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1 ADGI05 CLAIMS MANAGEMENT STUDY TEXT (2 nd EDITION, 2012) Version 1.1 Issued On: 1 June 2012 Note: (1) This Version 1.1 of the amendments below shall apply to any candidate who sits for the Claims Management examination as from 1 June 2012 onwards. (2) The next set of amendments, if any, will be issued on 1 October Amendments are made to the Claims Management Study Text (2 nd Edition, 2012) as follows: 1. Examination Syllabus (NEW) By adding the new Examination Syllabus after the Acknowledgement (page iii) with the following: 1. Understand the claims environment 1.1 Claims management strategy 1.2 Claims philosophies 1.3 Organisation design and structure Claims department within the insurer (divisional / functional / other) Interaction of claims department with other functions Internal structure of the department; job roles, teams, responsibilities, specialism Referral points; authorities The role and responsibilities of the department manager 1.4 Policy interpretation 1.5 Regulation and legislation Implication of Consumer Protection (Fair Trading) Act (Cap. 52A) Contract certainty 2. Understand and apply claims service management practices 2.1 Customer experience expectations, satisfaction Ethical codes of practice Use of Claims service as a marketing tool Treating Customers Fairly 2.2 Customer retention 2.3 Complaints handling Alternative Dispute Resolution 2.4 Policyholder litigation and breach of contract Bad faith Copyright reserved by Singapore College of Insurance Page 1 of 5

2 3. Understand and apply claims management practices 3.1 Design and implementation of claims handling procedures for both first and third party 3.2 Civil Procedure Rules 3.3 The pre-action protocols 3.4 Process review and quality management 3.5 Compliance with claims procedures 3.6 Claims handling operation Segmentation (volume and complexity) Authorities Outsourcing Delegated authorities Catastrophe management 3.7 Supplier and relationship management; panels Loss adjusters Solicitors Suppliers of goods and services 3.8 Call centre management 4. Understand and apply claims technical management 4.1 Reserving philosophies 4.2 Interaction between claims, actuaries and underwriting 4.3 Information technology 4.4 Management information 4.5 Fraudulent claims Ethical aspects 4.6 London and Lloyd s market 4.7 Reinsurance 4.8 Subrogation and recoveries 4.9 International claims 5. Understand and calculate the cost of management practices 5.1 Cost control strategy Indemnity spend, handling spend and their interrelationship 5.2 Estimating and reserving 5.3 Leakage 5.4 Cost of the claims function internal costs, share of overheads, etc 2. Chapter 5, Section 1.3, Page 105 By deleting the entire Section 1.3 and substituting the following: 1.3 Cost Of Claims Management In this context, cost refers firstly to the cost of running the claims operation, and secondly, to the cost of settling the claims by the claims department. Managing the cost means controlling the amount of money expended over a defined period of time. Copyright reserved by Singapore College of Insurance Page 2 of 5

3 The operating costs are: the cost of running the claims department itself, such as the staff remuneration of the claims department; costs allocated to the department from costs of running the entire operation, i.e. costs incurred running the insurance company as a whole, such as IT, office space, and other department staff members; and external costs, i.e. the cost of engaging service suppliers and vendors. In this section, we will consider the internal costs relating to the business Internal Cost When we look at outsourcing, we say that the cost of outsourcing has to be balanced against the savings made in respect of internal costs. However, what are these costs and how do they impact on the business? Every dollar taken in premium must meet the cost, not only of claims and of fees, but also of running the business. These costs include, but are not limited to: Staff costs, including salaries, bonuses, employee benefits, employer s contributions to the Central Provident Fund; Corporate tax and other taxes; Cleaning and sanitation; Maintaining the office building, property, machinery and office equipment (e.g. company cars, photocopiers, computer system, phone system, etc.); Utilities, including air-condition; rentals; Stationery, printing and mailing; and Company insurance. In addition, if an insurer has a branch network, each branch will need to contribute a proportion of its income to the head office for its share of overheads. These overheads include, but are not limited to: travel costs; hotel costs training; subsistence; entertainment; marketing; printing; legal fees; human resources; server maintenance; and IT helpdesk. Copyright reserved by Singapore College of Insurance Page 3 of 5

4 Having looked at some of the internal costs of the claims department, we will move on to consider some of the external costs Fee Spend Insurers seek the service of loss adjusters and legal advisers to assist in the handling of complex or large claims. Such service providers have their own stakeholders who are running these commercial enterprises to maximise profitability. Therefore, it is essential that the claims manager negotiates a competitive price prior to the agreement of service rendering by such service providers, be it hourly rate or fixed fee basis. These are the costs of actually running the claims department. The other major source of expenditure is the cost of settling claims Indemnity Spend Indemnity spend is the total spend by an insurer in respect of payments made to indemnify policyholders following the submission of valid claims. Insurers are able to benchmark average indemnity spend for certain types of claims across the market, as well as being able to compare and contrast it in the light of different portfolios of business. This is usually undertaken by reference to premium in order to calculate a loss ratio, thus: Indemnity claims spend Premium = Loss ratio Controlling Costs One of the roles of the claims manager is to manage the cost of the claims department. There are several ways to compare the cost of managing a claims department against those of its competitors: unit case costs, i.e. the average operational cost of handling a claim; average time spent on one claim; and claims expense ratio, i.e. the ratio of internal costs to premiums. As claims management is specifically interested in operational costs, it is also important to consider how to control these, through: competent and well-trained staff; efficient administrative support; efficient claims procedures; efficient record-keeping; a well-written corporate claims philosophy; use of a quality management programme; effective management of the claims department; effective use of IT; and use of outsourcing. Copyright reserved by Singapore College of Insurance Page 4 of 5

5 Operational costs often add up to a significant outlay for the insurance company. In order to keep these costs to a minimum, there should be a constant review to incorporate potential: restructuring; merging; management changes; IT system changes; systems and processing changes; partial or total outsourcing of the claims function; and changes in the make-up of the book or the nature of the risks written. The geographical structure of the company can also influence costs. A trend in recent years is to have fewer and larger cost centres. The claims manager cannot analyse the management of the operational costs of the claims department in isolation: any reduction in the operational costs can have an impact on how well it operates. A reduction may have an impact on: how many claims are overpaid; customer satisfaction reflected in: - reduced customer retention; - reduced customer enquiries; - damage to brand and reputation; - FIDReC adjudication fee charges as complaints increase; and the potential for punitive costs / awards if deadlines are missed. Such effects may outweigh savings made. Conversely, an increase in operational costs - provided that they are properly targeted and can result in an improvement in areas important to the customer - is likely to have a positive impact. The claims manager needs to balance the cost of the operation against the desired level of service. A company can gain a competitive advantage by having the most efficient expense ratios. An efficient expense ratio gets the balance between cost and loss of expertise right. Many insurers prefer a lower initial cost base at the outset and then try to control spend, by putting in place rigid processes via IT, audit and supervision. The importance of claims cost in the insurance industry cannot be underestimated. If the cost of claims at any point in time (including the estimated future cost) exceeds the available resources to pay such liabilities, then the insurance company is technically insolvent and must enter into insolvency. Hence, the estimation of future liabilities is just as important as the control of current claim payments. Copyright reserved by Singapore College of Insurance Page 5 of 5

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