The Triple function is to assess the risk at the time of the sale of the contract, to conduct investigations to detect possible fraud (with the subscription of the contract or at the time of the claim) and to advocate, the case the commitment of civil or criminal prosecution.
The inspector of claims, most of the time employed in a large insurance company, therefore has a crucial role of control over the accuracy of the statements made by insurers to the insurer. It is he who is then responsible for applying, when frauds are detected, the sanctions in case of false declaration.
On this page, we will describe its role and functions, and see what is generally, his training course. As with other insurance profile fact sheets, we will see how much salary levels and what are the prospects for career development that can open to him.
Role and profile of the inspector Claims Regulator
Inspector Claims Regulator The role regulator is to intervene most of the time after disaster on important or contentious files, in order to carry out the necessary checks and investigations aimed at appreciating the responsibilities and prejudices suffered by the victims.
It is generally mandated, when working in a large insurance company, by litigation or medical services. Its task, dividing between work work on the ground and work of constitution and follow-up, consists in:
- go to the damaged places (in the case of damage insurance), or carry out a visit of the insured (in the case of a disaster occurring as part of a persons insurance contract), in order to to carry out an assessment, verification and control of the damage or the disease,
- determine the causes, circumstances and responsibilities at the origin of the occurrence of the incident,
- Write a report following the observation during the field visit,
- in the event of a contested situation, and in the context of private insurance, avoid a litigation and the commitment of heavy court proceedings, by negotiating and attempting to find compromises with the insured,
- In case of lack of dispute, or after finding a compromise with the insured, fix the amount of the regulations and make the payment, directly or indirectly, by ordering it to the department of claims regulations within the company.
But the inspector of claims is not limited, as we remembered in the introduction, to intervene after the occurrence of a disaster. It may also be used to him at the time of subscription of the contract, in order to verify the authenticity of the statements of the insured during the compilation of the questionnaire submitted to him by the insurer and which serves as a foundation to the the establishment of the insurance policy. In this case, the inspector Claims Regulator will make a visit to the field to make a check on the declarations of the insured. In the event of a false declaration, it is he who will be responsible for applying the legal sanctions provided for by the legislation in case of false declaration, that it is good or bad faith (to know more, see the "Sanctions in case of false declaration").
As part of the performance of its duties, the inspector of claims must work in direct contact with the insured and / or with other potential stakeholders (claims managers, experts, lawyers ...). It can also be brought, in some companies, to define a claims management development strategy, and to train employees to improve them in the negotiation to result in the friendly settlement of allowances.
Thus, to exercise the profession of inspector claims, it is necessary above all to have a sense of acute relational, since one is led above all to work in contact with other people, that he are insured or other employees of the company.
There is also a need for great legal and technical skills in a particular area, since this knowledge is indispensable both to accurately assess the contextual elements to determine the causes and circumstances at the origin of the occurrence of A disaster, and to be able to control the legal mechanisms inherent in the compensation process.
The inspector regulator of claims, autonomous and responsible, must also be able to objectively analyze a situation, while showing a great sense of diplomacy, its objective being, remember, to obtain the friendly settlement Indemnities.
Training of the inspector declares claims
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