Special Investigations Unit (SIU) Reference Manual

Transcription

1 Citizens Property Insurance Corp.

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3 Table of Contents In this reference manual This reference manual contains the following topics: Special Investigations... 5 Accept/Reject SIU Referral Status... 6 Updating the SIU Activity... 9 Submitting a Metro Report Request Updating SIU Details /30/2013 Citizens Property Insurance Corp Page 3

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5 Special Investigations Overview When you receive a Special Investigations referral, you will need to investigate and determine the next steps. This information is entered into ClaimCenter by the Special Investigations Unit unless otherwise directed by management. Procedures in this Accept/Reject SIU Referral Updating the SIU Activity Submitting a Metro Report Request Updating SIU Details Tasks prior to completing an SIU Referral Adjusters must complete the following items prior to submitting an SIU referral: All claim files should be brought current with an updated status report outlining the SIU issues. All documents should be uploaded to the claim file, including interviews and statement summaries. 12/30/2013 Citizens Property Insurance Corp Page 5

6 1 Accept/Reject SIU Referral Procedure Follow these steps to accept or reject the SIU referral: 1 Review the claim to determine whether the referral is valid. You can use the links in the side bar to review the claim. 2 After determining the referral is valid, click the SIU Accept/Reject link. 12/30/2013 Citizens Property Insurance Corp Page 6

7 Accept/Reject SIU Referral, 3 Click Edit to update the SIU referral status. 4 Use the drop-down menu to accept or reject the referral. Then click Update to save the changes. If you reject the referral, it will be sent back to the adjuster and will no longer display in your Activities. After accepting the SIU referral activity, you will need to continuously update the activity with information regarding your investigation. 12/30/2013 Citizens Property Insurance Corp Page 7

8 Accept/Reject SIU Referral, 5 If you are rejecting the SIU referral, you must select the rejection reason prior to clicking Update. 12/30/2013 Citizens Property Insurance Corp Page 8

9 Updating the SIU Activity Procedure After accepting the SIU referral activity, you will need to continuously update the activity with information regarding your investigation. You may also update the activity and reset the due date to correspond with the work plan. Follow these steps to update an SIU activity: 1 In the Activities workspace, click the activity link corresponding to the SIU referral. Result: The Activity Detail for the claim opens displaying details of the referral. 2 Enter the Subject and Text details for the activity. 12/30/2013 Citizens Property Insurance Corp Page 9

10 Updating the SIU Activity, 3 Complete any additional updates to the activity and then click Update to save the changes. Note: The Escalation Date provides a period of time to complete the activity before it is escalated to your supervisor s activities queue. When the investigation has concluded, click Complete to remove the activity from the Workplan. (IMPORTANT: This closes the SIU investigation and should only be done when there are no outstanding leads to pursue.) Results: After the note is saved, it can be reviewed in the Notes workspace. 12/30/2013 Citizens Property Insurance Corp Page 10

11 Submitting a Metro Report Request Procedure During your investigation, you may determine that you need to request a police or fire report. In ClaimCenter, this is referred to as a Metropolitan or Metro report. Follow these steps to submit a Metro Report request: 1 Click the Loss Details link in the side bar. 2 Click Edit. 3 Scroll down to the Metropolitan Report section and click Add. Result: The Metropolitan Report Details screen displays. 12/30/2013 Citizens Property Insurance Corp Page 11

12 Submitting a Metro Report Request, 4 Complete the Report Information and Investigating Agency Information sections. Click OK when done. Note: The State of Investigating Agency is always Florida. Result: The Metro report request appears in the Metropolitan Reports section of Loss Details. Once the Metro Report is received, an activity is generated notifying you that the report is available for review within the Documents link of the claim file. 12/30/2013 Citizens Property Insurance Corp Page 12

13 Updating SIU Details Procedure Complete the SIU Details as they occur during the investigation. Follow these steps to update the SIU Details for a claim: 1 Click the Special Investigation link in the side bar. 2 Click Edit to update the investigation details as they occur. 12/30/2013 Citizens Property Insurance Corp Page 13

14 Updating SIU Details, 3 When you receive notice that the claim has been closed, complete the following: 1. Enter the SIU Completion Date (the date when the SIU activity concludes prior to the claim disposition). 2. Enter the Claim Disposition Date (the date when the adjuster closes his/her file). 4 Select the Disposition type from the drop-down menu. 12/30/2013 Citizens Property Insurance Corp Page 14

15 Updating SIU Details, 5 Indicate if an Examination Under Oath (EUO) is involved on the claim using the drop-down menu. This can be done anytime during the investigation. 6 IMPORTANT: If the disposition is anything other than a paid/adjuster disposition, complete the following: 1. Enter the Reserve/Exposure, the Total Indemnity Payment, and Allocated Expenses amounts. 2. Click Calculate to determine the Loss Mitigation Management (LMM) amount. 12/30/2013 Citizens Property Insurance Corp Page 15

16 Updating SIU Details, 7 As you progress through the investigation, you can update information in the Fraud Bureau & Enforcement section: 1. Use the DIF Referral drop-down menu to indicate if a referral has been made to the Division of Insurance Fraud (DIF). 2. If a referral has been made to DIF, indicate the date in the Date of DIF Referral field. 3. Record the Date of Suspicion. Once you receive the acknowledgement form DIF: 4. Use the DIF Office drop-down menu to select the DIF field office location. 5. If you have the DIF Tip Number, enter it. 6. If you have the case number, enter it in the DIF Case Number field. 7. Use the NICB field to indicate if the National Insurance Crime Bureau has become involved in the claim. 12/30/2013 Citizens Property Insurance Corp Page 16

17 Updating SIU Details, 8 Click Add in the DIF History section to record the DIF action details. 9 Enter the date of the DIF action. Then select a result from the menu options displayed and enter a comment if applicable. 12/30/2013 Citizens Property Insurance Corp Page 17

18 Updating SIU Details, 10 Click Add in the Other Agencies section to add other agencies that are involved in the investigation. 11 Enter the following details: 1. Select the agency from the Name drop-down menu. 2. In the Type field, select whether the agency is local, state, or federal. 3. Any comments that are necessary can be added in the Comment field. 12/30/2013 Citizens Property Insurance Corp Page 18

19 Updating SIU Details, 12 Click Add in the Person of Interest section to enter the name of a person or company associated with the investigation. 13 Enter the following details: 1. In the Subject field, enter the name of the person or company associated with the investigation. 2. In the Relationship field, you can select whether the agency is local, state, or federal. 3. Any comments that are necessary can be added in the Comment field. 12/30/2013 Citizens Property Insurance Corp Page 19

20 Updating SIU Details, 14 Once you have finished modifying the SIU Details screen, click Update to save your entries. Result: The updated information now displays in the Claim Outcome section. After finalizing the SIU details, you need to pay the invoices for the claim. 12/30/2013 Citizens Property Insurance Corp Page 20