Death Claims Adjudication

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PostPosted: Wed Sep 03, 2008 10:59 am   Post subject: Death Claims Adjudication  

Hi ,



I intend to seek detailed information on



a) Steps involved in Death Claim Adjudication process.

b) The levels at which an Adjudication of a Death Claim can be done(for example Policy level, Coverage level)



I googled but in vain. I would request the members to help me on the above points.I would need some links to Scholarly articles on Death Claim's Management.





Gagan Sabharwal

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PostPosted: Wed Sep 03, 2008 12:58 pm   Post subject:   

I'm not getting exactly what you want....do you mean from the time the policy is written to when the insured dies then what is the process from then on out?



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PostPosted: Wed Sep 03, 2008 1:11 pm   Post subject: Details  

Hi Lori,

Thanks for replying.Sorry if i wasnt clear with my question.



What i exactly want is to know the process of Adjudication in Claims Management. When i say this , what i exactly mean is to know that when an insured dies and the primary beneficiary applies for a death claim on the concerned policy....



1) How exactly an insurance company deals with the case futher.(Department wise) ?

2) What all things/requirements are kept in mind before the claim made by the insured is approved ?





I need the whole scenario from an insurance company's point of view and not from a claimant's point of view.



Thanks

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PostPosted: Wed Sep 03, 2008 2:02 pm   Post subject:   

Hi, lets first see what this "Adjudication" is all about. Adjudication hearing only comes into the picture when a plea agreement does not apply. The parties concerning a particular case would be called to testify in front of a judge. Some of them may be asked to stay out of the courtroom till the testifying is in process. This is done in order to eradicate any possibilities of some of the parties getting influenced by the testimony of their counterparts.



See, once you're a victim under such circumstances eg. mismanagement of insurance claims, you could exercise your right to attend the entire legal hearing. In the absence of jury trials, it becomes the sole responsibility of the Judge to determine the negligence of the defaulter (even if it is the carrier in your case) towards committing the defying act on the basis of the associated facts.



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PostPosted: Wed Sep 03, 2008 9:45 pm   Post subject:   

Putting on my suspicious post hat.....



It's a red flag when someone wants to know the claims paying process regarding life insurance.



The insurance company will pay all legitimate claims.



Fraudulent or suspected fraudulent claims or an insured dying under suspicious circumstances will be investigated by the insurance company and law enforcement.



There have been many posts on this board about a spouse buying life insurance on the other without their knowledge and now this post about how claims are paid.



I find this an odd topic.



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PostPosted: Thu Sep 04, 2008 12:47 am   Post subject:   

Well Gagansab (what does that mean by the way? Confused )...You have to admit it is an odd question...the term adjudication, is an odd choice of terms as well...unless we have two different meanings of that term...which I take to mean a final judgement in a legal proceeding after some type of hearing or trial, which would not be the case normally regarding a life policy claim..



Quote:
1) How exactly an insurance company deals with the case futher.(Department wise) ?
Well it would go to the claims dept of course, then all the required information would be reviewed, if there are any red flags it would be passed on to an SIU (special investigation unit) to pursue...
Quote:
2) What all things/requirements are kept in mind before the claim made by the insured is approved ?
Well actually the insured would be dead, so it would be the beneficary making the claim...all company's are different but all require a certified death certificate for sure...some require the policy or a copy there of, it would depend on the cause of death whatever else may be required...

Quote:
I need the whole scenario from an insurance company's point of view and not from a claimant's point of view.
All company's operate differently to a point...also all states have their own laws and regulations ( you could check your states dept of ins web site for information as well)...I will tell you that of all claims, life claims with ''any'' smell to them at all get scrutinized hard...


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Last edited by Lori on Thu Sep 04, 2008 9:05 am
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PostPosted: Thu Sep 04, 2008 4:18 am   Post subject:   

Hi gagansab, I see Lori has perfectly explained how the term "adjudication" could be used. Adjudication is pretty much a final judgment to which there is every possibility that the prosecution & the defense would request the judge to explain the case. That is exactly when such a case is presented against the defendant. Under such circumstances the state has the sole responsibility to prove the measure of the guilt & that the defendant would be responsible for a considerable amount of negligence. Fatman

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PostPosted: Thu Sep 04, 2008 10:13 am   Post subject:   

There could be a language issue here where English is not OP's first language.



I'll enter into the dangerous territory of making "inferences" and state he probably means the word mitigation rather than adjudication.



After all our English language has the words to, two and too not to mention the words there, their or they're and right, write and rite. Loose and lose are pretty close but close and close are two different things.



OP perhaps thinks inaccurately the company pays something less than full death benefit because of some problem related to the claim.



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