SERVICES
Adjusters, Inc. has served as third party administrators for accounts generating over 3,000 claims per year, minimizing the impact accounts like these will present to the Claims Department of an insurer. A proven feature to assist in promoting new business for our clients is personalized service to large accounts throughout the island. Once approved by the principal, we can receive claims directly from the insured or authorized general agents with certified coverage confirmation and immediately commence investigation and handling locally. We notify the insurance company with confirmation of coverage, accident report, and original reserve recommendations transmitted with our acknowledgment and claim number.
The adjuster services we provide include:
• TPA (Third Party Administration Services)
• Liability Litigation Management
• Professional Liability, specializing in Medical Malpractice
• Personal and Commercial Lines (Liability and Property)
• Automobile Appraisals
• Equipment Breakdown Claims
• Catastrophic Occurrences
• Frequency Accounts - Currently handling Puerto Rico Aqueduct and Sewer Authority's Commercial General Liability Account
• Errors & Omissions
The services we can provide would encompass full management of these claims throughout the Island to include:
Incidents:
If authorized by our principal, we will receive and screen all incidents reported by the insured and determine the necessary course of action.
Regular Claims (Basic Handling):
• Receipt and acknowledgment of claims; identification of claim suffixes and reserve per suffix.
• Data entry of claims for follow-up and compliance with administrative terms (Sec. 27.162 of the Puerto Rico Insurance Code)
• Contact letter to claimant.
• Insured investigation: witness statement, photographs
• Claimant investigation: statements, compilation and verification of damage evidence (PD & BI) and evaluation of same.
• Liability assessment evaluation of damages, exposure and appropriate compensation with supervisory staff, if applicable.
• Negotiation and settlement of claim with appropriate release secured or denial addressed to the claimant.
• Report to Company with issuance of payment, payment request, or denial letter.
Legal Claims (Extended Handling):
In those claims that must be legally defended, our services will include all the above and extend to:
• Complaint allegations analysis.
• Contact assigned counsel to coordinate investigation process.
• Canvass: statements, photos, obtain official documents (police reports, fire department reports, etc).
• Reporting to assigned counsel and company with periodic reserve evaluation and recommendations.
PUERTO RICO INSURANCE CODE COMPLIANCE
All claims are to be settled or denied within ninety (90) days of their receipt. When this is not possible, we will make sure that each file contains all the documentation required to justify the extension of time as per Puerto Rico Insurance Code requirements, including the recent amendments to the Insurance Code (Law #230).
BUSINESS CONTINUITY PLAN
Our work force can expeditiously manage catastrophic property losses as we spread out the entire Island and our facilities extend daily working hours to twelve (12) with supplemental electric generator and cloud-enabled computer systems which guarantee business continuity.
We rest assured that an opportunity to service you will promptly demonstrate our capabilities and prove a wise decision in entrusting your investigations and claims handling to us.
