Agent Claim Manual
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INTRODUCTION:
This section of the manual will provide our agent with reporting guidelines that will meet the requirements of the various regulatory statutes we must comply with.
All parties that file a claim with our company are entitled to courteous treatment from our representatives. You, as the agent will be the insured's first contact when they have a loss. Any claim, whether large or small, is serious to the insured and should not be treated lightly.

FULMONT'S CLAIM PRACTICE POLICY:

  1. Prompt and fair settlement of all claims.

  2. Assist the claimant in the processing of a claim.

  3. When the verification of pertinent facts is necessary, it will be done as expeditiously as possible.

  4. Clearly inform the claimant of the insurer's position re­garding any disputed matter.

  5. Respond promptly, when response is indicated, to all communications from insured's, claimant's, attorney's, agent's and any other qualified persons.

  6. Operate and comply at all times within the parameters and requirements of our Regulatory Authorities.
    CONTACT PEOPLE:
    The con­tact people at Fulmont Mutual are as follows:
    Johnstown Office:  Laurie Schroeder, Claims Adjuster, P.O. Box 487, Johnstown, NY 12095-0487, Phone - 518-762-3171, (105 respectively), Fax - 518-762-7870
     

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REPORTING THE CLAIM TO FULMONT:
The following will conform to the criteria of New York State Insurance Law when the agent files a claim with Fulmont:

  1. Prepare a "LOSS NOTICE"; if property loss, use "Property Loss Notice"; if liability loss, use "General Liability Loss Notice (other than automobile)." The information that you will need to get from your insured is the date and time of the loss, kind of loss, property damaged, brief description of what happened and the probable cause of the loss, person to contact, phone number, where and when to contact. Any additional pertinent information that you can provide will be helpful. PLEASE NOTE: See the following pages for more detailed procedures on completing the loss notice.

  2. Mail or fax the loss notice to the company office as soon as possible. If faxing, please note on the original that it was previously reported and follow up with the original in the US Mail.

  3. On a property loss, advise the insured that the company will at least need an estimate from a contractor.

SUGGESTED CLAIMS HANDLING TECHNIQUES FOR AGENCY PERSONNEL:

  1. Show compassion and concern to the parties involved with the claim.

  2. Discuss reporting and other provisions relating to claims adjusting with the insured and/or claimant. Report all claims and/or incidents to the insurance company, no matter how minor they seem. (Refer to procedure for liability or property claims.) PLEASE NOTE: It is very important to file a loss notice on every liability claim reported to you, even if the insured indicates that the third party does not intend to file a claim.

  3. With a first-party claim, never make coverage or loss payment decisions.

  4. With a third-party claim, do not give legal advice to the insured or the claimant, and do not make decisions concerning the liability of the parties.

  5. Promptly report all relevant information to the insurance company.

  6. Good record keeping procedures are critical in all claims handling.

  7. All phone conversations should be documented, with a copy of the information placed in the client's file. When evi­dence of a verbal conversation is ever needed, it will be readily available.

  8. Follow up on the claim in writing with the company and the customer.

PROCEDURE:

Liability Claims

  1. When filing a liability claim a GENERAL LIABILITY LOSS NOTICE (Other Than Automobile) should be used. We emphasize it is very important that all sections of the notice are filled in, especially the date of loss. If there are areas on the form that are not applicable, a line through them will make sure nothing is missed.

  2. Phone numbers: Phone numbers, including area codes for both home and work are vital for contacting the insured and/or claimant.

  3. Injured Parties and Witnesses: Injured parties and witnesses names, address and phone numbers are equally as important to include.

Property Claims

  1. When filing a property claim an ACORD PROPERTY LOSS NOTICE must be used. We emphasize that it is very important that all sections of the Acord are filled in, especially the date of loss. If there are areas on the form which are not applicable, a line through them will make sure nothing is missed.

  2. When completing the loss notice, please communicate with the insured and check mailing addresses, mortgagees etc. for any additions, deletions or changes. This will give our claims person­nel time to rectify the records and could make the claim payment more timely.

  3. Phone numbers: Phone numbers including area codes for both home and work are vital for contacting the insured.

  4. Estimates and/or supporting material: Estimates &/or supporting material will normally be needed for all property claims. Advise the insured that the Company will need at least a detailed repair estimate from a contractor. In addition to the estimate, we will also need the age and condition of the damaged property prior to the loss. i.e. a furnace was 15 yrs old, and according to the heating contractor it was in excellent condition, or the roof was 10 years old, and had moss growing all over it due to dampness. In all claims have the insured forward any estimates, bills or supporting material directly to the company. By conveying this information to the insured, it can expedite the handling of the claim.

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Closed Claims

As an accommodation to our agents, the agent will normally receive a copy of the written notification of payment when a claim is closed.

NYS LAWS AND REGULATIONS

All insurance companies licensed and/or doing business in NYS are regulated by the New York State Insurance Department. The following is a brief outline of laws and regulations directly affecting the claims department or claims processing:

  1. REGULATION #64 AND SECTION 2601 of the Insurance Law prohibits insurers from engaging in unfair claims settlement practices. The statutes contain claim practice rules which insurers must apply to the processing of all first-and third-party claims. Some of the standards the statutes address are prompt investigation, acknowledgment of pertinent communications, policy provisions, and fair and equitable settlements.

  2. REGULATION 96 of the Insurance Law requires insurers to report all fire and theft losses in excess of $1,000 to a central organization engaged in property loss registration (PILR) in order to prevent fraudulent payments. The report is to be filed to PILR within 5 business days following receipt of the notice of loss, and if we have not received a response from PILR within 15 calendar days, we may proceed with the processing of the claim.

  3. SECTION 331 of the New York State Insurance Law, requires insurers at the time of a loss to ALL PROPERTY other than a one- or two-family residential structure, to contact the tax office in each municipality which has indicated its intent to claim proceeds of Fire Insurance policies to the extent of tax liens.
    The municipality has twenty (20) days to respond to the request from the insurance company. Failure to serve a Certificate of Lien during that time will terminate the claim of the tax district to any proceeds. The insurance company has ten (10) days after the final determination of its obligations to pay such proceeds, to pay the amount specified in the lien to the collecting officer.

PLEASE NOTE: The claim of the municipality is second only to that of a mortgagee of record.

As of this writing, September 23, 1996, the Tax Districts Filing Notice of Intention to Claim Against Fire Insurance Proceeds are:

Albany, County of

Amsterdam, City of

Buffalo, City of

Cattaraugus County

Chautaugua, County of

Erie, County of

Fleischmanns, Village of

Franklin, County of

Freeport, Village of

Green Island, Village of

Hempstead, Village of

Jamestown, City of

Kenmore, Village of

Kingston, City of

Lewisboro, Town of

Liberty, Village of

Long Beach, City of

Malone, Village of

Middletown, City of

Monroe, County of

Mount Vernon, City of

New York, City of

New Rochelle, City of

Newburgh, City of

Niagara, County of

Niagara Falls, City of

North Tonawanda, City of

Ogdensburg, City of

Oneida, County of

Oneida, City of

Orange, County of

Orleans, County of

Otsego, County of

Poughkeepsie, City of

Rochester, City of

Rockland, County of

Sand Lake, Town of

Schenectady, City of

Spring Valley, Village of

Suffolk, County of

Sullivan, County of

Syracuse, City of

Troy, City of

Ulster, County of

Utica, City of

Watertown, City of

Wayne, County of

Williamsville, Village of

Wyoming, County of

Yates County

Yonkers, City of

The company must comply with the above rules and regulations. Due to these rules and regulations, Fulmont is delayed occasionally from paying claims as quickly as we would like them paid. With properly completed loss notices we can continue offering better-than-average claims service to your customers. We hope this section of your manual will be of assistance to you. Please contact our office if you need further assistance or have any comments.

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