Training on Insurance Underwriting & Claims Management

Module 1: Underwriting Fundamentals – Risk Selection & Pricing

• Underwriting cycle and risk appetite statements

• Key information sources: applications, loss runs, MVRs, credit reports, inspections

• Rating methodologies: manual rates, loss costs, experience mods, schedule rating

• Hands-on Exercise: Review a commercial auto application and loss run – calculate final premium using a 1.20 mod and 10% schedule debit, then accept or decline with rationale

Module 2: Policy Construction & Interpretation

• Four corners of a policy: declarations, insuring agreement, conditions, exclusions

• Occurrence vs. claims-made triggers and tail coverage implications

• Rules of interpretation: contra proferentem, reasonable expectations, ejusdem generis

• Case Study: Analyze a CGL policy – determine coverage for three claim scenarios and draft a one-paragraph coverage opinion

Module 3:Claims Fundamentals -Investigation, Reserving & Documentation

• Initial claim triage: coverage, liability, damages, and fraud red flags

• Evidence gathering: recorded statements, scene photos, witness interviews

• Reserving methods: case-by-case, average cost, and Bornhuetter-Ferguson

• Hands-on Exercise: Review a warehouse fire FNOL – list five investigation steps, then set initial reserves and update at month 3 based on new evidence

Module 4: Fraud Detection, Negotiation & Settlement

• Hard fraud (staged accidents, arson) vs. soft fraud (exaggerated damages)

• Red flags: late reporting, inconsistent statements, demanding quick settlement

• Negotiation tactics: collaborative vs. adversarial, bracketing, split-the-difference

• Case Study: Analyze a homeowner's fire claim with three fraud indicators – draft an SIU referral memo and role-play a negotiation with plaintiff counsel (starting demand $500k, authority $150k)

Module 5 : Subrogation & Integrated Underwriting-Claims File Review

• Legal basis for subrogation: equitable vs. contractual

• Identifying subrogation potential early and pursuing recovery

• How claims data informs underwriting: loss runs, class relativities, pricing adjustments

• Hands-on Exercise: Review a 5-year loss run for a contractor-draft a subrogation demand letter for a paid $100k fire claim (defective appliance) and recommend underwriting actions (renew, modify, non-renew)