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As the Program Manager, REInsurePro acts as a liaison between our appointed agents and the Third-Party Administrators we partner with to manage the claims process with our carriers. We do not investigate, pay or deny claims, but we will work with you as you assist your clients through the process. Please note that as the agent, it is your responsibility to submit loss information on behalf of your clients. REInsurePro will not be in communication with your client.
You, the agent, will formally initiate the claims process with REInsurePro by filling out the Report an Incident form, which is linked in your portal. Our team will provide a general outline of the coverage and then submit the claim to the Third-Party Administrator (TPA) or appropriate carrier based on the insurance contract to investigate coverage for the loss.
Upon receiving the claim submission, the TPA will review and send to the insurer for approval to proceed with the investigation. The TPA identifies and appoints an independent adjuster within a local proximity to the loss. The adjuster will contact the insured (typically within 48 to 72 business hours) to schedule an inspection of the property at the earliest available time. This is the only time your client will be contacted regarding this claim and they should be advised to work with you on any updates.
From the time of the inspection, the adjuster typically has from 10 to 21 days to complete a report of their investigation findings and provide their coverage recommendations, communicate with relevant parties, retrieve necessary claim documentation and develop a report to send to the TPA for further review.
The TPA reviews the adjuster’s report and then submits their recommendation to the insurer. Please note that the insurance carrier is listed on the Evidence of Insurance. You can access a copy of the policy via the links on the Proposal or Binder. Or request a copy from your Sales Manager.
It is up to the insurer to approve or deny the claim based on the adjuster’s report and TPA’s recommendation. There are a number of reasons a claim may be denied: the cause of loss is not covered on the policy, the insured did not fulfill certain responsibilities of the insurance contract, the loss was deemed intentional, the occupancy status was misreported, among other common exclusions. Claims resolution can take a matter of days, or up to several months depending on the complexity of the loss and required investigation. Our team will do everything we can to keep you informed during this process.
The TPA will notify the insured of the insurers decision in writing. Then the insurer will submit payment to the insured (if deemed appropriate), taking into account any deductibles, depreciation, or co-insurance penalties. Depending on whether the policy is Actual Cash Value or Replacement Cost settlement method, the client may receive the claims payment in either one check, or two checks, the second being to recover depreciation (following submission of photographs of the completed work, certificate of completion/invoice for the work completed, and proof of payment showing the amounts paid for repairs. These could include: Cleared checks, bank/credit statements, material receipts, among other documentation).
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