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THE CLAIMS FUNCTION

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INSURANCE COMPANY VALUECHAIN

INBOUND

LOGISTICSOPERATIONS OUTBOUND

LOGISTICS

MARKETING

& SALES SERVICES

Reinsurance

Loss

Adjusting

Underwriting

Surveying

InvestmentClaims Broker services

Risk management

Repairs

FIRM INFRASTRUCTURE

HUMAN RESOURCE MANAGEMENT

TECHNOLOGY

PROCUREMENT

SUPPORT ACTIVITIES

PRIMARY ACTIVITIES

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INSURANCE COMPANYORGANISATION

Claims

Manager

Underwriting manager Reinsurance

Tehnical general

manager

Investment General

Manager

Marketing General Manager Administrative General manager

Chief Executor Officer

Board of directors

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AN IRISH COMPANY

Reinsurance

Director

Underwriting

Director

Claims Director Personnel

Director

Managing

Director

CHAIR OF

THE BOARD

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BRANCH ORGANISATION

Claims

Handlers

Claims

Inspectors

Engineers

CLAIMS

SUPERINTENDENT

UNDERWRITING

SUPERINTENDENT

REINSURANCE

Type title here

PERSONNEL

BRANCH

MANAGER

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INSURANCE INTERMEDIARIES

Governed by Insurance Act 1989

Brokers

Hold themselves out as experts ininsurance

Must deal with at least five life and five

non-life companies Must be a member of the Irish Brokers

association (IBA)

Must have a separate guarantee fund

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WHOSE AGENT IS THEBROKER

Agents of the insured

May be times when agents of insurer Collection of premium

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INSURANCE INTERMEDIARIESAGENTS

Work with less than five insurers

Agents of the insured

Act now provides agent of insurer whencompleting proposal forms

Tied agents

Work with only one company

Agents of insurer

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LOSS ADJUSTERS

Specialists in claims investigation andnegotiation

Only appointed by insurers

May specialise in a particular class ofloss

Normally members of the CharteredInstitute of Loss Adjusters

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LOSS ADJUSTERS

There task is to:

Investigate cover

Investigate quantum

Report to their principles

They have no authority outside that given

by their principles

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LOSS ASSESSORS

Appointed by insured

Investigate and negotiate on behalf of

the insured

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THE CLAIMS PROCESS

How are claims made?

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Developmentaltheoryoflitigation

Accident

Perception of the injury

Grievance

Claim

Litigation

Recognition Barrier

Attribution Barrier

Abandonment

Confrontation

AbandonmentBarrier

Litigation Barrier

Kritzer, 1991

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HOW INSUREDS MAKE THEIR DECISIONS

Realisation of loss

Causation

Attribution to peril

Claim under policy

Policy provides

cover

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Broker advised Insurer advisedBroker advised

Insured reports Loss

Check coverCover

No cover

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Claim reported to

insurer

Insurer

Checks cover

Appoints loss

adjusterChecks

Quantum

Investigates and

reportsSettles

Estimate

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CHECKING COVER

Check name of insured

Check policy in force

Check that the circumstances of theloss fall within the four walls of thepolicy

Check all conditions complied with.

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LOSS ADJUSTER

Appointed by

Insurer

Checks facts

Checks cover

Checks Quantum

Reports to

Insurer

Negotiates with

Insured

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