Review coverage and settlement decisions

Insurance claims handling policy, §3.3

Have an authorized reviewer check policy wording, investigation support and the explanation to the claimant. Escalate unfair-treatment concerns; record corrections and approval.

Event-driven

Before a denial, disputed valuation or settlement communication

Have an authorized reviewer check policy wording, investigation support and the explanation to the claimant. Escalate unfair-treatment concerns; record corrections and approval.

• Decision review and approved communication

  Controlled record with date, owner, source and review history

Claims supervisor

Leela can prepare a draft and evidence checklist for the accountable reviewer. Adoption and legal conclusions require human review.

Tell Leela about your company to see whether this applies.