Advocating your interests in all claims.

Rose & Kiernan, Inc. has a staff of full-time claims professionals dedicated to ensuring that your claims are properly handled.  Our agency recognizes the varying needs and differences in claims management required from customer to customer.  Our claims advocates work directly with you to identify your specific handling needs, recommend best practices, and act on your behalf in managing the claims process.

Rose & Kiernan takes all first reports of claims, and faxes all notices of losses to our carriers the same day. Our claims tracking and advocacy service functions as our client’s monitoring and quality control vehicle in managing the claims process.  Our staff will advocate your interest in the loss directly with an adjuster, while maintaining an in-depth involvement as your intermediary - your voice -  in the claim. 

Our automated diary system follows each claim to ensure timely handling.

The claims tracking process is managed by using our state-of-the-art automated diary system that actively follows each claim to ensure carriers are timely, and appropriately engaged in handling your claim.  Our claims advocates, throughout the lifecycle of the claims are communicating with both you and our carriers to provide up to date information and ensure the best service and outcomes are delivered.

Rose & Kiernan’s claim review service provides customers with an updated analysis of their open claims as we work towards claim resolution and reserve reductions.  On-site claim reviews are conducted for our customers by using a proactive process with our customers being provided detailed, easy to understand claim status reports highlighting the facts of the claim, describing our input on the litigation strategy, and explaining the financial status, and potential upside and downside.  This service helps our clients easily understand claim payments, carrier tactics and claims strategies, and their reserve rationale. We conduct the entire process and prepare these reports for you with the objective of creating a better understanding of the likely financial outcome and reducing reserves to the proper amount for each claim.

For property, business interruption, homeowners and personal auto, and auto physical damage claims, we ensure you get the claims covered and the payments you deserve.

Claim review services are performed for commercial customers using the following coverage and time-sensitive guidelines:

• Workers' Compensation:  four months after policy renewal, meet with commercial claims representatives with the goal of reducing reserves where possible; this ensures that the lowest possible reserves are used by the Workers Compensation Board when calculating your experience modification factor.

• Property, Casualty and Auto:  in conjunction with Workers’ Compensation claim reviews and more often if necessary.

As a part of our Claims services, Rose & Kiernan utilizes ModMaster^®, a recognized industry software product used to accurately develop Experience Modification Rating (EMR) calculations.  Our ModMaster^® service can quickly and accurately calculate workers' compensation experience modification factors based on past years’ loss history and payrolls.  In addition to providing these projections for the coming policy year, ModMaster^® allows us to provide you a variety of detailed reports that help explain the impact of specific claims on your experience modification factor.  This service is frequently conducted in conjunction with our claim review service.

Our available services include, but are not limited to:

• Assisting you in the development and implementation of formalized claim and incident reporting guidelines and procedures
• Providing assistance in the evaluation and selection of a Claims Administrator for Self-Insured Programs
• Evaluating and auditing of carrier claim files where access is not restricted by law
• Reviewing and providing analysis and oversight of specific loss reports & carrier loss coding
• Providing a review, and assessing the accuracy of your experience modification factor – including a review of the underlying claims data from which the experience modification factor was developed
• Providing Workers’ Compensation claim reviews and case reserve reduction management:
  • Complete case file reviews based on a pre-determined plan
  • Assess the impact of individual case reserves on the experience modification factor
  • Produce pro-forma experience modification factor calculations based on Rose & Kiernan’s case reserve reductions
  • Review claims for possible transference to New York State’s various Injury Funds
  • Facilitate and steward carrier re-submittal of claims data to the Workers’ Compensation Board to affect experience modification factor reductions
  • Identify Workers’ Compensation claims coding mistakes made by insurance carriers which resulted in erroneous, over-stated promulgations of the experience modification factor
  • Submit evidence supporting the reduction of prior years’ audited premiums based on corrections developed to experience modification factor errors noted above

   

Claims Cases:

• A social service agency suffered a total loss fire at their main headquarters on a Saturday night.  We received the call early Sunday morning; we were on the scene by noon on Sunday, having already notified the Insurance carrier to expedite an adjuster to the property.  We remained instrumental as our client’s advocate in resolving both with their insurer and the association’s master policy insurer.

• A local college suffered extensive water damage from a frozen pipe breaking late Friday afternoon.  We notified the carrier after-hours on Friday, and visited the site Saturday morning in order to assist with mitigation plans and carrier interaction.

• A national retailer suffered heavy smoke damage to inventory, necessitating cleaning and repair of the entire store interior.  We intervened when the original restoration company was uncooperative with the insurer; we suggested an alternate vendor who performed work on a more timely and economical basis to the benefit of both the client and the carrier.

Claims Successes

• In 2008, the R&K Claims team successfully challenged Workers’ Compensation carrier loss reserves, yielding over $1,000,000 in reserve reductions for numerous commercial clients.

• In 2008, the R&K Claims team calculated ModMaster^® revisions yielding $385,000 premium savings for several commercial clients.