For both insureds and insurers, the ability to appropriately and efficiently handle claims is a critical component of any insurance program. As members of the group captives we support, our clients assume both roles (insured and insurer), making claims services even more challenging. To this end, Captive Resources (CRI) provides hands-on services to make sure member companies have the support they need when they need it.
Our Claims Services department is staffed with experienced professionals who assist members with claims handling services by overseeing third-party claims administration. Our claims professionals work closely with captive members to develop an effective service program to ensure claim reserves and settlement values are appropriate.
Onboarding introduces the member to the claims reporting process and provides information on how to access claims data. During the onboarding process, we review special handling requirements, explain the claim review process, and outline the member’s overall role in claims handling. Members are encouraged to participate in the claims process and will receive a claims kit with all the necessary information for active claims management.
Special Handling Instructions
CRI works with each group captive to ensure that Special Handling Instructions are in place to cover member involvement in selecting defense counsel, nurse case management, and investigative services such as surveillance. In addition, each member may add its own company-specific instructions, if necessary.
Our Claims Services Managers participate in all claim reviews and consult on any questions or concerns that may arise. While the threshold for reviewing claims during a formal review is set at $20,000, members may also choose to include smaller claims that may be of particular concern. So while the reserve and settlement consultation threshold is set at $20,000, there is flexibility to address specific concerns.
Specialized Claims Services
To ensure claims are handled efficiently and appropriately, CRI offers specialized claims services like:
We flag any claim that merits special attention, has questionable compensability, or involves significant exposure. For these “Hot” Claims, CRI will quickly reach out to the member(s) and its broker(s) to discuss any issues and concerns.
For group captive members that work with us, CRI offers Pulpstream — a cloud-based mobile platform that makes scheduling and managing claim reviews simple and effective. We also use Pulpstream to manage Risk Control Assessments and safety consulting activities.
Our claim professionals act as a liaison between members, carriers, TPAs, and brokers. In this capacity, team members monitor larger value and complex claims and work closely with members to encourage participation and sufficient resolution of the claim handling process.