The Sedgwick Claims Management Services, Inc. (Sedgwick CMS) best practice is to centralize liability units in order to provide a number of benefits to our clients, including but not limited to greater ease of communication within the unit and - more importantly - with our clients, efficient organization, and consistency in the management of our clients’ programs. We also have extensive experience in the development of customized units for our clients to handle particularly demanding types of cases, such as fast track, litigated, and complex/catastrophic claims.

Our internal liability practice group supports our network of services by providing input in case valuation/handling. The group acts as a resource to field adjusters in all matters relating to liability claims handling and best practices. Sedgwick CMS has developed industry-leading best practices as a result of our experience in this area. We also have extensive relationships with vendor partners in such areas as litigation management (legal bill review and audit), matter management, and the application of managed care/medical review in select liability cases.

A broad menu of services

Sedgwick CMS offers liability claims management services in the following areas:

• General liability, including bodily injury and property
• Professional liability, including medical malpractice
• First party property damage
• First party automobile physical damage claims (collision & comprehensive
• Automobile liability, including bodily injury, property
• Garage keepers liability
• Inland marine/motor truck cargo
• Where applicable Sedgwick CMS provides centralized subrogation services

Reporting

When a liability claim is reported, immediate contact is made with the client (if desired) to discuss which party should receive first contact and the order for calling the other pertinent parties. Unless the client directs otherwise, it is Sedgwick CMS’ best practice to make immediate contact with injured third party claimants to ascertain the facts and claimed damages. Statements are taken as appropriate from the claimant and witnesses; police reports are obtained when available and relevant; photographs may also be obtained. Throughout the investigation process, the adjuster communicates whenever necessary to keep clients informed, to make recommendations, and to agree on a strategy and action plan for case resolution.

Documentation

All of our claims handlers are required to place very thorough, complete notes in the JURIS ® claim record. Documents obtained through investigation and other activities will be added to the claim file and all pertinent information derived from these documents is added to the computer note file.

Included are:

• Documentation of all phone conversations, meetings, etc.
• Subrogation and tender opportunities
• Documentation of all payments
• Diary
• Documentation of the findings of the liability investigation, how it impacts the file, and reserves, along with an
• Documentation of police reports, witness information
• Documentation of claimant attorney representation, retention of defense counsel, suit/hearing indicator, venue, and other

All of the above items are recorded, established, and updated in our computer system when they occur. Notes of all other documents are recorded in the computer claim file. Hard copy files can normally be obtained the same day as requested. All payments are initiated through the system (whether we issue the actual payment or issue a voucher to the client who then makes the payment). Copies of checks are kept in a numbered and chronological file and the documents against which they were issued are kept in the physical file.

Every claim is recorded in a computer diary that may be reviewed by the client as long as the claim is open. Other reviews and other diary call-ups may be set in the system. The system allows for parallel adjuster, supervisor, and other diaries on the same claim. JURIS assists the adjuster by automatically documenting critical activities with system generated diaries and file notes, and by performing extensive data validation and edits throughout the claims management process.

Sedgwick CMS’ standards require that a plan of action be documented in the JURIS system on all claims. The plan is then updated at regular intervals depending on new developments on the claim.

Investigation

All cases are reviewed by a Sedgwick CMS manager or supervisor and assigned to the appropriate adjuster for initial investigation. The verification of information occurs during the initial investigation work. All information is reviewed with the client, the client’s employee(s), and the claimant during the initial contacts.

While our best practice is to conduct all investigations utilizing Sedgwick CMS personnel, there are situations in which an independent adjuster is required to perform additional onsite investigation. Sedgwick CMS uses various independent adjusters throughout the country. We select independent adjusters with whom we have had prior experience, give them clear assignments, monitor their results, and carefully define the limits of their activity. Sedgwick CMS has national and regional relationships with quality vendors. We negotiate fair pricing based on the volume of our claims activity.

As indicated by the characteristics of the case, we also refer claims to our Special Investigation Unit (SIU). This referral process allows us to investigate claims with fraud potential. Any claim with suspected fraud elements or that would benefit from information verification can be referred to the SIU team with client approval.

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