INSURANCE CLAIM SETTLEMENTS

Insurance Claim Settlements by means of Artificial Intelligence

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Artificial Intelligence or AI has inspired several global businesses in various industries to develop and implement their required technologies. AI revolutionizes our traditional day-to-day tasks.

One of the domains that can benefit from AI is insurance Claim Settlements. Artificial Intelligence guarantees a fair and fast settlement which would have taken days had traditional approach been accepted for claim settlement. Adopting Artificial Intelligence brings advantages for both companies and their customers. It can simplify claims processing for adjusters and make settlement quicker and more transparent for clients. It can help bringing this most responsible and difficult segmented task of the industry to a new level and attract even more clients.

It is true that we can never underestimate the importance of Artificial Intelligence in other tasks of total Insurance. This technology can greatly improve the insurance industry, simplify routine processes and take care of mundane tasks. We can only anticipate the positive changes AI will trigger in the near future.

it can be said that technology is now being increasingly utilized to make the insurance claims simpler, faster and more cost effective. The outdated processes are slowly being changed for the better, in view of the advancement of artificial intelligence and machine learning, among other forms of technology. Not only will this adoption of technology improve the insurance processes, but will eventually lead to a much better and smoother customer experience.

Soft Settle adopting Artificial Intelligence as the technological stimulant for Insurance Claim Settlement has facilitated automatic process of requests and interactions between the Insurance Company or its adjuster and the client. As such chatbots, related fields and other mode of interactions are being integrated in the workflow can simplify the conversation and make communication more effective and stress-free. Such an approach facilitates reduction of amount of time and thus let the disputants negotiates with respective interests getting reconciled to reach a decision.

As of now, Claim Settlement Process is a manual and laborious affair that requires the involvement of several people in the form of witnesses with a lot of paperwork and communication methods. The devices of communications can be advanced using the optimizing algorithms which ultimately capable of eliminating the process which are prone to not only time consuming and costly but is also prone to errors and inconsistencies. The integration of artificial intelligence and machine learning in Soft Settle Platform to accelerate the process of negotiations to the effect of claim settlement claims settlement adjudication is already helping increase the efficiency of case managers and enabling them to take more informed decisions.

Insurance Companies discount your Pain and Sufferings

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Pain and suffering is a legal term that refers to a host of injuries that a plaintiff may suffer as a result of an accident. It encompasses not just physical pain, but also emotional and mental injuries such as fear, insomnia, grief, worry, inconvenience and even the loss of the enjoyment of life.

The extent of your injury and accompanying pain and suffering can be evidenced through documentation such as photographs and personal journals that record the plaintiff’s physical and emotional feelings. Documentation from friends and family can provide additional evidence of the way the particular injury has negatively impacted the plaintiff’s life. Proof of treatment by a mental health professional is also helpful, and is necessary where the plaintiff is claiming injuries such as increased anxiety, insomnia, or depression.

There is no hard and fast rule for how an insurance company must calculate pain and suffering.

You will need to prove your financial losses so that you can rightfully claim the money you need to rebuild your life. The money for these losses is known as damages. Damages include easily calculable items like medical bills, and non-economic claims like pain and suffering. However, understanding how much money one can claim for pain and suffering is a bit more difficult since there are no receipts or bills.

But you deserve to be compensated for significant temporary and permanent limitations on activities. You also deserve to be compensated if your injuries can potentially shorten your life. Hence the compensation against pain and sufferings shall be on the basis of:

Existing medical bills.
Future medical expenses.
Lost wages or other permanent remuneration or earnings.

Soft Settle’s Consultancy and Resolution services can be invoked at this time.

Typically faster mode of Mediation is guaranteed and the negotiation for clear verdict in the form of claim settlement which is software stimulated, got integrated in the portal www.softsettle.com and the mobile application. A win-win proposition is guaranteed.

Insurance Companies are not reluctant to make you convince that their (less) offer is final

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The hypothetical scenario is with regard to an injury in a vehicle accident. After suffering an injury in an accident, you may be able to turn to insurance for coverage of medical costs and other losses. You might file a claim under a policy you hold (e.g., auto collision insurance, homeowners’ insurance, health insurance) or through another person’s liability insurance if he or she was at fault.

A claims adjuster should follow up on your claim by contacting you and investigating your case. The investigation may include reviewing your medical records, obtaining vehicle repair estimates, reviewing police accident reports, interviewing you and reviewing your initial claim documents.

There are certain damages to be categorized for the insurance purpose. They are as follows:

Special damages include:

Present and future medical expenses, from emergency care through hospitalization and rehabilitation
Property damage (costs to repair or replace)
Lost income during recovery or because of disability
Out-of-pocket expenses, such as the cost of towing a wrecked car, prescription medication, travel to doctors’ appointments or wheelchair rental.

General damages include payments for:

Pain and suffering (physical)
Emotional distress
Loss of enjoyment of life, such as inability to pursue recreation, hobbies, or other activity as you did prior to injury
Loss of consortium (marital/partner relations).

An insurance settlement should account for all of these losses as they apply to you and your situation, up to the limits of the applicable insurance coverage.

However, a settlement offer may be less than what you expected if the claims adjustor decides that your losses were not as much as you originally demanded, or that your own negligence or recklessness contributed to your injury.

If you question the settlement offer, the claims adjustor may not be reluctant to suppress all relevant facts and put you in the peril by convincing you that offer is the generosity from the part of the insurance company.

Soft Settle’s Consultancy and Resolution services can be invoked at this time.

Soft Settle negotiations capable of undoing the hassles used to crop up in physical negotiations to settle insurance claim.

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The initial settlement offer that comes from the insurance company can come at any time after you’ve filed your claim. Some claimants have to wait weeks to receive the offer, and some receive it rather quickly. Unfortunately, there is no set time in which the initial offer must be made.

The initial offer you receive from the insurance adjuster will almost always be a “lowball” offer. They may defend their low offer by claiming that you were partially at fault for the accident that caused your injuries in the case of physical injury, or that the injuries you suffered weren’t severe enough to warrant a greater amount. They may also question the amount of pain and suffering you experienced. They will aggressively defend their position of a low offer because this will often intimidate people into simply accepting the low offer. Do not ever accept the initial offer unless it is a fair offer.

When you receive the initial settlement offer in writing, examine the reasons the insurance adjuster has given for the low settlement amount. Each of these points will become a part of your counteroffer letter, and you should respond to each and every one. Your counteroffer letter will reassert your original position described in your demand letter, as well as respond to each of their low-offer reasons in turn. Keep your emotions out of the letter and stick to facts, such as the extreme pain and suffering you have had to endure and the frustration and hassle of attending medical treatments. Be professional, courteous, and confident, and never attack the claims adjuster personally in your counteroffer letter.

The above developments are there never to be overlooked and those using the platform Soft Settle, also experience the same process prior to the negotiation. But you can convert the offer into a fairer one with the negotiations using the platform under the supervision and facilitation of SS-Equity (ICS).

You may automatically react to the initial low offer from the part of the adjuster of the insurance company. You will counter the offer and ultimately this would turn into a prolonged counter offer battle where you may hire an attorney to bring everything to tedious court litigation.

Soft Settle does facilitate both insured and insurer to come in terms with each other and it would take the interests of the parties rather than their positions getting reconciled so as to make them come together in the potential zone of agreement to reach a solution acceptable to both. This has to be treated as win-win proposition or beyond.

Above everything the expensive litigation could be avoided and the elements of scientific mediation are being evaluated to bring the most cost effective, appropriate and harmonious settlement between or among the parties.

You need not accept a raw deal, but you have to make your case and negotiate a better settlement

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Before you get annoyed about a claim payment or denial, review your insurance policy to see if you are covered for the damage in dispute and what the money limits for your coverage. Once you realized how much you deserve out of the policy you have availed, it will help your strengthen your argument if you are in the right.

You can seek clarifications to insurers when you are blurred over the settlement was lower than expected. If policy sounds ambiguous, you have to make it clear the particular section in question. Once you are clear on your insurer’s position, prepare document that can help prove your case. If your insurance company thinks it will cost certain amount to compensate the loss you have suffered but you think it will be more, get a written estimate from an independent contractor.

If you need to dispute a denial or low settlement offer, start by writing a letter to your claims adjuster. Briefly explain your point of view, including any evidence you have prepared that supports your side, and request that the adjuster review the claim.

Even if you’re seething inside, remain polite. Don’t threaten to hire an attorney. If you take an adversarial tone right off the bat, your insurer might decide to let its lawyers do the talking. If your case is week, a law suit may damage your expectations.

Appraisal is a common process used in disagreements between insured and insurers over property damage. Two appraisers will be in charge if a dispute arises as both sides pick each appraiser to represent them. If there is a deadlock they can resort to the dispute resolution process mooted by SoftSettle Support using the platform of MEDIATOR AFFAIR integrated in the portal www.odrsupport.com
Further an online mediation can be called for, where a Mediator can be nominated by both parties from among the panel of professionals provided by the ODR providers. SoftSettle Support channelizes online mediation using the platform MEDIATOR AFFAIR integrated in www.odrsupport.com. Typically faster mode of Mediation is guaranteed through this portal and application respectively and the negotiation for clear verdict in the form of claim settlement which is software stimulated, integrated in the portal www.softsettle.com and the mobile application SOFT SETTLE

Approach in resolving Insurance Disputes

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As careful as we are, there is the possibility of being involved in an accident while you’re driving. Or having damage occur to your home due to circumstances you can’t control. While carrying car insurance and home insurance minimizes the financial risks and responsibilities of the aftermath of an accident, there is a possibility that you and your insurance company could disagree about the benefits you’re entitled to in the event that you have to file a claim.

What can you do in the case of a dispute with your insurance company? The best scenario is that you and your insurance provider can come to an agreement that works for both of you, but in the case that it isn’t possible to resolve the disagreement between both parties, there are other options available to you.

SoftSettle Support shapes online platforms for insurance claim settlement.

There is, of course, a range of options available to disputing parties who do not wish to proceed to formal litigation (litigation Is typically costly, time consuming. Uncertain and ultimately unsatisfying regardless of the outcome.) A number of processes, of varying degrees of formality, are available to assist the parties to resolve their dispute themselves, or in some cases, to impose a settlement regime on the parties. These resolution processes can be divided into two broad categories.

First are consensual processes such as conciliation and mediation, where the parties to the dispute typically meet with an independent third party to explore settlement options. The third party is not supposed to impose any unilateral decision but to assist and persuade the parties to generate and refine their own settlement options.

Second are adjudicative processes such as arbitration, appraisal, early neutral evaluation or mini trial. The parties are given the opportunity to make submissions to an independent umpire. Each parties’ submissions are weighed by the umpire and a decision is made. This third party must them review that material before formulating an appropriate settlement regime.

SoftSettle Support facilitates an environment for both insurers and insured as insurer will gain more credibility to canvass more clients as he is not inclined to constantly battling with customers in court and insured will get sigh of relief so far as insurer used to be conciliatory and attractive to their existing and prospective customers

SoftSettle Support provides a portal or application to insurer and insured where they can submit their disputes to get it resolved by means of online mediation and online arbitration presided by experienced neutral and arbitrators. These advantages are being built and integrated in the virtual court powered by SoftSettle Support in www.odrsupport.com. Apart from regular disputes used to occur in the negotiation (resolution) process to reach an accepted claim settlement is being integrated in www.softsettle.com. These opportunities allows the insured more time in mediation sessions to articulate his or her position. The insurer would also get an opportunity to reconcile to go with a win-win strategy rather than preserving an attitude of obstinacy in the process of litigation.

Hence SoftSettle Support strikes the conscious of the parties as the conciliatory nature of processes like online mediation ensures that the parties are given every chance to preserve their existing relationships. Consensual processes encourage the parties to work together to generate settlement options.

Hope these suggestions might be some of the analytical answers to the questions posed by the scenario described in the top paragraphs.

SoftSettle Support manages Disputes in respect of value of the insured property

The Dispute Resolution Process

When you cannot reach an agreement about the value of the insured property, the value of the property saved, the nature and extent of the repairs or replacements required, or the amount of the loss or damage, those questions must be determined using the Dispute Resolution Process. The Dispute Resolution Process by means of Online Arbitration or Online Mediation are being integrated in the ODR portal www.odrsupport.com using the platform MEDIATOR AFFAIR powered by SoftSettle Support.

The dispute resolution process must be used in settling the amount of a loss with your own insurer. Rather the insurance company is supposed to send you a statement determining that there is dispute in respect to the amount of a loss.

Alternatively, as an insured, you can initiate the dispute resolution process in respect to the amount of a loss at any time, through the following process by resorting to the concerned services of SoftSettle Support. SoftSettle Support facilitates online conferencing which could bring the insured and insurer confronting over video so that the following steps can be carried out without further delays.

You must file a proof of loss form with the insurer and make a written request to start the dispute resolution process. A proof of loss form is available from your adjuster by online.
Within seven days, you and your insurer must each appoint, at your own cost, someone to represent your interests. Neither party can represent themselves, nor can appoint employees.
There is no requirement to appoint an appraiser to represent you. You may appoint anyone of your own choosing, although it is highly recommended you appoint a representative with expertise in the subject matter being disputed.
If the two representatives cannot agree on the amount of the loss, they will appoint an umpire to assist in establishing the amount of the loss. If the representatives cannot agree on an umpire, they can seek the assistance of the selected ODR provider to provide an umpire/neutral to decide the case.
Selection of an umpire/neutral to decide the case
The umpire will issue a written decision based on information provided by the representatives.
The outcome of the dispute resolution process is final and binding for both the insured and the insurer on the issue of the amount of the loss.
It is important to note that the dispute resolution cannot be used to resolve contractual disagreements, such as whether there is coverage under the policy. The interpretation of what is covered by your policy is a matter for the courts to decide or resort to online dispute resolution facilitated by the platform MEDIATOR AFFAIR integrated in www.odrsupport.com.

Soft Settle discharges this service as a special effort to help both claimant and insurance company to sort their differences over the determination of the loss. As such, the insurance company can make an analytical study which could lead to a perfect way of dealing the settlement

Dealing the Insurance Claim Settlement Offer or Denial

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If you filed an insurance claim (in general) and feel your insurer should pay more than they estimated, or wrongfully denied your claim, you aren’t helpless. This guide will walk you through the process to dispute a claim offer or claim denial, and help make sure your settlement is fair.

Discrepancies over the cost of damages or a loss are common between insurance companies and policyholders. Policyholders pay premiums and expect all of their claims to be paid in-full. It is in insurance companies’ best financial interests to pay as little as possible in claims, which directly affect their profit and ultimately affect the cost of premiums. But that doesn’t mean companies automatically try to lowball their policyholders. Both parties often just need to share more information with one another to come to an agreement, or at least an understanding behind a settlement.

Then there is room for disputing. Exactly what you shall do is to contact your insurer or company. But you should review the claim you filed earlier. Consider if there is any way you can improve it. The quality of evidence showing damage or a loss can have a significant impact on the claim settlement. You have to refresh the claims with evidences potentially with materials such as photos, videos, repair estimates and receipts for items; you should organize before reconnecting with your insurer or company. It must be borne in mind that these materials should not have evidenced in the initial claim. Remember that an adjuster from the company calculated the estimate, not your agent or the person you’ll speak to. Be polite, listen to what they have to say and follow any instruction they might give you regarding a claim dispute. It has to be learnt whether the adjuster can reexamine the property damaged or loss of particular assets against which you have made the claims as mistakes happen and it is possible that the adjustor might have succumbed to miscalculations. A company might review it again but that doesn’t mean that settlement offer might change.

As the insurer or company is reluctant to make any amends, you may be forced to resort to certain private appraiser. SoftSettle Support is there to assist you in accepting the role of an appraiser with their expertise in assessing or appraising the loss suffered by you. It is a special service that SoftSettle Support intends to provide to their clients. On the other hand you will be pleased to enjoy the services of SoftSettle Support rather than seeking the assistance of a private appraiser so far as their services demands heavy pounds or fees. The extension of the special services provided by SoftSettle Support is by means of MEDIATOR AFFAIR integrated in the portal www.odrsupport.com powered by SoftSettle Support.

Claim disputes rarely make it to this stage. If you are unable to reach an agreement on a claim with your insurance company, and have exhausted all of the above options, there are certain options to be worked out which includes reporting the mistreatment or bad business practices to concerned authorities and facing the investigation to evaluate whether your complaint is justified or not along with the second option of hiring an attorney to pursue the case dragging it to court litigation and bear the heavy litigation expenses.

Rather ignoring the above two options, as the first gesture, you can reliably seek the assistance of SS-Equity (Insurance Claim Settlement) using the Soft Settle platform in deciding the disputes over the insurance claim which is more convenient in settling your case may also be acceptable by your insurance company to be justifiably delivered with a win-win outcome.

Low Insurance Settlement Offer – A source for Concern & Source of Conflict.

By SoftSettle Support

Do not be surprised if the initial settlement offer is a low figure. There are many reasons why you might receive a “low” offer. The claims adjuster may have concluded that you are partially at fault for your injuries, or that your injuries were not serious enough to justify the amount of damages you included in your demand letter. He may also produce concerns about your pain and suffering demand.

Consider this a test from the claims adjuster. The insurance company has nothing to lose and everything to gain by making you a low bid settlement offers. Many people are struggling financially after an accident and are desperate to jump at the first settlement offer that comes their way. Even though it may be difficult to pass up a settlement offer, you should not accept the initial offer unless it is fair. How to evaluate and deal with a fair settlement offer is discussed at the conclusion of this article.

Do not panic over a low settlement offer. Remember, the insurance company is running a business and must maintain its profits. The claims adjuster does not expect you to accept the first offer, but rather hopes that you will. Naive personal injury claimants accept lowball offers all the time.

As soon as you receive the initial settlement offer in writing, carefully evaluate the stated reasons for the low settlement amount. You should respond to each of the points made by the claims adjuster in a written letter that includes a counteroffer. In this letter, you will reassert your position (this is the same position you carefully described in your demand letter). Focus on the extreme pain and suffering you endured. Never personally attack the claims adjuster. Be professional yet firm in explaining why you deserve more money for your injuries and other losses.

Rejecting the Low Offer

In order to reject the initial settlement from the insurance company, you should send a details to the claims adjuster through the medium of Soft Settle that:

States you do not find the initial settlement offer acceptable;

Lists the reasons why you deserve a higher settlement offer; and

Includes a demand for a higher settlement offer stating reasons.

In this case you can invite the Insurance Company for negotiation so that you can tell them Soft Settle Platform offers a potential zone of agreement where they can reach a settlement acceptable to both.

In the meanwhile you can serve a letter rejecting the initial settlement offer and include your personal information about your loss or damages where applicable. This record will help you in case you are heading for court litigation if any.

The initial or later low offer from the part of the insurance company is the cause of the dispute and usually the claimants may consider entrusting lawyers to contest for them to claim and earn more which could be settle their loss.

Soft Settle thus helps both claimant and insurance company by judiciously settling their claims which could bring a harmony in respect of their relationships, otherwise would have been in peril in case the claimant proceeds to court litigation

Set Limits on Conversations

SoftSettle Support narrates the following hypothetical situation over a personal injury – auto accident insurance case as cautioning notice to the parties who will find rather difficult time with the insurance company on the occasion of an event – injury or accident.

In your first contact with an insurance adjuster (which usually comes via a phone call) make it clear that you will not be discussing much.

Let the adjuster know that, until you have finished investigating the accident, have completed medical treatment, and have fully recovered from your injuries, you do not want to discuss anything related to:

how the accident happened
what your injuries are (or how serious they are, or whether your condition is improving), or
what a settlement amount should be

In this first discussion with insurance adjuster, set boundaries. Ask that the adjuster communicate with you in writing until you present your written demand for compensation and actual settlement negotiations begin.

In some situations, however, it may not be practical to stop all phone conversations. For example, if you have been in an auto accident, you may need to discuss repairs to your car. If you do need to speak to the adjuster again, set whatever limits you want on the place and times — home or work, morning, evening, weekends — for telephone contact.

There are good reasons to limit your phone conversations with insurance adjusters. Some will call frequently in an attempt to get you to settle quickly, and they can become a real nuisance. It’s good to nip this in the bud.

More important, until you have had a full opportunity to investigate and think about the accident, to determine the nature and extent of your injuries, and to recover (or reach “maximum medical improvement” in insurance parlance), you will not have accurate information to provide. And, if you give incomplete or inaccurate information on the phone, the insurance company may try to make you stick to it later on. Some insurance adjusters are good at getting you to say something which could be considered an admission of some fault on your part, or which limits the seriousness of your injuries. It is therefore much better to have no discussions at all until you have made your compensation demand in writing and you are fully prepared to discuss a settlement.