Keyword matching was key

To rectify the potential disparities between the actual claim and the submitted code, we applied a simple keyword matching search through the auditing software we use, ACL™ GRC. Here are some examples of what we found:

One loss cause code in our system was "Fire and Lightning." A kid playing with matches who accidentally started a fire didn't qualify for catastrophe reinsurance. However, a lightning strike that started a fire did! But we only had one code. It was incredibly helpful to extract the description-of-loss field for the entire population of fire claims.
Loss cause codes could be keyed as "theft," which by itself is not reimbursable under the catastrophe agreement. A closer look at one loss cause code description revealed that a storm was responsible: "Wind knocked out power to alarm system and theft occurred." This would be covered under the agreement.
Similar problems were noted in our Equipment Breakdown (EBK) contract. Eligible claims have a specific EBK loss cause code. Claims without the EBK code but with certain keywords in the loss description field, like lightning, broken, failed or cracked, were run through ACL keyword matching, yielding hundreds of thousands of dollars in recoveries.

We found $1 million!

Overall, we found that under normal operations, the description of loss was often not being matched to the code that drove the automated portion of catastrophe loss recoveries. Upon review, we uncovered a small number of losses that had already been submitted to the reinsurer for reimbursement that were not eligible based on loss description.

Special Reports /

How to find $1M or more in your reinsurance contracts

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