The following document templates are found in ClaimCenter. This job aid describes the purpose of each document.

Transcription

1 Document Templates Personal Lines Overview The following document templates are found in ClaimCenter. This job aid describes the purpose of each document. Procedure Use the following table to jump to the corresponding pages for Document Template descriptions: Claims Documents... 2 Appraisal Letters... 7 Sinkhole Letters... 8 Mediation Letters SIU Letters Forms NPIF Letters

2 Claims Documents CC Claim 90 Day Status Letter CC 90-Day Interest Payment Letter CC 90 Day Violation Settlement Denial CC Claim Closed Without Payment CC Contact Letter CC Denial Letter CC Disclosure FL Without Defense Letter CC Excess Letter PCLMS1 PCLMS2 PCLMS4 PCLMS6 PCLMS7 PCLMS8 PCLMS9 PCLMS10 Letter sent to insured requesting additional documentation or follow up in order for Citizens to complete its investigation. It acknowledges Citizens is unable to comply with statute due to circumstances beyond their control. Letter sent to insured advising them that 90 days has passed since they reported their claim and they are owed interest based on Florida statute. Letter sent to insured advising them that even though 90 days has passed since they reported their loss, there is no coverage under their policy so they are not owed any interest. Letter sent to insured confirming that the claim has been closed with no payment per their request. Letter sent to insured requesting them to contact adjuster if adjuster has been unable to contact them via phone within 72 hours from FNOL. Letter sent to insured advising that there is no coverage for their claim. Letter sent to liability claimant or their representative disclosing insurance policy information pursuant to Florida Statute Letter sent to insured informing them that the liability claim or claims presented against them may exceed the policy limits available on the referenced policy. 2

3 Claims Documents CC Claim ACV Settlement Status Letter CC Initiation Duties Letter CC Liability Denial MP Offer Letter CC Lightning Affidavit Letter CC Loss Below Deductible CC Loss Below Ded Denial Letter CC Medical Authorization Letter CC Medical Records Request Letter CC MH Agent Letter CC MH Debris Removal Consent Letter PCLMS11 PCLMS12 PCLMS13 PCLMS14 PCLMS15 PCLMS16 PCLMS17 PCLMS18 Letter sent to insured inquiring as to whether or not repairs have been completed. Letter sent to insured advising them of their duties required by the policy. Letter sent to claimant or his/her attorney advising him/her that we are denying coverage or liability for their injuries or damages, but that there is $2,000 of medical payment coverage available upon receipt of documentation to support same. Letter sent to insured detailing the instructions on completion of an enclosed lightning affidavit form. Letter sent to insured advising them that the amount of damages to their claim do not exceed their policy deductible. Letter sent to insured advising them that the amount of damages to their claim do not exceed their policy deductible as well as detailing the items not covered by their policy. Letter sent to claimant or his/her attorney asking him/her to sign and return the attached Medical Authorization Form that will allow us to request bills and records from their treatment providers. Letter sent to Treatment Providers requesting copies of bills and records pursuant to Medical Authorization Form Provided. PCLMS19 Letter sent to agent notifying of a mobile home total loss. PCLMS20 Letter sent to policyholder asking for consent to remove mobile home. 3

4 Claims Documents CC MH Election to Repair Form CC MH Letter of Guarantee CC MH Options Letter CC RCV payment prior to repairs made Letter CC RCV Pmt Repairs Completed CC Plaintiffs Attorney Follow Up Letter PCLMS21 PCLMS22 PCLMS25 PCLMS27 PCLMS28 PCLMS29 Letter of Agreement sent to insured confirming their intent to repair the mobile home. Letter of Agreement sent to leinholder guaranteeing that title will be surrendered at time of the mobile home total loss settlement. Letter sent to insured notifying of their option to repair or surrender titles when mobile home is a total loss. Letter sent to insured releasing all of the held back recoverable depreciation detailing the procedures to notify Citizens should they receive an estimate higher than ours. Letter sent to insured releasing all of the held back recoverable depreciation as repairs have been completed. Letter to liability claimant s attorney requesting current status of the claim. CC Police Interest Restitution Letter PCLMS30 Letter used to put the Police Dept on notice that Citizens has an interest with the court assigning restitution to the responsible party if an arrest is made. CC Proof of Loss Acknowledgement Letter PCLMS31 Letter sent to insured advising them that their submitted Proof of Loss has been received. CC POL Additional Information PCLMS32 Letter sent to insured advising them that their submitted Proof of Loss is denied as it is either incomplete or contains errors. 4

5 Claims Documents CC POL Denied Response Letter CC Proof of Loss Sworn Statement Letter CC Reopen Letter CC Reservation of Rights Letter CC RFI Letter CC RFI- 10 Day Closure Letter CC Settlement Letter CC ACV Settlement Denial Letter CC Settlement Held Back Depreciation Letter CC Settlement with Partial Denial Letter_Medt PCLMS33 PCLMS34 CLMS41 PCLMS37 PCLMS38 PCLMS39 PCLMS40 PCLMS41 PCLMS42 PCLMS43 Letter sent to insured advising that the claim for which the Proof of Loss has been received was denied. Letter sent to insured requesting them to complete a Statement of Loss form. Letter sent to insured confirming claim opening based on insured request and adjuster requests additional information. Letter sent to insured advising them that their claim is being handled under a Reservation of Rights. Letter sent to insured requesting information required to proceed with the handling of their claim. Letter sent to insured advising them that if requested claim information is not received within 10 days, their claim will be closed. Letter sent to insured explaining their claim settlement/payment(s). Letter sent to insured advising them that there has been depreciation applied to their claim payment that is recoverable based on their policy as well as detailing the items not covered by their policy. Letter sent to insured advising them that there has been depreciation applied to their claim payment that is recoverable based on their policy. Letter sent to insured advising them of their claim settlement/payment(s) as well as detailing the items not covered by their policy. 5

6 Claims Documents CC Suit Acknowledgement Excess Letter PCLMS45 Letter sent to insured acknowledging receipt of a lawsuit against them AND advising them that the ultimate value of the claim may be more than their policy limits. CC PPIF Letter PCLMS46 Letter sent to insured requesting them to complete a Personal Property Inventory Form. CC X Wind Homeowners or Dwelling Letter PCLMS48 Letter sent to insured advising them that their policy does not include coverage for wind related losses. 6

7 Appraisal Letters CC Claim Premature Letter CC Partial Denial Appraisal CC Appraisal RFI CC Appraisal Premature - Decline Appraisal CC Appraisal Failure to Agree CC Appraisal Agreement Follow-up CC Appraisal Agreement Cover letter Award below deductible PCLMS68 PCLMS86 PCLMS87 PCLMS88 PCLMS89 PCLMS90 Letter sent to insured to advise them that the request for appraisal is premature and the claim is not ready to start the appraisal process. Letter sent to insured to advise them a part of their claim is being denied or is not covered under their policy. Letter sent to insured to request for more information on their claim Letter sent to insured to advise them that we are not going to complete an appraisal on their claim. Letter sent to insured to advise them we cannot come to an agreement on what we are going to allow in the appraisal process. Letter sent to insured to follow up when the insured has not responded to our requested appraisal agreement. PCLMS91 Cover letter sent to insured with the appraisal agreement. PCLMS92 Letter sent to insured explaining the award is less than their deductible therefore there will be no payment for the damages. 7

8 Sinkhole Letters Sinkhole Denial & Partial Denial Letters CC 2010 SH Policy Period Late tice Prejudice Denial CC SH 2010 SA Denial All Forms CC SH 2012 Denial SH Loss 7072 Compliant CC SH Denial SH Loss t7072 Compliant CC SH Loss Structural Damage Conf All Forms CC SH DP SH endorsement - not pol spec Ltr CC SH FNOL Duties Letter CC SH 2012 Post Inspection PSINK1 PSINK5 PSINK12 PSINK10 PSINK25 PSINK3 PSINK4 PSINK11 Denial letter sent to insured when the claim is reported outside the policy period (late notice) & there is prejudice. Denial letter sent to insured when there is no Sinkhole Activity found after testing completed. Denial letter sent to insured when there is no Sinkhole Loss found after testing completed. The engineer report in the file is found to be statutorily compliant. Denial letter sent to insured when there is no Sinkhole Loss found after testing completed. The engineer report in the file is not found to be statutorily compliant (older 2012/2013 claims). Denial letter sent to insured when there is no Sinkhole Loss found after testing completed, but there is Structural Damage from other causes of loss. Denial letter sent to insured when there is no Sinkhole endorsement on the policy. Cites Catastrophic Ground Cover Collapse definitions. Sinkhole Duties & Post Inspection Letters Acknowledgement of claim letter sent to insured which outlines the insured s Duties After Loss. Follow up (post-inspection) letter sent to insured confirming engineering firm assigned. 8

9 Sinkhole Letters Sinkhole NEP Letters CC SH Confirmation of Agreed NE CC SH GC Overcharge on NEP CC SH NE Additional Testing CC SH NEP Acknowledge Letter CC NEP Status Letter CC SH Post NEP Agree Chem Grout CC SH Post NEP Deny Chem Grout CC SH Post NEP Stand behind Denial PSINK2 PSINK26 PSINK7 PSINK27 Letter sent to insured confirming agreement of Neutral Evaluator and scheduled/agreed date for Neutral Evaluation conference to be held. Letter sent to insured to reject charges that are outside of reasonable and customary. For use with NEP. Letter sent to insured acknowledging the agreement with additional testing at NE s request but affirming desire for Engineer of Record (our engineer) to perform testing. Letter sent to insured acknowledging receipt of new request for Neutral Evaluation. PSINK8 Status letter for Neutral Evaluation. PSINK30 PSINK9 PSINK28 Letter sent to insured acknowledging agreement by Citizens to pay for Chemical Grout. Letter sent to insured indicating rejection by Citizens of need for Chemical Grout. Letter used by Citizens affirming our position regarding pre-nep conference. 9

10 Sinkhole Letters Sinkhole Reservation of Rights Letters CC SH ROR late notice pol period CC ROR NO SH Endt CGCC Defined Letter CC SH ROR t Principal Bldg PSINK14 PSINK15 PSINK16 Reservation of Rights letter sent to insured when a claim is reported late and/or outside the policy period. Reservation of Rights letter sent to insured when a claim has no Sinkhole endorsement attached. Reservation of Rights letter sent to insured when a claim has damage observed to non-covered property. Sinkhole Stabilizations Letters (Settlement & Partial Settlement CC SH Stab Final Payment Monitoring Rpt to Insured CC SH Stabilization Instructions - Cover Loss CC SH Stabilization Letter CC SH Stabilization Letter Portion t Covered CC SH Response to Testing Request PSINK17 PSINK18 PSINK19 PSINK20 Settlement letter affirming repairs completed per engineer s specifications. Insert to be used pre-stabilization which outlines the process and expectations. Acknowledgment and acceptance of Stabilization contract received. Acknowledgment and partial acceptance of Stabilization contract received. PSINK21 Rejection of insured s request for further testing to property. 10

11 Sinkhole Stabilizations Letters (Settlement & Partial Settlement CC SH Status Letter CC SH Master ACV-RCV Partial Denial - All forms CC SH Monitoring Rpt to Insured wfinal Stab Pay CC SH Withdrawal Letter PSINK22 Letter to be sent every 30 days claim is open outlining current status. PSINK6 Partial Settlement / Partial Denial template. PSINK24 Letter to be used once Stabilization is complete; affirming repairs completed per Engineer s specifications. May also have partial settlement details for Stabilization payment. PSINK29 Confirmation of insured s request for withdrawal of their claim. Mediation Letters CC Mediation Acknowledgem ent Letter CC Letter to Mortgagee Re Negotiation Settlement PMED1 PMED2 Letter to insured acknowledging the receipt of the claim into mediation and explaining the mediation process. Letter to the insured or Mortgage Company explaining that there is no estimate or adjuster s summary due to the fact that the claim was settled on a negotiated basis. 11

12 SIU Letters CC 626 Letter to Carrier SIU1 Letter sent to other carriers to request a copy of claim or underwriting file materials and information pursuant to the Florida Immunity Statutes (4) (d) Forms CC Property Settlement Form CC Stop Pay Check Request CC Centralized Claims Unit Referral Form CC Contents Pricing Referral Form CC tice of Right to Mediation CC PPIF - To be attached CC Lightning Affidavit Form CC Medical Authorization Form PCLMS52 Internal form to be utilized by the claim owner based on their specific business unit requirements. PCLMS55 Form sent to Accounting requesting a Stop Pay action to a check. PCLMS59 PCLMS60 PCLMS61 PCLMS62 PCLMS63 PCLMS64 Form detailing claim specifics and requesting transfer to Centralized Claims Unit for handling. Form requesting pricing for multiple item personal property listings. Form sent to insured advising them of their right to request mediation on their claim. Personal Property Inventory Form which is to be completed by the insured to create an inventory of their contents damage(s). Form sent to insured to be completed by a qualified repair technician verifying lightning damage. Form signed by claimant authorizing Citizens to obtain copies of his/her treatment records and bills. 12

13 Forms CC MH Debris Removal Consent Form CC Authorization for Release of Information form CC MH RFI Letter CC MH Certificate of Destruction Assignment CC Power of Attorney CC Total Loss Information Sheet CC Loss of Use Additional Living Expense Form CC ALE Information letter CC ALE Advance Payment Letter CC MH Statutes attachment PCLMS65 Signature form for Debris Removal Consent Letter. PCLMS66 Authorization signed by a policyholder for third parties to provide policyholders business records as necessary to adjust their claim. PCLMS71 Mobile Home request for information. PCLMS72 PCLMS73 PCLMS75 PCLMS76 PCLMS77 PCLMS78 tice to the demolition firm for mobile home certificate of destruction assignment. Form granting Citizens Property Insurance Power of Attorney on a Mobile Home Form sent to Department of Motor Vehicles requesting them to issue a Certificate of Destruction for described mobile home. Form utilized to track and calculate additional living expenses incurred by an insured. Letter sent to insured to accompany the Additional Living Expense form in response to an ALE/FRV request. Letter sent to insured detailing the advance payment and coverage requirements for Additional Living Expenses. PCLMS79 Attachment with applicable mobile home statutes. 13

14 Forms CC Liability Police Report Request Letter CC CAT Contact Letter 1 CC CAT Contact Letter 2 CC CAT Contact Letter 3 CC ALE Cover Info PCLMS80 PCLMS81 PCLMS82 PCLMS83 PCLMS85 Letter to Police Agency requesting copy of the Incident Report or Investigative Report. System generated letter sent to Insured advising them their claim was received and due to claim volume they have not yet been contacted. System generated letter sent to Insured advising them their claim was received and due to claim volume they have not yet been contacted. System generated letter sent to Insured advising them their claim was received and due to claim volume they have not yet been contacted. A cover form to be sent to the Insured as a guide to their Additional Living Expense claim NPIF Letters CC NPIF Investigation Commenced CLMS26 Letter to insured reminding that Citizens has yet to find an active policy for time of loss identified, but we will continue to investigate the loss. CC NPIF ROR CLMS27 Letter to insured confirming receipt of claim and notifying we are unable to verify there was an active policy in force at the time of loss and reserves our rights if any further action is taken in the investigation of the loss. CC NPF CLMS30 Letter to insured to inform there is no policy in our records for property address to which a loss is being claimed. 14

15 NPIF Letters CC NPIF3 CLMS31 Letter to insured to inform the policy referenced at FNOL was not in force on claimed date of loss. CC NPIF Existing Claim Transfer2 CLMS32 Letter to insured informing them that the policy the claim was associated to was not in force, however there is an active policy with an existing claim for that DOL. CC NPIF Letter CLMS33 Letter informing insured they had no policy in force for claimed date of loss. CC NPIF LOR CLMS34 Letter to PA indicating we received LOR, but there is no policy in force for claimed date of loss. CC NPIF New Claims Transfer1 CLMS35 Letter to insured to inform that the policy the claim was associated to was not in force, however there was an active policy that the claim has been transferred under. 15