Claims reporting guide and office directory

Transcripción

1 Claims reporting guide and office directory

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3 Wesley Shiplett Senior Vice President Customer Relationship Management- Claims Dear valued customer: Thank you for choosing Zurich. We appreciate your confidence and are grateful for your trust. Zurich PO Box Schaumburg, IL Phone (404) Fax (404) Our 11,000 plus employees understand that when your business incurs a loss it can create stress - and you deserve a quick response. Rest assured that we maximize the skills of our claims professionals and leverage technology to streamline the handling process and help manage loss costs. The enclosed Claims Reporting Guide and Office Directory will serve as a valuable resource to fully utilize the skills of our claims professionals. It contains information you will find helpful in reporting your claim. The booklet also explains the four channels you can use to report a claim easily and in a timely fashion. Please review and familiarize yourself with its contents. You will also find information about our services that go beyond claims handling. Zurich maintains industry-leading loss-cost management capabilities that include Staff Legal, Special Investigations, Recovery Operations and Managed Care to deliver the full spectrum of claim-related services. If you have any questions or need additional information, please don t hesitate to call us at or visit our web site at Sincerely, Wesley Shiplett

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5 Here to Help your world. At Zurich, we believe claims reporting should be easy and aligned with your needs. We are dedicated to continually enhancing our report-intake capabilities. The benefit to this approach is simple you can devote most of your time and resources to managing your business instead of reporting claims. Table of contents The Zurich Claims model Multiple reporting channels deliver flexibility and convenience Embracing technology An all-encompassing approach to managing loss costs Directory of claims offices Timely claims reporting is essential to effectively managing your loss costs. Zurich understands this reality. It is an integral element of our overall claims handling approach predicated on helping you protecting and preserving your employees, assets and intellectual capital. Businesses of various types and sizes have different claims needs. As a Zurich policyholder, you have access to as many as six different channels to report claims. We offer multiple options so you can use the ones that most closely fit with the scope and locations of your operations. 1 1

6 The Zurich Claims model Overview Zurich leverages the talents, experience and resources of our entire Claims organization to deliver professional and responsive service. The variety and complexity of claims we handle is as diverse as our customer base. Our professionals are as well-versed in creating a customized service program for a Fortune 500 company as they are in handling a business interruption claim for a small business owner. Starting out on the fast track A quick and clean start is essential to effective claims management. Our Claims Reporting Care Center (CRCC) is staffed by a team of specialists trained to get your claim on the fast track. This facility is the central intake point of all new claims reported to Zurich. CRCC service representatives collect all pertinent information, make a preliminary assessment of facts and assign the claim to one of our 1,800 professionals located throughout the U.S. Our professionals the secret to our success Successful outcomes require qualified personnel to navigate both the expected and unexpected while remaining focused on the task at hand proactively managing your claim. Our people make the difference. Collectively, our professionals average 15 years of claims handling experience. They are committed to managing your claim effectively. We pride ourselves on delivering consistent service regardless of the type of claim or the location handling it. The entire Claims organization shares a set of performance drivers. These shared drivers, along with our best practices, create a common mindset that enables Zurich to provide consistent, quality service no matter where your claim occurs. 2

7 Multiple reporting channels deliver flexibility and convenience Claims reporting needs and preferences vary by customer. Some prefer traditional reporting channels, while others favor more advanced methods. Either way, Zurich has all the bases covered. We offer up to six different reporting channels for your convenience. Bottom line, no matter the date or time, we offer you the flexibility to report your claims around the clock 365 days a year. Internet reporting quick and easy The Internet is the fastest and most streamlined channel available to report claims. Customers will find that Internet reporting can help address most, if not all, of their needs. We have developed customized screens for several types of claims you may have. Rapid response is critical to help achieve effective claims management. Use of the Internet puts Zurich in the best position possible to initiate the service of your claim. To report a claim via the Internet, take these simple steps: 1. Go to our Web site at 2. Click on the Claims link. 3. On the right side of the screen under Report a Claim, click ZNA Online Claims. 4. From the left navigation menu, click on the type of claim you want to file. 5. Follow the simple prompts to enter the required information. 6. Click Submit claim. We will send a confirmation of receipt, the 10-digit claim number and the office assigned to service your claim via generally within 2 hours. We have posted Zurich Claims Reporting Guides, ACORD forms for the major lines of business and workers compensation state forms on our Web site at These forms will help ensure that you provide all the necessary detail for us to begin servicing your claim upon receipt. You can print any one of these forms simply by following the above instructions but instead of clicking the type of claim you would like to file, you click Zurich/Industry Forms and then click on the link for the appropriate document and choose the print option on your Internet browser. 3

8 is another expedited reporting channel. Send a completed ACORD form, state notification form or first notice of loss form to usz_carecenter@zurichna.com that includes the following information: Policy number Company name Name of contact person, telephone and facsimile numbers Date of loss Type of loss: automobile, general liability, property or workers compensation File transfer protocol This reporting channel is suitable for larger customers who generate a substantial amount of claims. Zurich will establish a direct interface with your system to streamline the reporting process. Ask your Zurich representative or contact our Claims Reporting Care Center at if you think this channel might be appropriate to address your needs. Mail Zurich Claim Reporting Care Center P.O. Box Schaumburg, Illinois Description of the loss Phone or facsimile Use one of the following toll-free numbers to report a claim via phone or facsimile. Please be prepared to furnish the following information: policy number, company name, contact person, his/her telephone and facsimile numbers, date of loss and type of claim automobile, general liability, property or workers compensation and a description of the loss. Phone Facsimile Main/general purpose Construction Specialties Accident & Health Surety & Financial Enterprises Zurich Claims Reporting Guides, ACORD forms and workers compensation state forms are posted on our Web site at 4

9 Embracing technology Technology enables our claims professionals to make informed decisions and helps our customers to identify and reduce current and emerging exposures that can lead to future losses. Many of our technology applications perform core functions that can potentially create tangible benefits for customers. Obtaining claim information through automated tools As a customer, you are likely to have ongoing questions throughout the life of a claim. We have developed two automated tools to provide basic information and updates: Claims information Use the following simple steps to access claims information using the Zurich Web site. You will need the date of loss and the incident or claim number to use the tool. To access claims information via the Internet: Go to our Web site at Click on the Claims menu option. Next, click on ZNA Online Claims. Next, click on Claim Handler Locator. Type in the date of loss and the claim or incident number. Hit the return key and your search will begin. The system will provide the claim number, name of the Zurich professional assigned to service your file, office location and phone number. In the near future, you will also be able to receive the address and mailing location as well. Interactive voice response (IVR) Customers can use the IVR tool to retrieve information and/or contact their Zurich claims professional from anywhere in the country. To initiate the process, call and take the following steps: If you know your claim number, select option #2 Existing Claim. Next, select option #1 and enter your claim number. The IVR system will verify the date of loss and provide the handling office and name and contact information of the assigned claims professional. The system will then automatically transfer you to your Zurich claims professional. If you don t know your claim number, select option #2. The system will transfer you to a Zurich representative who will provide the file number, assigned office, claims professional s name and direct dial number. Once the information is relayed, your call will be forwarded directly to the claims professional. 5

10 Review and analysis of current claims and overall loss data Effective, loss cost management depends on active review and analysis of claims information. It is how we work with our customers to identify issues and help customers resolve them. We offer a set of tools customers can use to review and analyze individual and overall claims data. The tools are tailored to help address the varying needs of small, medium, large and global businesses. RiskAccess Claim information viewing tool With RiskAccess, you can see real-time loss information and claims professional notes, including case summaries and action plans online, any time. No more waiting for answers to arrive by fax or phone just easy access to the information you need. You can also review disability dates, as well as review payment history, reserves and reserve history even enter detailed information such as site codes and user defined fields. RiskIntelligence Enterprise Portal Zurich RiskIntelligence is a powerful web-based system that provides daily updates of claims and loss information in standardized or customized reports. Our premier solution has graphical analysis, interactive report design, Other Carrier data and scheduled report functionality. RiskIntelligence enables you to review loss costs, analyze loss trends, and pinpoint problem claims or loss areas early on so that corrective action can be implemented. Our new Home Page is a gateway to features such as an alert system to notify you of new claim information or valuation changes, Quick Links, Video Tutorials and a Work Comp Dashboard Report. Don t have a claim number? No problem, search for a claimant by last name directly from our Home Page, saving you time accessing claim information. RiskIntelligence Express RiskIntelligence Express provides access to loss information without having to contact your claims professional or underwriting office. This electronic tool is available 24/7 online to simplify loss analysis for authorized users with low to moderate loss frequency. RiskIntelligence Express features include: Daily updates to loss information (including payments and reserves) Claim number search Real-time adjuster notes Ability to adjuster Loss runs with view, print and download capability (Microsoft Excel format) RiskImage Large account casualty customers can use RiskImage to review claim files whenever the need arises. This tool helps eases administrative burdens and maximizes your efficiency by giving highly secure electronic access to the claims documents normally contained in a paper claim file. No need to wait for them to arrive in the mail. And there s far less need for costly and time-consuming onsite audits. You can review explanation of benefits, medical bills and records, settlement information, legal documents and general correspondence. Our newly integrated tab within the Zurich RiskIntelligence Home Page allows RiskImage users a single sign-on feature! 6

11 Risk management reports Risk management reports are monthly loss runs that can be viewed through the Zurich Web site. Such reports identify claim trends and historical data and give specific financial information relating to the entire claims portfolio. The use of technology empowers Zurich to rapidly respond to first notices of loss, make informed decisions based on real-time information and deliver consistent service to all customers, regardless of location or type of claim. Claims Best Practices our commitment to you What gets measured gets done. This is an integral element of the Zurich culture. We have developed a formal set of Claims Best Practices that measure performance. They cover all phases of the process, from initial reporting to final disposition. Customer contact and communication are two examples. We have established standards regarding initial contact after receipt of the initial notice of loss and the frequency of our communications throughout the life of the claim. Zurich has Catastrophe Response for events that involve multiple areas of your business operations, potentially large financial impact, and more than one coverage type. In these cases, you will receive a coordinated response from the teams handling the claims. This unified approach helps manage loss costs effectively, while delivering when it matters. The entire set of standards helps you develop a strong understanding of what to expect from Zurich. 7

12 An approach to managing loss costs Effective loss cost management requires much more than just claims service. Our approach involves the use of a range of capabilities capabilities that go hand in hand with our core claims offering. We have and will continue to make investments in these and other areas of to continually enhance the value we deliver to our customers. Staff legal Litigation is a serious threat for every business. To defend your business against litigated claims, Zurich has built a national network of over 400 defense attorneys in 46 offices who specialize in one area defending commercial businesses. Our attorneys are: Experienced professionals Staff Legal attorneys on average have over 15 years experience in insurance defense trial work. Industry specialists Our attorneys have extensive experience working with construction, food and restaurant, hospitality, manufacturing, professional services, retail, trucking and wholesale businesses. They understand your business and use that knowledge in defending your business from legal claims. Practice area specialists Our attorneys concentrate their practice in specialized areas. We have attorneys with extensive experience in construction, employment practice, liability, product liability, professional liability and workers compensation. Special investigations unit* The commercial insurance industry pays out billions of dollars each year in fraudulent claims. In the end, all insurance buyers end up footing the bill for the bogus claims in the form of higher rates. Zurich has taken a very proactive approach to fighting fraud. We offer all of our customers the services of our special investigations unit (SIU). SIU employs more than 40 investigators who possess an average of 26 years experience with special investigations units, insurance, law enforcement or other investigative fields. They work closely with our claims professionals to help identify and reduce fraud. The special investigations unit is committed to the timely, thorough and efficient resolution of questionable claims. Their quality review program helps deliver commitment. We believe early identification of fraud is the key and, to that end, provide training to our claims professionals on a continual basis. To report suspected fraud, contact the SIU hotline at *All such services are provided by Zurich Services Corporation.

13 Managed care* Managed care is much more than just reducing medical bills. It s about doing everything possible to help the injured worker receives quality care and returns to work as soon as possible. Our 375 medical professionals provide many services such as bill review, medical case management, return-to-work and utilization review. We also offer access to preferred provider organizations and a pharmacy program. All of the offerings are designed to help achieve a shared goal for your company and Zurich tries to deliver quality care in a cost-efficient manner. Return to work Employers who have an effective return-to-work process see a positive cultural and financial impact on their organization. Industry estimates reveal that for every dollar spent on absence management, a company may save $10. In fact, we can help you improve your productivity while enhancing the physical and psychological recovery process for an injured worker. We add value by assisting you with the implementation of a solid return-to-work solution, prior to any loss at your organization. Assistance in establishing a model return-to-work program is just a click away. For information and assistance with any of our capabilities below, please us at RTW@zurichna.com Create an ez Transition through return-to-work tools and resources that help you reduce workers compensation costs: Implement customized RTW policies and procedures. Develop modified duty job description profiles with physical job demands. Develop temporary transitional work assignments. Train Zurich customers to communicate information regarding their job descriptions, physical job demands and temporary transitional work assignments with health care providers and Zurich claim representatives. Generate return-to-work program implementation and training materials. Provide access to Americans with Disabilities Act (ADA) and state-specific Family and Medical Leave Act (FMLA) information. 9

14 Recovery services Zurich established a dedicated recovery services unit to investigate and pursue monies owed by third parties. Often times, in the course of ordinary business, your organization becomes involved in claims caused by the actions of third parties. Whether you are insured on a guaranteed cost program or loss-sensitive plan, these types of claims can have a material negative impact on your loss costs. The unit is another example of how we go beyond traditional claims services to deliver value to customers. Our seven regional recovery hubs provide multi-line, multi-jurisdictional commercial recovery services on both a domestic and international basis. Litigation management, forensic engineering, front-end data mining, monthly audits and balanced scorecard programs provide structure and consistency streamlining the recognition, referral and recovery processes. Zurich recovery services also provides recovery solutions for losses not covered by your policy. We offer these services across various lines of business on a contingency fee basis. Vendor Management Zurich operates a Claims Vendor Management department to proactively manage the services, costs and quality delivered through the use of a network of providers. We have established a broad panel of vendors including medical service providers, auto repair networks and water remediation services to help deliver a positive claims experience when it matters most. Our commitment to excellence includes: Establishing a rigorous selection process to promote customer satisfaction Identifying key service providers who will deliver quality workmanship and responsive service Our claims vendor management program helps increased value to the services our claims professionals deliver for our Zurich Customers. To contact one of our recovery professionals and learn more about the financial benefit of our services for your company, call *All such services are provided by Zurich Services Corporation.

15 Risk engineering* Claims frequency can often be reduced by analyzing your risks and loss exposures. Once this is understood, solutions can be implemented to control losses before they occur. We understand risk in your business. Our risk engineers work in a wide variety of industries and possess in-depth knowledge, experience assess your specific risks. So whether it s property protection, liability, employee safety and health or transportation, we have the capabilities to help you understand what causes your losses as well as what to do to help mitigate and reduce your exposures. Visit us on the web at This is intended as a general description of certain types of insurance and services available to qualified customers through the companies of Zurich in North America. Your policy is the contract that specifically and fully describes your coverage. The description of the policy provisions gives a broad overview of coverages and does not revise or amend the policy. Risk engineering services are provided by Zurich Services Corporation. All information in this brochure is subject to change. Policyholders should review their own operations to determine which tools are best suited to address their needs. *All such services are provided by Zurich Services Corporation. 11

16 Directory of claims offices Atlanta PO Box Schaumburg, IL Phone: Fax: Indianapolis PO Box Schaumburg, IL Phone: Fax: New Jersey PO Box Schaumburg, IL Phone: Fax: Rocky Hill PO Box Schaumburg, IL Phone: Fax: Boston PO Box Schaumburg, IL Phone: Fax: Charlotte PO Box Schaumburg, IL Phone: Fax: Dallas WC PO Box Schaumburg, IL Phone: Fax: Dallas Casualty PO Box Schaumburg, IL Phone: Fax: Illinois PO Box Chicago, IL Phone: Fax: Kansas City PO Box Schaumburg, IL Phone: Fax: Long Island PO Box Schaumburg, IL Phone: Fax: Los Angeles PO Box Schaumburg, IL Phone: Fax: Nashville PO Box Schaumburg, IL Phone: Fax: New Mexico (Kansas City Remote) PO Box Schaumburg, IL Phone: Fax: New York PO Box Schaumburg, IL Fax: Programs - Omaha PO Box 4034 Schaumburg, IL Phone: Fax: Orlando PO Box Schaumburg, IL Phone: Fax: Philadelphia PO Box Schaumburg, IL Phone: Fax: Pittsburgh PO Box Schaumburg, IL Phone: Fax: Sacramento PO Box Schaumburg, IL Phone: Fax: San Francisco PO Box Schaumburg, IL Phone: Fax: Schaumburg PO Box Chicago, IL Phone: Fax: Toronto Canada 400 University Avenue Toronto, Ontario M5G 1S7 Phone: Fax:

17 Guía para presentar reclamaciones y directorio de oficinas

18 Wesley Shiplett Senior Vice President Customer Relationship Management- Claims Estimado cliente: Gracias por haber escogido a Zurich. Apreciamos su confianza y valoramos la fe depositada en nuestra firma. Zurich PO Box Schaumburg, IL Phone (404) Fax (404) Wesley.shiplett@zurichna.com Nuestros empleados, que superan los 11,000, comprenden el estrés que puede vivir su empresa tras el acaecimiento de un siniestro, y usted merece rapidez de respuesta. Puede tener la certeza de que optimizamos la idoneidad de nuestros profesionales especializados en reclamos y que apalancamos la tecnología, en pro de dinamizar el proceso de gestión y colaborar en la administración de los costos del siniestro. La Guía de Presentación de Reclamos y Directorio de Oficinas adjunta le servirá como un valioso recurso para aprovechar al máximo las aptitudes de nuestros profesionales especializados en siniestros. Contiene consejos y formularios de gran utilidad para documentar y denunciar su siniestro. El manual también le explica los cuatro canales a los que puede apelar para denunciar un siniestro sin dificultades ni dilaciones. Lo invitamos a leerlo y a familiarizarse con sus contenidos. También encontrará información acerca de nuestros servicios, que transcienden la simple gestión de siniestros. Zurich mantiene capacidades administrativas de bajo costo, líderes en la industria, que incluyen el Departamento de Legales, Investigaciones Especiales, Operaciones de Recupero y Atención Controlada, ofreciendo así el espectro completo de servicios referidos en materia de siniestros. Si tiene alguna duda o necesita más información, no dude en llamarnos al o en visitar nuestro sitio web: Sin otro particular, le saluda muy atentamente. Wesley Shiplett

19 Here to Help your world. En Zurich, creemos que presentar reclamaciones debiera ser sencillo y adaptarsea sus necesidades. Nuestro cometido es mejorar permanentemente el procesamiento de las reclamaciones recibidas. El beneficio de este enfoque es simple: usted puede dedicar la mayor parte de su tiempo y sus recursos a administrar su negocio en lugar de presentar reclamaciones Indice El modelo de reclamaciones de Zurich Los múltiples canales para presentar reclamaciones proporcionan flexibilidad y comodidad Sistemas tecnológicos Un enfoque global para administrar los costos por pérdidas Directorio de oficinas para presentar reclamaciones La presentación oportuna de reclamaciones es esencial para administrar sus costos por pérdidas de manera eficaz. Zurich comprende esta realidad. Es un elemento integral de nuestro enfoque general de procesamiento de reclamaciones, que se basa en ayudarlo a proteger y preservar a sus empleados, sus activos y su capital intelectual. Las empresas de diversos tipos y tamaños tienen diferentes necesidades de reclamaciones. Como titular de una póliza de Zurich, usted puede acceder a hasta seis canales diferentes para presentar reclamaciones. Ofrecemos múltiples alternativas para que usted utilice las que más se ajusten al alcance y la ubicación de sus operaciones. 15

20 El modelo de reclamaciones de Zurich Resumen Zurich aprovecha el potencial, experiencia y recursos de toda nuestra organización procesadora de reclamaciones para ofrecer un servicio profesional y competente. La diversidad y complejidad de las reclamaciones que procesamos es tan variada como nuestra base de clientes. Nuestros agentes son tan capaces de crear un programa de servicio personalizado para una empresa Fortune 500, como de gestionar una reclamación de interrupción comercial para el propietario de una empresa pequeña. Una partida rápida Un inicio rápido y expedito es elemental para procesar reclamaciones eficientemente. Nuestro centro de procesamiento de reclamaciones (CRCC) está conformado por un equipo de especialistas capacitados para gestionar su reclamación rápidamente desde el comienzo. Este departamento es el punto de partida central para todas las nuevas reclamaciones presentadas a Zurich. Los representantes de servicio de CRCC recopilan toda la información pertinente, realizan una evaluación preliminar de los hechos y asignan la reclamación a uno de nuestros agentes ubicados en todo Estados Unidos. Nuestros agentes: el secreto de nuestro éxito Para obtener óptimos resultados se requiere de personal calificado que sea capaz de abordar tanto lo previsto como lo imprevisto, y a la vez mantenerse centrado en su tarea primordial: gestionar eficientemente su reclamación. Nuestro personal marca la diferencia. En conjunto, nuestros agentes promedian 15 años de experiencia en el procesamiento de reclamaciones. Su cometido es gestionar eficientemente su reclamación. Nos enorgullece ofrecer un servicio uniforme, independientemente del tipo de reclamación o de la oficina que la procese. Toda la organización de gestión de reclamaciones comparte el mismo conjunto de normas diseñadas para fomentar el rendimiento. Estas normas compartidas, junto con nuestras prácticas óptimas, crean un enfoque en común que permite a Zurich ofrecer un servicio coherente y calificado sin importar dónde ocurra su reclamación. 16

21 Los múltiples canales para presentar reclamaciones proporcionan flexibilidad y comodidad Las preferencias y necesidades a la hora de presentar reclamaciones no son iguales para todos los clientes. Algunos prefieren presentar sus reclamaciones por canales tradicionales, mientras otros optan por métodos más avanzados. Cualquiera sea el caso, Zurich está preparado para cubrir cualquier necesidad. Ofrecemos hasta seis diferentes canales para que usted pueda presentar fácilmente sus reclamaciones. Porque en definitiva, lo que le ofrecemos es la flexibilidad de presentar sus reclamaciones 24 horas al día y 365 días al año, pase lo que pase. Reclamaciones por Internet: un trámite rápido y sencillo Internet es el canal más rápido y directo para presentar reclamaciones. Los clientes descubrirán que presentar sus reclamaciones por Internet puede cubrir la mayoría, por no decir todas, sus necesidades. Hemos desarrollado pantallas personalizadas para los diversos tipos de reclamaciones que usted puede tener. Una respuesta rápida es clave para procesar eficientemente las reclamaciones. El uso de Internet sitúa a Zurich en la mejor posición posible para iniciar el servicio de su reclamación. Para presentar una reclamación por Internet, realice estos pasos sencillos: 1. Vaya a nuestro sitio web en 2. Haga clic en el vínculo Claims (Reclamaciones). 3. Sobre el margen derecho de la pantalla, donde dice Report a Claim (Presentar una reclamación), haga clic en ZNA Online Claims. 4. En el menú de navegación de la izquierda, haga clic sobre el tipo de reclamación que desea presentar. 5. Siga las indicaciones sencillas para ingresar la información requerida. 6. Haga clic en Submit claim (Enviar la reclamación). En el lapso plazo de aproximadamente 2 horas le enviaremos un correo electrónico con la confirmación de recepción, el número de reclamación de diez dígitos y la oficina asignada para procesar su reclamación. En nuestro sitio web HYPERLINK tenemos guías para la presentación de reclamaciones a Zurich, formularios ACORD para todas las principales categorías de seguros y formularios estatales de indemnización de trabajadores. Estos formularios sirven para asegurar que usted proporcione todos los datos necesarios para que podamos comenzar a procesar su reclamación tras recibirla. Usted puede imprimir cualquiera de estos formularios simplemente siguiendo las instrucciones de arriba, pero en lugar de hacer clic en el tipo de reclamación que desea presentar, haga clic en Zurich/Industry Forms (Formularios de Zurich/Industria) y luego haga clic en el vínculo del documento correspondiente y seleccione la opción de impresión en su navegador de Internet. 17