DAMAGE ADJUSTMENT
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What is loss assessment?
Loss assessment refers to the professional process of determining whether a reported loss is covered under an insurance policy, evaluating the cause and extent of the damage, and calculating the appropriate amount of compensation payable under the policy. It encompasses the entire process of investigating and verifying an insured event, including identifying the cause of the accident, assessing the nature and scope of the damage, and determining the resulting financial loss. Based on this assessment, the insurer establishes the payable loss amount and proceeds with the settlement of the insurance claim.
What Is Desk Review?
Desk review is a type of loss assessment service primarily used for accident or health insurance claims.
When an insured files a claim for an insured event that occurs during the policy period, the claim is reviewed based on the submitted claim forms and supporting medical documentation provided by medical institutions. Through a simplified verification of the relevant facts, and without conducting an on-site investigation, the loss amount is assessed and the insurance payment is determined in an efficient and timely manner.
Workflow
Assessor
Assignment
Policy Review
& Document
Review
Claim Amount
Assessment
Result
Submission
What is on-site assessment?
On-site investigation is a type of loss assessment conducted for insurance claims that require field verification, such as cases involving hospitalization, surgery, disability, or death. In such cases, the insurer delegates the on-site investigation to a licensed loss adjustment company. Upon receiving the assignment, the loss adjustment company conducts a direct field investigation by visiting the insured or relevant parties, medical institutions, and government authorities as necessary to verify the facts of the claim. Based on the findings, the loss adjuster determines coverage and exclusions in accordance with the insurance policy terms and applicable laws and regulations, and assesses the amount of loss for insurance claim settlement.
Workflow
Assessor
Assignment
On-site
Investigation
Loss
Assessment
Result
Submission
What is Payment Guarantee?
An overseas medical payment guarantee is a service in which a guarantee provider directly assures and settles medical expenses with hospitals on behalf of the patient for treatment, hospitalization, or emergency medical care incurred abroad. Through this service, patients can receive necessary medical treatment without the burden of upfront payment, while medical institutions are assured of secure and reliable payment for their services. This system provides a safe and efficient payment solution for both patients and healthcare providers.
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