Claim Management Services and Client Advocacy Services

Above all, AGRisk 360 Claim Consultants act as your organization’s advocates, with a strong commitment to a guiding principle: as our client, you are entitled to every benefit provided by your insurance policy—and the insurer must perform accordingly.

Our consultants have substantial hands-on experience adjusting claims for major insurers, analyzing coverage, supervising litigated cases, managing other claim personnel, and assessing losses, injuries, and damages.

In short, we not only understand how the system works—we use this knowledge and experience on your organization’s behalf to:

  • Hold insurers accountable to perform as required by the insurance contract or as agreed with the insured (Quality Control).
  • Assist in the development of claim reporting protocols.
  • Facilitate access to online carrier information systems.
  • Challenge coverage denials and make every effort to obtain full coverage.
  • Assist with the submission of first party claims to ensure prompt and satisfactory resolution from the insurer.
  • Arrange for insurers to provide notification of reserves established or changed n excess of an agreed upon threshold, then negotiate for appropriate reserving based on potential liability and damages.
  • Participate in pre-settlement conferences with insurers to limit substantial liability payments to the extent possible.
  • If Loss Ratio is a problem, review loss runs before renewal and challenge reserves that appear to be too high in light of liability and damages.
  • Consult with your organization’s personnel to develop alternative claim and litigation management strategies, then lobby for implementation by the insurer.
  • Conduct or facilitate Claim Reviews to assure proper implementation of the agreed upon strategy and to refine the strategy as needed.
  • Provide effective Workers Compensation claim management by defining clear protocols for the use of medical management services—and for management of Network providers—to ensure that medical providers deliver quality care focused on return to work and expedited recovery.
  • Be aware of contracts related to the claim in question and encourage insurers to pursue risk transfer if possible, taking the lead if necessary.
  • Encourage insurers to vigorously pursue subrogation against and seek contribution from third parties.