General Liability Claims Management for Insurers (OLD)

General liability loss ratios are deteriorating. Ready to improve your outcomes?

General liability insurance — also known as business liability insurance — protects businesses from claims that result from normal business operations involving bodily injuries, medical payments, advertising injuries, and more.

It’s forecasted that liability premiums will increase by 4.7% (annual average) to $583 billion by 2040, representing 13% of the global P&C market. Emerging risk factors such as new technologies and environmental liability will contribute to additional liability exposure growth.

In the U.S., social inflation-related factors are driving more frequent and severe claims verdicts and settlements in the US. Claims teams are challenged with accurately assessing general damages and liability for complex claims. Insurers must respond with new analytical approaches and products to keep the growing risks insurable.

Key Challenges for General Liability Insurers

Optimizing Claims Resolution across Severity Types

Social trends are driving more frequent and high severity claims verdicts. Being able to triage claims quickly and accurately, assign claims seamlessly, and ensure that claims specific protocols are applied and executed on a timely basis will help you improve efficiency, reduce claim handling costs, and optimize claims resolution.

Injury Evaluation Consistency

Similar claimants (e.g., age, gender, pre-incident condition, etc.) with analogous injuries and treatment should be evaluated on a consistent basis. A modern claims system should have a dynamic injury module that represents and enforces your injury evaluation protocols, while capturing all evaluation data for analysis – to consistently value and settle similar claims.

Litigation Management

For claims involved in formal legal dispute to be optimally resolved, insurers need to consider expenses and indemnity over time. Maintaining ownership of decision-making and effectively managing expenses, while collaborating with counsel is challenging. A claims system that is integrated with internal billing systems and counsel can help you ensure that expenses are accurately managed, while maintaining case transparency and client privilege.

Omnichannel Communications

Your policyholders expect real-time communication across multiple channels (text, email, chat, phone, video) – corresponding just by snail mail or even email is no longer an option.  Unfortunately, most claims insurance technology is outdated and does not support omnichannel communications, leading to frustrated customers and unhappy adjusters.

The Benefits of Five Sigma's CMS for General Liability Insurers

Our cloud-native data-driven claims management solution makes your claims processing simple and smart.

Automated Claims Submission

Our digital claims management solutions (CMS) provide:

  • All FNOL data received from the insurers/digital channels are embedded automatically into our workflows and ready for the next step in the process
  • Rapid system identification of claim types
  • Automated triage and adjuster assignment

Embedded Omnichannel Communications

Our CMS includes an API-level communication module that support all types of communications including: SMS, mail, voice video calls, and even WhatsApp. All claims-related communication is documented, stored and analyzed automatically.

Just-in-time Recommendations

Our systems flags coverage and liability issues and presents the adjuster with relevant information and investigative steps within the claims system.

Damage Assessment and Negotiation

The key to effectively negotiating a claim begins with accurate damage assessment. Our CMS includes a digital bodily injury evaluation module to itemize, assess and aggregate damages.

Monitoring and Management

Based on our advanced data modeling, we enable insurers to monitor your operations and receive actionable insights that will help you make strategic management decisions.

Building an In-house Claims Operation with Five Sigma

A rapidly growing insurtech reached the scale and claims volume where they were considering whether to bring their claims operation in-house. They performed an audit of their current TPA’s claims process to determine if there would be a material improvement in expenses and accuracy if they resolved their claims.

They were surprised at the following findings:

  • There was little to none triaging of injury claims by the TPA. Often relatively minor injury claims were being assigned to more senior adjusters that were more expensive.
  • Across similar claimants that suffered analogous injuries, there was significant variance in how the claim was evaluated and the settlement amount.
  • Litigated claims appeared to be referred to outside counsel for resolution with minimal oversight and scrutiny over their activity or billing.

Learn how within six months of deploying Five Sigma’s SaaS claims management solution, claims had been successfully insourced with immediate improvement in LAE and resolution accuracy.

Go live in weeks with the state-of-the-art claims management platform.