Robert Miller

· Investigating, evaluating, reserving, negotiating and

resolving assigned construction defect property damage

claims.

· Analyze coverage, to include trigger-of-coverage, time-on-

risk, co-carriers, contractual risk transfer (additional

insured and/or contractual), involvement of wrap-up,

builder’s risk, OCP or other policies which may afford

primary coverage.

· Utilizes diary management to ensure all claims are

handled timely.

· Establishing and maintaining proper indemnity and

expense reserves.

· Managing litigated claims. Developing plans with staff or

panel counsel.

· Tracking and controlling legal expenses to assure cost-

effective resolution.

· Attending and presenting cases for roundtable pre-trial

strategy discussions.

· Consulting with manager on use of claim coverage counsel

as needed.

• Provide quality customer service and ensure file quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
• Analyze coverage, to include contractual risk transfer (additional insured and/or contractual), involvement of wrap-up, builder’s risk, OCP or other policies which may afford primary coverage.
• Consults with Manager on use of Claim Coverage Counsel as needed.
• Directly investigate each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
• Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts.
• Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
• Maintains claim files and documents claim file activities in accordance with established procedures.
• Utilizes evaluation documentation tools in accordance with department guidelines.
• Utilize diary management system to ensure that all claims are handled timely. At required time intervals, evaluate liability and damages exposure.
• Establish and maintains proper indemnity and expense reserves.
• Recommends appropriate cases for discussion at roundtable.
• Attends and/or presents at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
• Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others.
• Develops and employs creative resolution strategies.
• Prompt and proper disposition of all claims within delegated authority.
• Negotiates disposition of claims with insureds and claimants or their legal representatives.
• Recognizes and implements alternate means of resolution.
• Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
• Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy.
• Tracks and controls legal expenses to assure cost-effective resolution.
• Effectively and efficiently manage both allocated and unallocated loss adjustment expenses.
• Attends depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
• Updates appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
• Recognizes cases, based on severity/ complexity protocols that should be transferred to another level of claim professional and refers on a timely basis.
• Appropriately deals with information that is considered personal and confidential.
• Fulfills specific service commitments made to certain accounts, as outlined in Special.
• Account Communication (SAC) instructions and inquiries from agents and brokers.
• Represents the company as a technical resource; attends legal proceedings as needed, acts within established professional guidelines as well as applicable state laws.
• Actively provides mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength.
• Shares accountability with business partners to achieve and sustain quality results.
• Evaluates all claims for recovery potential; directly handles recovery efforts and/or engage and directs Company resources for recovery efforts.

• Conduct research and analyze evidence, documents, and police reports in order to fairly settle claims.
• Examine existing insurance policies and determine the extent to which damage is covered.
• Coordinate with appropriate parties, such as mechanics and repair shops to repair damage.
• Write and submit comprehensive reports detailing all findings from research, interviews, site visits, and policy stipulations.
• Negotiate claims settlements using expertise and research-based judgments.
• Verify that the insurance policies in question exist and examine terms and stipulations as they relate to claims.
• Conduct interviews with claimants, witnesses, and all involved parties to obtain a full picture of events detailed in each claim.
• Perform accident site visits as necessary to observe evidence and make judgments.
• Examine documentation, police reports, and all other pieces of evidence provided in the claim.
• Brainstorm creative solutions to bring to the claims negotiation process.