And while Critical Illness Insurance (CI) has been in the market for over 30 years, did you know that it is still considered by many to be in its infancy stage? This may seem shocking , but in fact, 30 years is considered to be relatively short compared to overall life insurance which has been around since the 18th century.

Given the early stages that CI is in, compared to other life insurance products currently in the market, many people don’t have a comprehensive understanding the protection it offers and its value. Given that advances in medicine are allowing us to live longer, CI was designed to protect consumers against unforeseen critical illnesses. Think you need to ramp up your knowledge on Critical Illness Insurance?  My three-part series will cover current trends, the difference between CI and Life and Disability Insurance and the challenges you may face with CI claims. To kick things off, I’ll start with where it originated from.

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Attending AHOU 2016?! Chat with us at the Expo!

Apr 20, 2016 4:17:12 PM / by Nick Joly posted in Underwriting, Claims, E-Learning / Training, Industry News

The 2016 AHOU (Association of Home Office Underwriters) Conference is just weeks away! As exhibitors, our team of underwriters are looking forward to the upcoming breakout sessions and exhibition trade show! We are big believers in keeping up with life underwriting trends, so we've definitely got our eyes on the insights that will be shared at AHOU 2016. Some of the topics that have piqued our interest and that our experts will definitely be attending are:

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How will Changes to Physician/Doctor-Assisted Suicide Impact Insurance Claims in Canada?

Jan 29, 2016 3:24:03 PM / by Fernanda Rodriguez posted in Claims, Life Insurance

The holidays are over, our list of goals for 2016 is ready and life seems to be falling back to normal… but wait, a major change is coming to Canada which will likely have an impact on the life insurance industry, and more specifically on life insurance claims. We are getting closer to the anniversary of the historical decision on physician-assisted suicide made by the Supreme Court of Canada. As a claims professional, you can imagine that I have a vested interest in this topic as it relates directly to (and will certainly have an impact on) many of the claims services I provide.  

Here is a summary of the decision that was made in early 2015 on Physician-Assisted Suicide in Canada:

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LOGiQ3 Life Insurance & Reinsurance Trend Watch!

May 27, 2015 9:30:00 AM / by Nick Joly posted in Underwriting, Claims, Reinsurance, LOGiQ3, Audit, Life Insurance

Hey there, 

You may or may not know this, but our team at HQ has been growing quite a bit lately, with new team members being added to the Underwriting & Claims department, to the Reinsurance Administration team to even our Audit Consultants! And with new family members comes new perspectives and new expertise from the industries we play in, namely life insurance and reinsurance! So I've decided to put together another great INFOGRAPHIC on what a couple of us have our eyes on, and what trends are on ALL of our radars! Have a look at the top trends that made our list in this half of the year for each of our business lines and share your thoughts with us! We'd love to know what you've got on YOUR #TRENDWATCH

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Claims Decision: The Impact of Cause of Death

May 6, 2015 2:25:00 PM / by Fernanda Rodriguez posted in Claims, Innovation, Life Insurance

What an honour it was to be part of the Eastern Claims Conference this past February! This year’s conference contained excellent quality claims content and speakers. And, there were attendees from all over the world, including Argentina! What was great for me as a claims professional attending this conference was that I got to benefit directly in seeing what the upcoming trends in Claims are for 2015 and how these may be relevant or benefit our current suite of claims services.  

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Does Early Rehab Improve the Outcome of Disability Claims Handling?

Dec 10, 2014 10:00:00 AM / by Fernanda Rodriguez posted in Claims

Assessing disability claims can be a culinary art sometimes...

... You have to mix the right combination of several ingredients to bake a delicious cake, or in the case of a disability claim… a delicious decision!

Contrary to the stereotype of claims being automatically denied, in claims administration, the job of the Claims Adjudicator (adjuster/case manager/assessor) is not just about making decisions based on days of the week or moods or the luck of the draw.

It is to review all evidence and use a combination of skills (medical, legal, financial, occupational, etc.) to arrive to a fair decision in the quickest time possible.

At the same time the adjudicator must maintain the trust of the claimant and manage expectations from advisors, employers, managers, etc. Not an easy task…and to complicate matters, let’s not forget that the Claims Adjudicator is dealing with humans, and human beings are all unique and react to adversity in different ways. For example, a claims department may use reasonable recovery times as guidelines for return to work, but the truth is…individuals have different pain tolerances, mind sets, motivations, and emotional IQ’s. Therefore, an insurer's claims experience and ultimate recovery guidelines are not the same for all. 

In my many years of claims adjudication, I have learned that the claims on my desk could not be treated simply as files; but rather as someone’s personal, individualized story. Therefore, I found that close interaction with the claimant was ALWAYS the best practice. 

  • It allowed me to gain a better understanding of their personal story.
  • It assisted me with connecting the dots, or completing the puzzle.

In my experience, I have found that most claimants do wish to go back to work as soon as possible, but have to deal with many barriers. Therefore, time is of the essence during this small window of opportunity.

Take a look at this chart:   

Published in 2005 by the American College of Occupational & Environmental Medicine

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Conference: Eastern Claims Conference 2014

Mar 18, 2014 1:38:00 AM / by Eli Wahby posted in Claims, Marketing

I had the privilege of attending the Eastern Claims Conference with Carmela late last month. It was good to see a strong program and attendees from North America, Europe, Asia and the Middle East.

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