Wrapping Up the Industry Guidelines Review
In 2016, we have featured a series of E-Bulletin articles to highlight individual E-Subro Hub industry guidelines that went active on February 15, 2016.
In this fifth and final article of the series, we will review the guidelines that have yet to be covered in the previous articles.
Two of the guidelines set qualification parameters for E-Subro Hub demands:
- Demands for injury claims are not handled in E-Subro Hub.
- E-Subro Hub should not be used to send the initial notice of subrogation. Demands should only be sent once known damage payments have been issued.
These guidelines do not require much explanation. One simply reiterates that qualifying demands involve Auto Physical Damage claims (E-Bulletin for E-Subro Hub, March 2016) and do not include PIP or MedPay subrogation. The other notes that demands should not be used as subrogation notice, which supports the suggestion in an earlier article (E-Bulletin for E-Subro Hub, July 2016) that E-Subro Hub demands should only be sent when all known damages have been resolved.
Since PIP and MedPay subrogation was referenced above, this is an appropriate time to call out the Liability Agreement guideline that states:
When a liability agreement is reached in E-Subro Hub, the agreed upon liability assessment will not be applied to other related claims (PIP and/or MedPay) that are being handled outside of E-Subro Hub.
This guideline acknowledges the fact that subrogation negotiation of different coverages can be completed independent of each other. When this occurs, a liability position established to resolve an E-Subro Hub demand does not automatically apply to the negotiation of other coverage such as PIP or MedPay.
The First Notice of Loss guideline states:
When an E-Subro Hub demand is the Responder's first notice of loss and an initial claim has not been created, the recipient company should assume responsibility for initiating a claim file.
Note: Absent appropriate information, as stated in the Demand Detail Requirements section, the responding party can and should initiate a Request for Information to the Demander.
In all response-side workflows, there is a procedure to receive and initiate a claim if an E-Subro Hub demand is the first notice of loss. However, the ability of the Responder to complete this task relies on the information provided by the Demander. The First Notice of Loss guideline and the Demand Detail Requirements guideline (E-Bulletin for E-Subro Hub, May 2016) outline a duty both Demander and Responder share to efficiently resolve E-Subro Hub demands.
The Counter Offer Acceptance guideline states:
Using the Accept action within E-Subro Hub to accept the last offer made by the Responder should be considered a final settlement.
When the Accept action is being used to accept the Responder's last offer as a partial acceptance, and there is intent to file arbitration for the remaining balance, it should be clearly noted in the message field that the counter offer is being accepted as a partial agreement and that arbitration will be filed.
This guideline supports the suggestion in the Best Practices for use of the Accept command (E-Bulletin for E-Subro Hub, September 2016). The Accept command should be used when the handling associate agrees to the current liability and damage negotiation. As a Responder, you are agreeing to issue a settlement for the current negotiation amount. As a Demander, if the payment received matches the agreed upon offer, then the matter should be considered closed. If arbitration is still a possibility, it should be clearly noted to the responding party when accepting a counter offer.
The Contact Information guideline states:
Demander and Responder Representative Information on the Demand Detail page for all E-Subro Hub demands must include a valid phone number for an individual or team that can access and discuss the demand.
If negotiations will take place outside of E-Subro Hub, the response-side demand owner should provide contact information for the investigating liability representative using the Negotiation or Message field (available in Send FYI, Request for Info, Counter Offer, or Deny). In addition, the response-side demand owner should ensure a copy of the demand is available to the investigating liability representative who is handling the claim.
This guideline states that the Demander and Responder Representative Information associated with a demand should be complete and accurate. For an individual associate, this information will populate from the User Profile page under the Member Access menu. If the claim is owned by a team, a company administrator will need to maintain the business unit's correct contact information. The user profile and any business unit configuration should be reviewed and updated on a regular basis.
The last portion of this guideline recognizes that more than one associate may be responsible for the claim resolution. In this situation, the contact information for all relevant parties to the claims process should be noted and available in the E-Subro Hub demand. Additionally, those individuals should have access to the demand directly through the E-Subro Hub system or their internal claim platform.
Welcome New E-Subro Hub Members!
AF would like to welcome Nonprofit Insurance Trust, which became active in October, and American Millennium Insurance Company, which will become active on December 5, 2016, to E-Subro Hub. A list of other participating companies is available on AF's website.