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Claims Section

Mission

The Claims Section is dedicated to providing claimants in receivership estates with the most cost-effective and efficient method for processing claims, in order to maximize the amount of a potential distribution.

Program Responsibilities of the Section

The Claims Section is composed of three units: Claims Financial Management, Claims Data Management, and Estate Claims Management-charged with processing and evaluating all claims filed in receivership estates according to Chapter 631, Florida Statutes. The Section also oversees the claims handling responsibilities of insurance entities in receivership for purposes of rehabilitation. Additionally, the Section assists and educates the public regarding receivership issues, via mail, e-mail, phone calls and the Receiver’s website at www.floridainsurancereceiver.org.

The responsibilities of the Claims Services Section are to:

  • Identify all parties who may have a claim in a receivership estate.
  • Maintain a claimant information database for each estate.
  • Notify known potential claimants of the court-ordered claims deadline and advising them of procedures for filing a claim with the Receiver.
  • Process proof-of-claim forms.
  • Evaluate the legitimacy of all properly filed claims and assign a dollar amount.
  • Coordinate claims activities with receivers in other states for multi-state receiverships.
  • Coordinate with various insurance guaranty funds that are triggered by the court order of liquidation.
  • Provide claimants with notice of the Receiver’s recommendations on filed claims and advise them of the deadline for filing any objections to the Receiver’s recommendations.
  • Negotiate and resolve objections to classifications and amounts recommended on claims by the Receiver.
  • Coordinate oversight and review of guaranty association claims paying practices in Florida.
  • Oversee the claims processing activities of companies in receivership for purposes of rehabilitation.
  • Procure and manage contract providers involved in section activities in accordance with applicable policies.
  • Respond to public inquiries relating to claims filing deadlines, policy cancellation dates, and the status of active claims.

Accomplishments in the 2006-2007 Fiscal Year

In the 2006-2007 Fiscal Year, the Claims Section evaluated 12,580 claims and mailed  55,882 claimant proof of claim notifications. The Claims Section also processed  3,905 claimant proof of claim notices, 2,254 as filed claims and 1,651 as other mail returns.  On-site claims activity resulted in the inventory and transfer of  50,898 claims to affected guaranty associations.  Inaddition, the Claims Section mailed 11,925 notices of determination and responded to 781 claims-related Internet inquiries. 

Other accomplishments in the 2006-2007 Fiscal Year include the following:

  • Supervised oversight of claims handling for five on-site receiverships and explored alternative information technology and staffing options to maximize the quality and minimize the expense of providing claims adjusting services.
  • Finalized the development, testing and implementation of ClaimNet (version 1), an NAIC Internet-based claims system, and activated its use by claimants in a Florida domestic receivership to complete and submit electronic proof of claim forms to the Receiver.
  • Finalized development of OLCPSQL reserving software and implemented post liquidation claims reserving on four property and casualty receiverships.
  • Participated in the development and implementation of OLCPSQL software version 3.3 to enable utilization of ClaimNet as well as enhanced business and data validation rules and an on-line help system.
  • Streamlined the process of transferring claims data from company information systems to affected guaranty associations to enhance customer service and claim payment capabilities.
  • Continued to develop paperless work initiatives with the Florida Insurance Guaranty Association to enable such improvements as the conversion of a company’s new claims handling from a paper to a paperless process.
  • Participated in various NAIC workgroups to develop recommended updates affecting claims handling to the NAIC Receiver’s Handbook for Insurance Company Insolvencies and the NAIC Uniform Data Standard Manual.
  • Coordinated an operational review of the Florida Guaranty Association.
  • Implemented recommended improvements to the process for identifying and processing federal government claims.
  • Updated claims processes affected by 2006 changes to Florida Statutes Chapter 631, Part II, including higher guaranty association caps and deductibles. Implemented and enhanced claims authorization and security measures, including Claims Committee oversight.
  • Streamlined the process of handling claims related requests and inquiries through systems coordination and information centralization.
  • Implemented process changes to accommodate the future implementation of FileNet, an electronic document management system.

Goals

The Claims Section during the 2007-2008 fiscal year will aggressively seek methods to fulfill its responsibilities to claimants in receivership estates.  The following are some of the projects the Claims Section will be working on during the 2007-2008 Fiscal Year:

  • Participate in the development and implementation of updates to OLCPSQL to enable enhanced management reporting, expanded indexing capabilities, and improved navigational tools.
  • Participate in the implementation of ClaimNet (version 2).
  • Improve the process of identifying pre-liquidation liabilities for outstanding checks and drafts.
  • Streamline the process of handling unearned premium claims through deemed filing of claims in order to better meet the needs of affected claimants.
  • Implement process changes to accommodate the implementation of Service Point, a consumer response tracking system.
  • Coordinate a triennial operation review of the Florida Workers’ Compensation Insurance Guaranty Association.
  • Continue to work with affected guaranty associations to standardize data reporting and streamline the claims information transfer process.
  • Continue to identify cost savings opportunities and technology solutions in order to implement best practices in all areas of claims handling.

Staff and Contact Information

The Claims Director oversees the daily operations of the Claims Section’s 21 professional, technical, and support personnel.  The Claims Section can be reached at the Division’s main telephone number, (850) 413-3179, by fax at (850) 922-9115, or via the Internet at www.floridainsurancereceiver.org.