Claims⚠️

• Follow Agency Standards

• Direct clients to the correct person.

• Account manager logs call details and gathers necessary information.

• Transfer to the carrier on file.

• Confirm adjuster contact; follow up if needed.

• Conduct surveys and request testimonials/reviews post-claim.

• Reach out with 1 phone call, email and text; document with Labels.   

• NOT warmly transferring claims to the correct carrier.

• NOT verifying client information and asking appropriate questions.

• NOT accurately documenting claims with proper coding.

• NOT creating follow-up tasks for claims.

• NOT confirming adjuster contact with the claimant. 

• NOT sending claims satisfaction surveys post-claim. 

• NOT using the management system - Omitting notes with adequate documentation or following the checklist.✍🏻

• Claims Department Contact:

  • Instruct the insured to call the carrier's claims department (provide the number if available).

  • Request that the insured stays on the line until the claim is completed and a claim number is provided.

• System Entry and Follow-Up:

  • Enter the claim number into the system. Need to make sure adjuster information is added along with additional transactions (manual only)

    1. 1. • Important Note: The automated tasks emails and texts will not fire if under $1,000

  • Monitor the claim's progress and check back in 3 days to obtain adjuster information.

This is the section where we outline all of the hairball, wonky things that can happen so we have a Plan B ready to go. 😱

Here are some options for the what if situations that may arise. We want to empower you with a plan rather than having to scramble. 💪

🤔 What if it is a 3rd party filing a claim against our insured? (we have an obligation to file a claim, especially with a 3rd party)

• We must file the claim, we cannot just give the contact information to the carrier. If a 3rd party emails requesting to file a claim tell them to call the office and that no claim is filed until we discuss it over the phone. Once the claim is open, please reach the insured to advised that a claim has been filed. 

🤔 What if a claim is not filed in a timely manner? 

• We can face action from the DOBI 

🤔 What if the insured's policy is cancelled/expired?

• If the client is no longer active or with us we no longer need to follow up on this just close out task and then we can review at end of the year and clear out     

🤔 What if the insured called to file a claim against a 3rd party?

• When an insured call to file a claim against another party, first express concern for their well-being and apologize for their accident. Next, ask if they have a police report.

  1. • If they do, request that they send it to Steffany@streetsmart.insurance so we can review it and obtain the other party's insurance information.

     • If they don't, explain that the police report is necessary to obtain the other party's insurance information. If they exchanged information at the scene, ask for the other party's insurance carrier name.

• Tell the insured you will connect them with the insurance carrier. The agent will ask for details about the incident so the claim can be filed and will provide a claim number at the end of the call. An adjuster is usually assigned 24-48 hours after the claim is filed.

🤔 What if we received some correspondence from the insured or third party to file a claim ?

1. Notify the AM: Inform the AM about the received correspondence.

2. Check Policy Status: If the insured has multiple policies (active or inactive), work with the AM to identify the correct carrier.

3. Find Carrier Contact: Locate the email address for the claims department of the responsible carrier in the directory.

4. Send Claim Information: Use the "Notice of Loss Carrier" template to send the claim information. Fill the template with details from the correspondence and the insured's contact information.

5. CC the AM: Ensure to CC the AM on the email.

• Note: Typically, the claim is filed within 24-48 hours of receiving the claim correspondence.

🤔 What if the vehicle is not drivable? 

• If it is not drivable (totaled / total loss by carrier) they must return the plates to the DMV and we can remove it from the policy or we need to confirm if they are going to replace it. Is a must that the CSR/AM is aware. 

NOTE: It may not be possible for them to return plates if it is not in their possession. If it is no longer in their possession ask for proof of this and remove it. If they are working with a salvage company or autobody shop we need proof of the agreement or paperwork that the salvage company is taking possession of the vehicle. Our primary concern is removing the vehicle with no coverage and the insured is still technically the owner.

🤔 What if it is a small claim? 

• Usually claims for Tow are resolved fast, sometimes on the same day but it’s important to check the website (if it’s applicable) and most of the time there’s no adjuster assigned for this type of claim. 

🤔 What if the customer or adjuster is not responding to us?

• Customer: If you have issues reaching the insured because is missing some documents or the adjuster can’t reach him, after 3 attempts (Don’t forget to call, send text and email) if there’s no response please involve the CSR or the AM assigned to the account so they can be aware of the situation. 

• Adjuster: If you have issues reaching the adjuster, please try to reach the supervisor as well (Don’t forget to call and send an email) if after 3 attempts there’s no response (from the adjuster or the supervisor) please contact the claims department (General) or review the website (if it’s applicable) to check at least if the claim is open or closed. As a last resource, if all the previous points of contact don’t work, please reach the Marketing Representative. 

🤔 What if a claim WF is firing a lot? 

• Please send an email to Ezlynx Support, with the subject line ‘’EPS-5052 Claim Automation Firing’’ (Always use the ticket number 5052), and also CC’d Carlo on that email. 

🤔 What if the Insured doesn’t want to file a claim? 

• Over the Phone: "I'd like to reassure you that no claim has been filed at this point." Use the Claim not Filed Labels. In this case we need to make sure the insured is fully aware that no claim was filed put together an email that we can send to the team that we also need to either setup a claim with the carrier or advise the clients that no claim was filed even if it is with a 3rd party (the customer has to call them or we can help) but we are not filing a claim with their carrier. 

🤔 What if the insured had an Incident report? 

• For this case, we must advise the carrier but not file a claim so that the carrier can be aware of the situation. 

🤔 What if the insured wants to open a claim against a 3rd party? 

• Please request the police report, if it’s a personal auto, go to FAQs - StreetSmart , click on ‘’Find NJ Auto Insurance Company Code’’, and search for the code to find the insurance company, and call them to do a three-way call to complete file the claim. 

  • Pro Tip 💪🏻 Always check the vehicle/equipment/coverage information to file the claim in the right policy. 

🤔 What if the insured is not cooperating with the carrier? 

• Advise the insured that is a condition of the policy to always cooperate with the carrier to come to a reasonable resolution. The carrier is attempting to see if coverage applies (investigate) and settle the claim as fast as possible. It is only beneficial to all parties involved to cooperate. 

  • Pro Tip 💪🏻 Let the adjuster know what is happening. 

🤔 There’s no information in case this is a very small claim, is it worth it to file it or do we have to go by the insured’s request?

• If it is below or barely over the agency deductible its not worth claiming 

🤔 What if the insured wants to hire a public adjuster or an attorney?

• Advise the insured that they are free to do as they wish but they could incur additional costs not covered by the carrier or have a less than favorable outcome.

• If a client retains an attorney to go against the carrier that is ok but if they come against us, we need to advise the AM regarding any correspondence received against Streetsmart

🤔 Who is updating the claim information within EZLynx?

• The claims advocate

🤔 Do we need to get adjuster information within EZLynx?

• Yes, it is important to have this information

🤔 Do we need to Establish communication with Claim adjusters?

• Yes, and monitor it via email

🤔 What if the insured or carrier is unresponsive? 

• Remember to do two follow-ups, with a week between each. Please utilize the Labels to document this.

🤔 What if we receive a summons or other legal documents and we do not know who our insured is? 

• Reach out to the other attorney and let them know we received this (usually there is a case number or tracking number). Let them know we do not know who our insured is (DO NOT DIVULGE ANY INFORMATION ABOUT SIMILAR SOUNDING INSUREDS). Have them put what they are looking for in writing to make sure we do not miss anything. 

🤔 Is it okay to provide policy docs to a Claimant’s attorney or Third-party agencies to open a claim or during the claim process? 

• Yes, we need to have the request by letter but if it's over the phone, we should let them know to send the request in writing to avoid people we don't know getting this delicate information

🤔 What If the client is with a wholesaler or MGA? 

• Open the policy and look at how to handle Claims directly with the carrier

🤔 What If the claim payments are being made to a mortgage company? 

• Insurance companies do this to make sure the claim is settled properly. If a payment is being made to the mortgage company and not the insured email the insured and call them letting them know this. Put the mortgage company name in the email (check the policy for the additional interest tab for the bank/mortgage company). Sometimes they pay based on milestones (for example, they will split the payments as work progresses) let the insured know. 

🤔What if the insured does not have a police report?

• You can check Crashdocs.org website, where you can look for it using the accident date and police report number.

🤔 What if the driver is not listed?

• Once this information is received by the carrier, we need to inform the account manager about this.

🤔 What to do when an adjuster requests a whole copy of the policy from the insured?

• First, we advise the AM about this so it can be reviewed and get the insured's authorization by explaining the situation, to share this with them.

🤔 What if a denial letter is received for a claim?

• Upload the whole policy to Qumis to check as to why it was denied

• These are the prompts: https://sites.google.com/streetsmart.insurance/siteswiki/training/tech-stack/qumis#h.ffvbrps0j3du

🤔 What if the customer does not reply?

• At your discretion and depending on the severity of the concern use Postal Mail

🤔 What if the contact information is wrong?

• Use Postal Mail and send the Bad contact memo. 

🤔 What if the client does not respond, how many times should I follow up?  

• Reach out with an email, text, and call and let the client know upfront; document with Labels.  Let the carrier know in writing or over the phone the fact that the insured is not responding. Close out and let the carrier know.

• At your discretion and depending on the severity of the concern use Postal Mail 

🤔 What if the carrier is unresponsive?

• Let your team lead know.

🤔 Remove Vehicle/Trailer

• Are you aware of any claims or losses?

• What will be the effective date? If today, use tomorrow's date

• What is the year, make, and model of the vehicle

• Confirm the VIN

• What is the reason for removing it?

• Do they have coverage elsewhere? If not, please alert the agent and do not process the change.

• If backdating we need proof of backdate before removing. Notify agent

• Go back to the process Policy Change Request✏️ 

In the event of severe weather in our region carriers may become unresponsive or hold times will be long. It is best to online or email the Acord Loss notice to the carrier

The doc goes into details with some scenarios you may run into below such as should I file a claim or what policy to file a claim under? If a customer is experiencing a serious problem or need help  Provide the contact information for emergency services with Michelle at ServiceMaster Directory under Emergency Service/Claims/Inspections - Vendor

Insureds are going to have to apply for Disaster Assistance

24/7 phone number: 1-800-621-3362