claims reporting guide and office directory Delivering unparalleled results

Transcription

1 claims reporting guide and office directory Delivering unparalleled results Zurich North America

2 Table of Contents Zurich North America Claims Model Technological Features of the Claims Model How to Report a Claim Four Channels Claim Reporting Tips Other Complementary Services Directory of Offices The Zurich North America Claims organization continues to make technological and process enhancements that contribute to greater efficiency in handling your claims. An established common claims system and a virtually paperless process has increased our ability to better serve customers and make our claims system among the best in the industry. Overview of Zurich North America and Zurich Financial Services Group Zurich North America is a leading provider of property, casualty and specialty insurance and risk management solutions to businesses throughout the United States. We also offer customers a range of financial services in more than 60 countries worldwide through the affiliated companies of the Zurich Financial Services Group.

3 The Zurich Financial Services Group is a global leader of integrated financial services, providing its customers solutions in the areas of financial protection (nonlife insurance and structured solutions) and asset gathering (life insurance and asset management). Our system maximizes talent and efficiency Zurich North America Claims has created a claim-handling process based on centers of expertise. Specifically, we structured our organization to provide: unparalleled customer experience loss-cost management excellence world-class efficiency A claims model that knows no limits Our model can handle the full spectrum of possible claims. From small to large, simple to complex, we maximize the skill sets of our professionals to deliver unparalleled results. We manage this expertise through a tiered approach: care center, express centers and product management. Zurich North America s Claims Reporting Care Center provides customers with a prompt response to their needs. Located in Colorado Springs, Colorado, the care center serves as the central claim intake facility for Zurich North America. Our entire staff of customer service representatives in the care center quickly assess where a claim should be handled, whether it should be processed through the express centers or product management area and if there are any special requirements. The express centers specialize in servicing claims with low-dollar expense and loss potential for all lines of business. The product management tier handles more complex claims. This improves quality and expedites the process to close claims. Product management divides itself into two areas: field offices and centers of expertise. Field offices handle all commercial auto, general liability, property and workers compensation claims. The centers of expertise focus on specific claim areas. There are five centers that cover construction defect, environmental, global energy, specialties and surety financial services. Technology delivers enhanced customer service Our claims organization operates in an electronic environment. To process a claim as expeditiously as possible, Zurich North America images all pertinent documents. We immediately send all hard-copy claim reports received by fax or mail to our Document Distribution Center (DDC) and scan them as electronic images to ensure that each claims handler has timely access to all relevant information. We continue to break new ground in leveraging technology to offer enhanced 1

4 We continue to break new ground in leveraging technology to offer enhanced customer service. customer service. A cornerstone of our technology strategy is the ability to make claim information available to customers and distributors when and where they need it. We design our innovative electronic services to help customers control loss costs, make better insurance and risk management decisions and work more efficiently. These services include: RiskAccess provides comprehensive analysis of claim information, drilling down into thousands of claims to extract a textual history of each and every causal factor, as well as the current status of the claim and any resolution criteria. RiskIntelligence provides risk managers with the capability to run loss analysis reports via the web. Such reports identify claim trends and historical data, as well as provide specific financial information relating to the entire claim portfolio. RiskImage gives you fast, easy access to electronic versions of claim documents including: explanation of benefits, medical bills and records, return to work releases, settlement information and correspondence. With RiskImage, you ll no longer have to wait for documents to be sent to you. What s more, RiskImage may mean fewer on-site audits saving time and travel costs. Our use of technology not only builds in greater efficiencies in handling claims, but also passes many benefits to the customers, including: an expedited claim process reduced costs timely notification of current status immediate access to information Contact your underwriter or broker for more information on these and other electronic services offered by Zurich North America. 2

5 Multiple reporting channels deliver flexibility and convenience Customers can report a claim through toll-free phone or fax numbers, our website or postal mail 24 hours a day, 365 days a year. We created these options as part of our ongoing effort to make the claim reporting process as convenient as possible. Our experienced representatives work to ensure that your claim is processed quickly and efficiently no matter what reporting channel you use. Once we collect your information, our system automatically assigns the claim to one of the following three units that specialize in servicing specific needs: an express center, a product management field office or a center of expertise. We will provide you with confirmation that we received your claim and your claim number by the end of the next business day after receiving initial notice. The assigned professional receives notice of the new claim and through our electronic environment can immediately access all information obtained during the initial reporting process. This prompt access to claim information improves our ability to respond to your needs. Internet Customers can access our internet-reporting system through using the online Claims Reporting icon on the main page or through the customer online services section. The internet-reporting function provides screens by line of business (commercial auto, general liability, property and workers compensation). We designed this process to capture the information needed by our claim professionals to facilitate the quick processing of your claim. Upon completion of the internet-reporting process, you will receive an notice confirming that we obtained, processed and assigned your information to the appropriate Zurich North America Claims office. And, if needed, online assistance is available using the Contact Us link found throughout the website on the top navigation bar. Phone Our toll-free telephone reporting number is still the most widely used method to report claims. Customers can report a claim over the telephone using Facsimile Zurich North America customers can report a claim through our toll-free fax number at Mail Customers can mail a claim to any one of our claims offices across the country. Review the list of offices in the last section of this booklet to find the office nearest you. Go to next page for tips on claim reporting 3

6 Our quality review program ensures delivery of this commitment. 4 Claim reporting tips 1. Report the claim immediately don t delay. 2. If at all possible, submit the claim with a completed ACORD form or a Zurich Claims Reporting Guide. You do not need to complete both forms. For your convenience, this kit includes one copy each of the Zurich Claims Reporting Guides for commercial auto, general liability, property and workers compensation. Completing the reporting guide for the specific line of business will help you gather the necessary information prior to reporting the loss. You can download or print ACORD forms and reporting guides at You can mail or fax the completed form(s) to your local Zurich North America claims office (see office directory). 3. Collect as much information as possible regarding the loss such as date and time, address, policy numbers, name and address of company or reporting location, parties involved, accident description, type of injury and estimated damages. 4. Submit all estimates, photos and any materials/receipts. 5. Don t speak with third parties about the claim. We continue to deliver beyond the claim Zurich North America offers more than just prompt attention to your claim needs. We provide additional services that deliver added value and can reduce claim expenses and loss costs. These additional services go hand-in-hand with claims and are available to all customers. Staff Legal Our Staff Legal group offers customers excellent service and expertise. Through its process efficiencies and talent pool, Staff Legal handles more than 18,000 cases a year at a 30 percent reduction in cost with better net indemnity results compared to outside law firms. Staff Legal maintains such quality service in part through its ability to attract top legal talent. Special Investigations Unit Members of our Special Investigations Unit, who have an average of 26 years of experience with special investigations units, insurance, law enforcement or other investigative fields, work closely with our claims professionals to identify and stop fraud. The Special Investigations

7 Unit is committed to the timely, thorough and efficient resolution of questionable claims. Our quality review program ensures delivery of this commitment. The SIU believes early identification of fraud is the key, and to that end, provides training to claim handlers, underwriters, auditors and customers. To report suspected fraud, contact the toll-free SIU hotline at The Special Investigations Unit has developed a special fraud-fighting booklet for our workers compensation customers. This booklet includes fraud-fighting tips and a poster to display in the workplace. Contact your broker or Zurich North America account executive to obtain a copy. If you are a risk manager or broker and wish to learn more about how Zurich s SIU department can help you reduce fraud, contact Brian Wilson, vice president, at Recovery Operations Our Zurich North America Recovery Operations consist of six regional recovery hubs that provide multiline, multijurisdictional commercial subrogation services on both a domestic and international basis. Line of business action plans, monthly audits and balance scorecard programs provide a structured environment that streamlines the recognition, referral and subrogation processes, while delivering excellent results and customer service. Managed Care At Zurich North America, we believe managed care is about more than just reducing medical bills it s about helping to ensure the injured or ill person receives quality care, returning the injured worker back to work as soon as possible and, of course, reducing your costs. Our managed care programs serve multiple lines of business including workers compensation, disability, accident and health and auto liability. Zurich North America Claims offers a customer-focused approach to claim handling that delivers quick and efficient resolution of your needs. We coordinate our skilled personnel, technology innovations and specialty areas of expertise to create valuable services for our customers. Additionally, we maintain industry-leading loss-cost management capabilities such as our Staff Legal, Special Investigations Unit, Recovery Operations and Managed Care organizations to deliver the full spectrum of claim services that differentiate us in the industry and enhance our customers experience. Directory of offices Once your claim is registered in our care center, we will route it to the appropriate adjuster in one of our offices located throughout the country. 5

8 Directory of offices The following is a list of our offices. Use the toll-free number for each location to contact your local claims professional. You can also use our adjuster contact number to speak with your adjuster. Dial and follow the instructions to enter your claim number. The system will connect you to your applicable Zurich representative. Please do not use the toll-free office numbers to report a claim. Reference the multiple reporting section of this guide for instructions on how and where to report a claim. California Los Angeles P.O. Box Los Angeles, CA Fax San Francisco P.O. Box 7774 San Francisco, CA Fax Western Claims Center P.O. Box West Sacramento, CA Fax Colorado Zurich Claims Reporting Care Center P.O. Box Colorado Springs, CO Fax Connecticut Northeast Claims Center P.O. Box 4030 Rocky Hill, CT Fax Florida Orlando P.O. Box Orlando, FL Fax or Southeast Claims Center P.O. Box Tampa, FL Fax or Georgia Atlanta P.O. Box Atlanta, GA Fax

9 Directory of offices Illinois Chicago P.O. Box Chicago, IL Fax Indiana Central Claims Center P.O. Box Indianapolis, IN Fax Maryland Mid-Atlantic Claims Center P.O. Box Baltimore, MD Fax or Massachusetts Boston P.O. Box Boston, MA Fax Missouri Kansas City P.O. Box Kansas City, MO Fax New Jersey Parsippany P.O. Box 905 Newark, NJ Fax New York Long Island P.O. Box ZZ Jamaica, NY ZZ Fax North Carolina Charlotte P.O. Box Charlotte, NC Fax

10 Directory of offices Pennsylvania Philadelphia P.O. Box Philadelphia, PA Fax Texas Dallas P.O. Box Dallas, TX Fax Pittsburgh P.O. Box 1880 Pittsburgh, PA Fax Tennessee Nashville P.O. Box Nashville, TN Fax Southwest Claims Center P.O. Box Dallas, TX Fax Wisconsin Milwaukee P.O. Box 3193 Milwaukee, WI Fax

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12 A B 01/ Zurich North America Zurich Towers 1400 American Lane Schaumburg, Illinois Zurich American Insurance Company