INTRODUCTION

TO

OCEAN MARINE CLAIMS EXAMINER

AN 

EDUCATION & TRAINING COURSE  

AMERICAN INSTITUTE OF MARINE
UNDERWRITERS

 held at 

American Institute of Marine Underwriters
14 Wall Street, 8^th Floor, Suite 820
New York, NY 10005

in

April
(see course schedule for exact dates)

COURSE DESCRIPTION

This three-day course is designed for the Claims Professional who is primarily responsible for the investigation and settlement of claims made by policyholders and third-parties.  You will learn the methods, procedures and standards used in handling claims adjusting of hull and machinery, cargo, liability and recreational marine insurance.

Who Should Attend:

Insurance company claims personnel, agents and brokers, transportation shippers and carriers, maritime attorneys, risk managers, independent surveyors, claims adjusters, average adjusters, salvors, subrogation and recovery employees.
 

1.      The Marine Claims Professional

A.     Job Knowledge

¨         Technical

–        Cargo

–        Cargo Subrogation

–        Hull – Brown Water / Blue Water

–        Personal Injury

–        Excess P & I

–        Liability

–        Excess Liability

–        Bumbershoot

–        Reinsurance

¨         Legal

–        Litigation Management

–        State Federal Regulations

–        Privacy and Compliance

–        Adjuster Licensing

B.      Planning & Organizing

¨         Prioritize workflow

¨         Manage Diary System

¨         Respond to incoming telephone calls, faxes and mail

¨         Meet deadlines

¨         Risk information

¨         Time management

C.     Problem Solving / Creativity

¨         Analyze coverage

¨         Proper investigation

¨         Vendor Selection – Surveyor, Attorney and Experts

¨         Business strategy for case handling

¨         Document thought process in file notes

D.     Decision Making

¨         Gather and analyze information and documentation

¨         Develop plan for claim resolution

¨         Make a timely decision and proceed

E.      Judgment

¨         Technical expertise

¨         Best practices

¨         Market conditions

¨         Awareness of the total picture

F.       Adaptability

¨         Understanding the needs of customers

¨         Be open to new resources if they will improve our business results

¨         Understand and support business goals

G.     Initiative

¨         Diary

¨         Reserving

¨         Claim management

¨         Risk information

¨         Sharing information / reports

H.     Entrepreneurship

¨         Being pro-active

¨         Make things happen

¨         Being resourceful

I.        Communication Skills

¨         Internal / External

¨         Verbal / Written

¨         Clear / Concise / Professional

J.        Interpersonal Skills

¨         Communication

¨         Attitude

¨         Respect

¨         Enthusiasm

K.      Accountability for Results

¨         Take ownership of your work

¨         Take pride in your work

1.      Policy Coverage

A.     Conveyances, duration, valuation, geographical limits, goods insured, terms of sale, shipment reporting methods.

2.      Types of Loss – Measure of Indemnity

A.     Particular Average

B.      General Average

C.     Sue and Labor Expenses

D.     Goods on consignment fees and expenses

E.      Increased value policies, business income loss

F.       Total loss

G.     War claims and S.R. & C.C.

3.      Loss Investigation

A.     Assign surveyors

B.      Warranties

C.     Policy defenses – expressed and implied

D.     Legal counsel

4.      Loss Adjustment

A.     Replacement cost vs. actual cash value

B.      Depreciation

C.     Deductible

D.     Claim calculation, freight costs, selling price, valuation

E.      Special loss clauses due to type of commodities

5.      Subrogation

A.     Time limitations

B.      Carriers defenses

C.     Limitation, COGSA/Warsaw/Domestic transit

D.     Amounts recoverable

PART III

HULL CLAIMS

1.      Notice of Loss

A.     Policy Coverage and Verification

¨         Policy Period – Date of Loss

¨         Schedule of Vessels – Vessel Name and Value

¨         Assured Name

¨         Coverage and Perils

¨         Deductible

¨         Claims Lead and Following Clause

B.      Setting up the Claim File

2.      Types of Losses and Damages

A.     Losses

¨         Particular Average

¨         General Average

¨         Collision Liability

¨         Salvage

¨         Sue & Labor

¨         Total Loss

B.      Damages

3.      Loss Investigation and Assignment of Experts

A.     Appointing the Surveyor

B.     Appointment of Attorneys

C.     Appointing the Adjuster

4.      Loss Adjustment and Documentation

A.     Review sample Adjustments

B.      Discuss sections within the Adjustment

¨         Items of claims and Common Charges

C.     Documentation Necessary to Support a Claim

5.      Examining the Adjustment and Claims Settlements

A.     Warranties

¨         Expressed – Implied

¨         Seaworthiness – Trading

B.     Burden of Proof

C.     Assureds Allegation

D.    Proximate Cause

E.      Reasonable Cost of Repairs

F.      Surveyors Approvals

G.    Unrepaired Damage

H.    Payment on Account

I.       Consistency

J.       Without Prejudice

K.     Payments

¨         Loss Payee

¨         Pay Orders

1.      Policy Coverage

A.     Liability for:

¨         Death or injury to:

–        Crew

–        Shore workers

–        Marine workers / non-seamen

–        Offshore workers

–        Passengers

–        Third parties

¨         Property damage

–        Other vessels

–        Land or shore facilities

¨         Not “first party” losses

B.      Insuring agreements

¨         Indemnity v. liability policies

¨         Excess liability

–        Following form

–        manuscript

¨         Coverage for contractual indemnity

¨         Additional assured status

¨         Waivers of subrogation

¨         Duty to defend

¨         Other insurance clauses

C.     Frequent Exclusions

¨         Punitive damages

¨         Radioactive exposure

¨         Water craft exclusion

¨         Fines and penalties

¨         Crew exclusion

D.     Limitations

¨         “As owner” deletion

¨         “Limitation of liability” deletion

2.      Insured & Policy Forms

A.     Types of Insureds:

¨         Vessel

–        Owner

–        Employer

–        Dual capacity

¨         Wharfingers

¨         Terminal Operators

¨         Stevedores

¨         Marina

¨         Boat dealer

¨         Voyage & time charterers

¨         Pleasurecraft

¨         Shipyards

¨         Offshore operators, drilling companies and service contractors

B.      P & I Clubs

¨         Nature of insurance – shipowner’s mutual

¨         Typical assureds

–        Ocean or blue water ships

–        Liners

–        “tramps”

–        integrated tug and barge (“ITB’s”)

¨         Certificates of entry

¨         Fixed premium

¨         Typical clubs

–        U.S.

–        England

–        Scandinavia

C.     Types of policy forms

¨         Taylor SP-23 P & I

¨         Taylor SP-38 P & I

¨         Employers A & B with MEL Endorsement

¨         Marine CGL

¨         Marine Package Policy

¨         Builder’s Risk

¨         Excess

¨         Marine excess

¨         Bumbershoot

¨         Difference in conditions

3.      Types of Claimants

A.     Seamen

¨         The Merchant Marine Act of 1920 (Jones Act) 46 USC §688 et seq.

¨         Seamen status

¨         Theories of recovery for injury or death of seamen against an employer / vessel

–        Negligence

–        Warranty of seaworthiness

–        Maintenance and cure

¨         Borrowed employee

¨         Theories of recovery against third parties

B.      Marine Workers

¨         Longshore and Harbor Worker’s Compensation Act

–        905(a) compensation benefits

–        905(b) negligence action

–        905(c) prohibitions

C.     Offshore workers

D.     Third Party:

¨         Passen