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The ABCs of Claims Advocacy

Do you know what a claims advocate is or why it’s great to have one in your corner?  When it comes to defending your rights against an enormous insurance carrier, your claims advocate has your back.  Claims advocates provide technical consultation and assistance to make sure that claims are managed properly, reserves are adequate, and claims are closed quickly.  This is especially true if your case is the subject of an incorrect analysis of coverage/liability or an outright denial of coverage/liability due to an unfair assessment or misinterpretation of the policy language.

For example, we handled a recent case on behalf of a popular non-profit organization that experienced roof tile breakage after a wind storm impacted their Honolulu offices.   Since the roofing material had once been the subject of a class action claim – in which the non-profit had not participated –  the insurer refused to cover our client’s losses.  After some serious due diligence on the case, we worked to help our client recover damages, arguing that although the insured did not originally participate in suing the material’s manufacturer, the product had been installed to correct building standards at the time, yet still had been considerably damaged.  Based on the analysis we presented, the insurer agreed to provide a sizeable settlement to this client.

In another case, we helped a small business owner whose carrier anticipated the insured being sued by an injured employee following an auto accident in a vehicle being operated by a company driver.  The case had been assessed a large reserve by the carrier – over $280,000 – which we disputed, based on the governing statute that disallowed such lawsuits based on simple negligence.   The carrier then reviewed the case, including the precise statute wording, which excludes liability for this type of incident.  As a result, the carrier sharply lowered our client’s reserve requirement, allowing them to obtain far more competitive rates for the coming insurance year.

When working with an agency, it’s worth finding out whether they employ claims advocates to help work on your behalf in the event of a dispute.  Qualified advocates will fight strongly in favor of an agency’s clients, often meeting with them about their claim in person in order to fully gather important details.  Once the advocacy team has a solid understanding of the situation, they can draw from their own experience to determine how to best frame the clients’ arguments, instructing them on what to ask for and how to present their case.  In complex situations where litigation is involved, claims advocates can help iron out reporting details and step in to assist if the case is headed in the wrong direction.  Under this scenario, help can come from all sides – before, during and after the case – depending on the specific circumstance.

Your advocates’ backgrounds can greatly influence the quality and degree of representation you receive.  At Atlas, for example, the claims advocacy group has decades of experience working from various perspectives – with  insurance carriers, litigation attorneys, and of course, agencies.  This diverse backgrounds allows us to help clients submit their claims and appeals in the best possible light to achieve a positive outcome.  If you are searching for new coverage, and would like to meet our advocacy team, please be sure to let your broker know. We would be happy to answer your questions.

Contact a Risk Management Specialist

Atlas Insurance’s team of risk management professionals maintains designations such as Authorized OSHA Outreach Trainer, Certified Safety Professional, Workers’ Compensation Attorney, Certified Insurance Counselor, and Licensed Insurance Agent.

We can work with you to provide risk control measures that will help reduce losses, including safety training, developmental safety programs, hazard inspections, OSHA compliance, and more.

Our risk team can be reached via our online contact form.

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