Pro.

Technical outsourcing

Claims and TPA services

We have a global capability in the management of complex claims, both live and legacy, across multiple classes of business. This includes a specialism in private disability claims in continental Europe and a large team of TPA specialists in the US.

Services include:

  • Claims management services such as claims adjusting, strategic advice and negotiating with policyholders and cedants
  • Independent expert advice during arbitration and litigation
  • Reserve analysis and portfolio review: establishing ultimate liability on individual claims or entire portfolios using bespoke IT tools and enlisting our actuarial team where appropriate
  • External and internal auditing, including examination of static claims, peer reviews, process reviews, forensic reviews and inspection of records
  • Back-office support to ensure efficient and cost-effective processing
  • Technical claims support such as triage and indexation
  • Evaluation, critiquing and negotiation of policy buy-backs and commutations
  • Supply of resources to cover peak periods of claims activity

 

US third-party administrator (TPA) claims services

At Pro, our focus is your bottom line. We understand the issues that can affect the profitability of your business. Our approach is to handle your book of business as if it were our own. Our blend of people, services and processes are dedicated to controlling costs and providing effective program management. We have a full TPA operation and structure in place to receive, adjudicate, negotiate and report claims across multiple lines of commercial and personal insurance. Our multi-disciplined approach and worldwide team of experts allow us to support all aspects of the program, from underwriting and accounting controls to providing temporary resources to assist you during peaks in your business cycle.

Key elements of our client-led TPA program

To maximize your program’s value, communication between all stakeholders is at the front and center of our approach. We do this by:

  • Establishing clear and consistent loss-reserving practices
  • Proactive management of litigated claims
  • Evaluating, expanding and contracting our nationwide panel of experts based on outcomes
  • Recommending underwriting criteria enhancements
  • Providing operational consulting and related services
  • Seeking out new opportunities to create and develop new programs

Our most frequent programs include:

  • Commercial Auto Liability, Physical Damage
  • Commercial General Liability
  • Trucking Liability
  • Personal Lines Auto and Homeowners
  • Environmental, Asbestos, Toxic Tort
  • Professional Liability

 

“Bad faith” exposures

How can one claim undermine the results of even the best program?  In the U.S., most states and territories allow for plaintiffs, claimants and insureds alike,  to “open up” policy limits by alleging that the insurer has committed “bad faith”, fraud or gross negligence in the handling a claim by failing to take such actions as:

  • Settle within policy limits when there was an opportunity to do so
  • Provide an adequate defense to the insured
  • Timely or adequately investigate the claim
  • Timely or adequately communicate with the insured
  • Properly reserve rights
  • Properly or timely render a coverage determination

In any of the above circumstances, the consequences to an insurer found to be in “bad faith” can include:

  • Responsibility to pay any judgment, regardless of policy limits or coverage limitations and defenses
  • Payment of all defense costs, even where there was no duty to defend
  • Attorney’s fees and costs
  • Punitive and/or statutory doubled or trebled damage

Pro’s claims management team in the U.S. is knowledgeable and savvy to recognize “bad faith” traps as they are being set.  Our veteran claims group knows to quickly refer these very sensitive matters to our most experienced extra contractual claim handlers who are specifically trained to navigate through the very turbulent U.S. bad faith waters. 

 

Added value through a London presence

Many London-based carriers using US based TPAs may struggle with having face-to-face interactions with their service providers costing them valuable time and money. We provide our clients with the best and most convenient service. We offer a London-based, business-focused Client Relationship Manager, dedicated to being on hand for you at your convenience.

 

Claim leakage service

  • The most common areas reviewed are:
  • Workflow design
  • Claims examiner and supervisor expertise
  • Vendor rates and effectiveness
  • Salvage and subrogation efforts
  • Processing systems
  • Extra-Contractual Obligations

 

Pro Claims Solutions GmbH

Pro Claims Solutions GmbH, previously trading as Assekuranz, Service- und Sachverständigengesellschaft mbH, was founded over 20 years ago and is a leader for the provision of claims management services. Its specialisation lies in occupational disability insurance in the private insurance industry. Our clients include a number of high ranked insurance companies, which we support in individual cases as well as in entire claims audits. Our experienced and multidisciplined teams guarantee a competent provision of information to meet your needs and expectations. 

 

Our Services

  • Occupational disability insurance
  • Life and accidental insurance
  • Sick day payment insurance
  • Workshops / Audits

 

Our track record

  • UK Company – assumed the administration functions of set-up, triage and message processing as well as adjusting claims up to an agreed authority limit
  • Swiss reinsurer - support to reduce aged and large backlog of 7,436 claims. Triaged and adjusted claims in a timely and accurate fashion, resulting in improved practice and procedures and better service to cedants
  • US insurer – strengthened company’s surplus-line through effective claims management. Reduced open claim volumes and reserves while controlling costs. (CD, GL, trucking, non-standard auto, WC.)

We work closely with you to keep you fully informed through every stage in the development and execution of your claims strategy.