The NDIRF Claims Process

Published: 8/01/18 (Wed)

It probably comes as no surprise to any NDIRF member that questions regarding the claims resolution process are among the most frequently asked.  This article is intended to provide a broad overview of the claim volume handled by the Fund and the typical reporting and adjusting process.

First, let’s do the numbers.  NDIRF receives an average of 1,800 new claims every year.  At any point in time, the claims department is handling around 600 open claims – 20% of which are in various stages of litigation.  Total claim payments made in 2011 (the most recent full year for which figures are available) were approximately $6 million, including expenses for adjustment and legal representation.  Open claim reserves consistently run at approximately $8 million.

A variety of different types of claims are filed with the NDIRF.  These range from the fairly common, such as injuries arising from an automobile accident or slip and fall, to claims involving more complicated issues such as drainage disputes and contract interpretation.  In many instances, the facts and responsibilities are clear, allowing a claim to be resolved in a matter of days, while other situations may involve litigation lasting for years. 

What happens when a Fund member has a claim, either their own (a “first-party” claim, such as hail damage to covered vehicles or equipment) or one where an injured third party is making a claim against the member?  The normal procedure is to immediately contact your NDIRF agent and report the claim.  The agent is paid a commission to service the member’s account and a part of this service includes transfer to the NDIRF of claims information in a timely manner.  A notice should also be provided to your agent, even when no formal claim has been submitted, in situations where you expect that a claim will eventually be made.  Early reporting to your agent affords the NDIRF an opportunity to immediately investigate the circumstances of the incident and provide advice regarding further action.

Once notified of a claim, the agent completes a loss notice report and sends it on to the NDIRF.  This is often accomplished by fax transmission or a scan/email to speed up claims reporting as time is always important and, in cases where litigation has been commenced, critical.  A claim is set up on the NDIRF’s computer system the day it is received and a file is created.  An adjuster is assigned to the claim based on several factors including location, type of claim and complexity of the issues.  If the claim has been placed in litigation, the NDIRF assigns an appropriate defense attorney immediately so that a response can be entered in a timely fashion. 

Many claims can be adjusted in-house, meaning investigation by NDIRF staff adjusters using information gathered via telephone or mail, since on-site inspection is often not cost effective.  When claims do require on-site investigation to determine liability or verification of repair costs, they are handled either by NDIRF staff adjusters or outside independent adjusters retained by the NDIRF, depending upon the location and complexity of the claim.

The NDIRF’s underlying philosophy is to work with our members to reduce the likelihood of claims – but they do occur and their prompt, fair resolution is our goal.

 
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