Auto Claim Audit – CPR Insurance Group

GENERAL INFORMATION

Carrier

Claim Number

Auditor Name

Auditor Email

Adjuster

Review Period

COVERAGE

Policy dates verified

Comments

Jurisdiction determined and documented

Comments

Indication of any special account handling

Comments

INVESTIGATION

24 hour contact made with claimant

Comments

24 hour contact made with insured

Comments

Accident/Police report obtained

Comments

All necessary recorded statements were obtained

Comments

Auto salvage addressed

Comments

Diagram photos of scene

Comments

Outside investigator utilized if needed

Comments

Expert used for Cause of Loss or Accident Recon

Comments

Any evidence of fraud documented/reported to SIU

Comments

Notified Underwriting/Loss Control if issues ident

Comments

Class of Business appears match policy classifications

Comments

Index review completed and matches investigated

Comments

Liability determined and documented

Comments

Excess Carrier notified when reported criteria met

Comments

FILE DOCUMENTATION

Initial claim review complete and comprehensive

Comments

Notes clearly labeled

Comments

Plan of Action adequately explained and followed to reflect an accurate claim exposure

Comments

Evidence of ongoing contact with the claimant/plaintiff attorney

Comments

OFAC check for payees in the file

Comments

Medicare check for payees in the file

Comments

Appropriate diary follow-up is evident

Comments

Damages/Specials properly documented

Comments

Proper supervisor/manager documentation if needed

Comments

RESERVES

Reserve worksheet used to calculate reserve level

Comments

Initial reserves established timely after receipt of claim

Comments

Reserve review made within 30 days of a claim altering event (Reserve changes made if necessary)

Comments

Stairstepping of reserves avoided

Comments

Life expectancy taken into account in reserve evaluation if applicable

Comments

STRATEGIES

Plan of action outlined

Comments

Plan of action being executed

Comments

NEGOTIATIONS

Policy coverage and limits verified

Comments

Reasonable claim value determined

Comments

Supervisor approval above authority

Comments

Offers and correspondance documented

Comments

COST CONTAINMENT

Payment made timely once damages established and agreed upon

Comments

Vehicle moved from storage as quickly as possible

Comments

Rental ended as soon as possible after settlement/repairs completed

Comments

if accurate complete

LITIGATION

Assignment to counsel upon receipt of suit

Comments

Coverage issues recognized and assignment made to coverage attorney when indicated

Comments

Strategy with defense counsel documented within 30 days of assignment to counsel

Comments

Strategy defense budget obtained

Comments

Evidence of ongoing contact with the defense counsel

Comments

Attempts made to resolve litigation/settlements either before or at mediation.

Comments

Suit acknowledgements letters sent to policyholders and agents

Comments

Coverage denial letters sent to policyholders and agents

Comments

Reservation of rights letters sent to policyholders and agents

Comments

RECOVERY

Subro addressed, documented and pursued if appropriate

Comments

File referred for recovery as appropriate

Comments

Product/evidence id'd preserved if applicable

Comments

Contacts identified, obtained and documented

Comments

Subro diary has PoA recovery evaluation w/ target dates

Comments

OVERALL CLAIM FILE EVALUATION

Overall Claim File Evaluation