The "pièce de résistance" of an insurer's compliance and risk management program is its claims handbook or manual. Without written claims-handling policies and procedures, companies are at risk for significant losses.
Of note, failures to meet claim regulations and to keep claims policies and procedures updated rank high among the Top 10 criticisms found on market conduct examinations, according to Wolters Kluwer Financial Services' annual market conduct research. Such violations have resulted in millions of dollars of fines, fees, and penalties.
Drafting claims guidance, however, is as challenging as creating a work of fine art. For most insurers, painting a coherent picture from diverse regulatory requirements, and framing them into the claim process, poses unique challenges.
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