STRATEGIC INSURANCE & RISK SOLUTIONS (SIRS)

Insurance Claim Professional Services

Our Services

We have 30 years of leadership-level experience delivering Property/Casualty insurance claim solutions. Our clients number among top U.S.

and global companies, brokers, insurers, and TPAs. We help clients manage their claim-related business issues by optimizing and managing

their claim programs and outcomes; reducing claim costs; and improving business transaction and dispute outcomes.

Claims Advocacy

We work with companies, their

insurers, claim administrators

(TPAs), defense counsel, and

other advisors to reduce total

claim costs and produce the

most favorable claim outcomes.

Advocacy activities may include,

but are not limited to, the

following:

■ Design and oversee

performance-based claim

programs: monitor the

entire claim team (insurers

and TPAs) and claim process

to ensure continuous focus

on cost-containment

■ Prepare/negotiate Special

Account Handling

Instructions and TPA

Service-Level Agreements

■ Analyze claims for coverage

issues; articulate coverage

position to insurer to

provide foundation for

maximum recovery under

the policy

■ Advise on complex, high-

exposure claims as respects

settlement and litigation

strategy

■ Prepare and validate claim

valuations to ensure timely,

adequate case reserves

■ Conduct and coordinate

claim audits with client,

insurer, and TPA(s)

■ Create claim trend analysis

and status reports for clients

and producers

■ Develop and deliver training

for the claim service team,

focusing on such issues as

claim handling guidelines,

“good faith” claim

management and regulatory

compliance, and insurance

coverage

■ Attend claim meetings with

client, insurer, TPA, and

defense counsel to review

claim status and agree

litigation and settlement

strategy

■ Assist with identification

and collection of loss

information required to

support the proof of loss

■ Review NCCI experience

modification factor

calculations to identify

errors and reduce mods

■ Prepare renewal and client

information presentations

Insurance Contract and

Claim Dispute Support:

Expert Witness

We assist with insurance

coverage litigation strategy

development and provide expert

witness and consulting services

in the following areas:

■ Standard of care – Bad Faith

■ Claims handling practices

■ Claim processes

■ Claim program management

and design

■ Third-party claim

administration (TPAs)

■ Insurance coverage

construction and

interpretation – Property,

CGL, auto, pollution, excess

casualty, umbrella, D&O,

E&O, design professional,

construction wrap-up

STRATEGIC INSURANCE & RISK SOLUTIONS (SIRS)

Insurance Claim Professional Services

We have several decades of

experience designing and

managing claim operations and

complex claim programs;

evaluating and resolving high-

severity claims; and interpreting

manuscript commercial property

and liability policies with

alternative financing features,

including large deductibles and

retentions, captives, fronting,

and third-party claim

administration. It is this broad,

diverse experience that allows us

to successfully advocate for

client positions in insurance and

reinsurance contract and claim

disputes.

Supply Chain Vendor

Performance Optimization

Companies, insurers, and TPAs

employ a score of supply chain

vendors across the claims

process. Examples include claim

investigators, general adjusters,

auto body repair shops, and

defense and coverage counsel.

As insurers and TPAs consider

more flexible and expanded

business models in the Digital

Age, the opportunity to more

closely integrate business

partners into the claims process

and operating model will

become more prevalent.

We work to leverage leading-

practice supply chain

management tools and

techniques such as data analytics

and supply chain control tower

to enhance the current supply

chain management approach

and align it with claim and

insurance program goals in order

to optimize supply chain vendor

performance, reduce vendor

costs, and improve indemnity

outcomes.

Valuation of Claim

Liabilities

We have extensive experience

working with companies, their

insurers, and actuarial and

valuation consultants to

evaluate and design processes

and models for estimating

individual high-value claims or

entire claim portfolios. Our

valuation services include:

■ Modelling of long-tail

liabilities such as asbestos,

drug products, and

pollution: We work closely

with actuaries and other

valuation specialists to

identify the key factors that

impact possible outcomes

for such claims.

■ Due diligence for M&A and

claim portfolio acquisition:

We provide our opinion on

claim operations and claim

practices in conjunction with

actuarial review of gross

reserves and reinsurance

recoveries and security.

■ Runoff, commutation,

receiverships/liquidations

support: We review claim

operations, claim practices,

coverage, and reinsurance

contract issues to support

actuarial estimates of IBNR

and commutation pricing.

■ Reserve adequacy: We work

to understand the

characteristics of the book

or class of business,

including top exposures,

large loss activity, risk

aggregation, and any

changes in policy or contract

terms and conditions; claim

trends, legislative,

regulatory, and case law

changes impacting claim

emergence, frequency, and

severity; case reserving and

settlement practices; and

any claims operational and

technology changes that

have impacted or will

impact case reserving and

settlement. We provide an

opinion on the

reasonableness of case

reserves and claim

outcomes.

For further

Information on

our Claim Services,

please contact:

Claire Louis

President/Principal Consultant

Strategic Insurance & Risk

Solutions

claire_a_louis@yahoo.com

(201) 675-1141