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CSR SPR CRITERIA - ADDENDUM A

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mcvonbraun's version from 2015-06-17 22:48

Section 1

Question Answer
ATLAS MANUAL OPEN/CLOSE - COLLISION
Under what criteria being present should an examiner allow Collision Exposures and Loss Reserve Lines to automatically open?1. An at fault collision, non-fault collision or fault unknown - loss still under investigation type of loss
2. Any and all coverage issues are resolved
3. Damages are confirmed/indicated by insured or insured representative
4. A vehicle assignment is established
What should the examiner NOT do prior to establishing a vehicle assignment?The examiner should not override the auto open functionality by establishing an exposure or reserve line prior to establishing vehicle assignment
When is a manual open required (must be opened within 2 days of know exposure)?When an exposure exists for a vehicle not on the policy (common examples are: rental vehicles and vehicles not listed on the policy)
All collision exposures should be closed utilizing handling complete. What criteria is necessary prior to choosing H/C?1. Type of loss is completed
2. Subro indicator is completed
3. Claim Level % Neg is completed
4. The examiner has set the appointment with a good paycode
5. Arbitration Indicator in "complete" status if no subro adjuster assigned.
How long does the adjuster have to change H/C back to "yes" if H/C is marked "yes" and then changed back to "no" for further activity?The adjuster has 24 hours to change H/C back to "yes" once further activity is complete
When is a manual close required? 1. If the exposure is closed due to no coverage
2. If exhaustion of limits
Note: Under the above 2 scenarios the exposure must be closed within 15 days
3. Exposure was opened in error
Note: under the above scenario #3, the exposure must be closed within 24 hours
memorize

Section 2

Question Answer
ATLAS MANUAL OPEN/CLOSE - COMPREHENSIVE
Under what criteria should the examiner allow Comprehensive Exposures and Loss Reserve Lines to automatically open?1. Type of loss is established with a comprehensive loss description
2. Any and all coverage issues are resolved
3. A vehicle assignment is established
What should the examiner NOT do prior to establishing a vehicle assignment?The examiner should not override the auto open functionality by establishing an exposure or reserve line prior to establishing vehicle assignment
When is a manual open required (must be opened within 2 days of known exposure)?1. When an exposure exists for a vehicle not on the policy (common examples are rental vehicles and vehicles not listed on the policy).
All COMP exposures should be closed utilizing handling complete. What criteria are necessary prior to choosing H/C?1. Type of loss is completed
2. Subro indicator is completed
3. Claim level % negligence is completed
4. The examiner has set the appointment with a good paycode
5. Arbitration Indicator in "complete" status if no subro adjuster assigned
How long does the adjuster have to change H/C back to "yes" if H/C is marked "yes" and then changed back to "no" for further activity?The adjuster has 24 hours to change H/C back to "yes" once further activity is complete
When is a manual close required? 1. If the exposure is closed due to no coverage
2. If exhaustion of limits
Note: Under the above 2 scenarios the exposure must be closed within 15 days
3. Exposure was opened in error
Note: under the above scenario #3, the exposure must be closed within 24 hours
memorize

Section 3

Question Answer
ATLAS MANUAL OPEN/CLOSE - PROPERTY DAMAGE
What criteria should be present under which the examiner should allow PD exposures and loss reserve lines to automatically open?1. Type of loss completed
2. % Negligence updated to an at fault loss
3. Any and all coverage issues are resolved
4. Less than 2 vehicle and/or property incidents are involved
Note: Pure comparative state will auto open. Modified comparative state or contributory state will not auto open if the claimant is barred from recovery.
What should the examiner NOT do prior to establishing a vehicle assignment?The examiner should not override the auto open functionality by establishing an exposure or reserve line prior to establishing vehicle assignment
When is a manual open required (must be opened within 2 days of known exposure)?When more than one claimant vehicle requires a manual open
All APD exposures should be closed utilizing handling complete. Which criteria are necessary prior to choosing H/C?1. Type of loss is completed
2. Subro indicator is completed
3. The examiner has set the appointment with a good paycode.
4. Claim level % negligence is completed
5. Arbitration indicator is "complete" status if no subro adjuster assigned.
How long does the adjuster have to change H/C back to "yes" if H/C is marked "yes" and then changed back to "no" for further activity?The adjuster has 24 hours to change H/C back to "yes" once further activity is complete
When is a manual close required? 1. If the exposure is closed due to no coverage
2. If exhaustion of limits
Note: Under the above 2 scenarios the exposure must be closed within 15 days
3. Exposure was opened in error
Note: under the above scenario #3, the exposure must be closed within 24 hours
memorize

Section 4

Question Answer
ATLAS MANUAL OPEN/CLOSE - RENTAL/LOSS UF USE
What criteria must be present under which the examiner should allow REN and LOU exposures and loss reserve lines to automatically open?1. A COLL or PD feature has been opened
2. Type of loss is completed
3. % Negligence is completed
4. Any and all coverage issues are resolved
NOTE: The examiner should not override the auto open functionality by establishing an exposure or reserve line prior to manually establishing an ARMS reservation
When is a manual close required (must be opened within 2 days of known exposure)?1. Rental reservation is established with a non-ERAC company
2. Insured pays out of pocket for rental expenses
3. Rental falls under UMPD
4. Claimant files through adverse carrier and handled via subrogation (LOU)
5. Commercial vehicles presenting a claim for LOU
All REN/LOU features should be closed utilizing handling complete. What criteria are necessary prior to choosing H/C?1. Type of loss is completed
2. Subro indicator is completed
3. Claim level % negligence is completed
4. The examiner has set the appointment with a good paycode
5. Arbitration indicator in "complete" status if no subro adjuster assigned
How long does the adjuster have to change H/C back to "yes" if H/C is marked "yes" and then changed back to "no" for further activity?The adjuster has 24 hours to change H/C back to "yes" once further activity is complete
When is a manual close required? 1. If the exposure is closed due to no coverage
2. If exhaustion of limits
Note: Under the above 2 scenarios the exposure must be closed within 15 days
3. Exposure was opened in error
Note: under the above scenario #3, the exposure must be closed within 24 hours
NOTE: UPD and Expense reserve line never auto open and should be manually opened when a probable cost is presented.
memorize