Mitsui Sumitomo Marine Management (U.S.A.), Inc.
(MSMM), the manager of insurance services for Mitsui
Sumitomo Insurance Company of America and Mitsui
Sumitomo Insurance USA Inc. (The Companies), and the
members of the MSMM claim staff subscribe to the
following principals regarding the management and
handling of claims presented under insurance
contracts issued by The Companies to its customers
and policyholders.
MSMM will provide timely and informed claim services
to all policyholders, third party claimants, injured
employees, and other members of the insurance
community and public (claimants), as claims are
reported to MSMM by The Companies policyholders and
brokers. All reasonable and justified claims will be
paid promptly, along with other appropriate services
provided in a fair, equitable, and timely manner.
Full compliance will be provided by MSMM and its
representatives with all requirements and guidelines
of the various Unfair Claim Practices Acts enacted
by the various jurisdictions where MSMM provides
claim services. In those jurisdictions where an
Unfair Claim Practices Act is not in place, MSMM and
its representatives will be guided by and adhere to
the provisions of the NAIC Model Act (National
Association of Insurance Commissioners). A copy of
the model act is part of MSMM's Claim Handling
Manual.
CLAIM POLICY
ACTIVITIES REQUIRED
1. Enlightened and informative claim
services are to be provided for all
customers and claimants by MSMM, and its
representatives, at all times.
Compliance with MSMM's Claim
Handling Philosophy
Compliance with MSMM's Claim
Handling Guidelines and Service
Standards
Compliance with MSMM's various Claim
Operational Guidelines
2. Achieve and maintain
Strong Customer Satisfaction attracting and
attaining new customers for the companies.
Immediate response to the needs of
our Customers
Thorough and timely investigation of
all claims
Prompt contact with customers
Timely response to all inquiries
Professional and timely completion
of customer claim reviews
Create Special Claim Handling
procedures to accommodate the specific
needs of our insured
3. Fair
and prompt claims settlement
Strict compliance with the various
state Unfair Claim Practices Acts
Prompt evaluation of compensability
/ liability to ensure timely posting of
reserves to reflect full exposure
Prompt acquisition of settlement
authority
Prompt payment of all justified and
appropriate claims
4. Provide
and maintain a strong workforce of highly
qualified personnel.
Completion of internal audits to
ensure compliance
Offer internal/external training
opportunities for employees
Pursuit of Continued Education
5.
Minimize case backlogs
Compliance with MSMM's Claim
Handling Philosophy
Strict adherence to Diary Management
Completion of Internal Audits
Completion of Financial Audits
6.
Effectively utilize the systems and
information platforms provided by the MSMM
IT Department
Continue to make strategic use of IT
in servicing our customers
Promote the utilization of Claim
Inquiry with our Customers
Accurate and timely completion of
system claim records
7. Provide
strong internal controls and quality
analysis of all claim handling policies and
practices
Compliance with MSMM's Claim
Handling Philosophy
Compliance with MSMM's Claim
Handling Guidelines and Service
Standards
Compliance with MSMM's various Claim
Operational Guidelines
Thorough and timely investigation of
all claims
Completion of Internal Audits
Completion of Financial Audits
Uniform Claim Handling Guidelines
MSMM staffs its branch offices with dedicated,
professional claim representatives. We established
Claim Handling Procedures to guide the staff, and
the supervisory process insures compliance with the
guidelines. All claim files are supervised at the
Branch level to monitor compliance with the
established Claim Handling Procedures.
Branches are required to report large exposure files
to the Home Office in Warren, NJ. There they receive
the benefit and experience of the Home Office staff.
This group of seasoned claims professionals provides
additional supervision and guidance to the local
Branch through the final resolution of the claim.
We can accommodate the special needs of our
customers with customized claim handling procedures.
(See *Special Handling Instructions.)
