Does Your Staff Assess or Confirm Coverage?

The assessment of coverage is the most important yet frequently brushed over area in claims handling. 

Specific to property, professional liability, and employment practices liability, the coverage analysis should outline the counts/actions/allegations in the claim or lawsuit and the application of the coverage document language including effective date of coverage, policy term, named perils applicable, retroactive date (claims made policy), limits, sub-limits, self-insured retention, as well as potential exclusions and limitations.  Knowing and being able to apply the applicable state statutes and governmental immunities is a crucial part of the process as well. 

The proper evaluation of coverage must include reading the policy/coverage document in its entirety.  If coverage is found, keep reading to ensure that it is not excluded later on in the document or policy endorsements. 

Even for the most seasoned claims handlers, there will be complicated coverage issues where the services of coverage counsel should be secured.  Similar to having a defense counsel panel, ensure that you have a similar panel of coverage counsel.    

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