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AJGRMS_5669 
  
Claims Solutions: Case Study 

The Problem

The carrier was insistent that the Arthur J. Gallagher Risk Management Services (AJGRMS) client owed additional money since they were on a loss-sensitive program and the loss history indicated an increase was appropriate.

The Methodology

The AJGRMS claims expert was asked by the client to intervene as it was felt the loss history was adverse in part because of mishandling by the carriers claim department. The claims consultant reviewed the loss history and analyzed several claims. It was determined that one very large claim seemed to be the driving factor for the increase in retrospective premium adjustment.

The Results

The claim expert reviewed the claim file, met with the claims manager for the carrier and obtained and analyzed the entire trial transcript. It was determined that many items of investigation were left undone and that a less than vigorous defense was offered at the hearing. The resulting report and efforts of the consultant culminated in saving the client $30,000 off of the retrospective premium adjustment they otherwise would have been obligated to pay the carrier.

The Role the Claims Consultant Played

Saving money for our clients is a primary function whether through coverage advocacy, loss history reduction, or going to bat on retrospective premium adjustments on loss-sensitive programs. Without this kind of advocacy for clients, they are often at the mercy of the unilateral actions and decisions of the insurance company.

Benefits the Client Experienced 
  • Hard monetary savings—the insured did not have to come up with $30,000.
  • Expertise to evaluate the carrier’s claims—the insured is not expected to be a claims expert and can focus on what they do best.
  • Peace of mind—someone is going to bat for them.

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