Delegated Claims programme of work

In collaboration with the LMACC & Lloyd’s claims team, the LMA has put together a delegated claims model, encompassing a long term delegated claims strategy addressing both business process and underlying systems to support that change. A program of work has been designed to help to address both of these and in response to the Lloyd’s delegated authority (DA) claims thematic review undertaken in 2017.

The main aims of the program are to provide an improved and more consistent DA experience for TPAs, improved service for customers and increased indemnity accuracy. This will be achieved by providing the market with guidance, tools, model wordings and frameworks to assist in moving towards a common market approach in managing delegated claims.

For an executive summary of the programme, click the document link below, or download the detailed guidance on the side panel.

An overview of the proposed deliverables for the program is as follows:

Due Diligence & Compliance:

• assess feasibility, function and scale of a framework for central due diligence/compliance system
• market guidance on suitability criteria to include thresholds for capabilities, services and controls
• making data from all sources (e.g. DA SATS, audits, complaints data, etc) readily available to managing agents, auditors and Lloyd’s.

Terms of Delegation:

• update of LMA Model TPA Agreement
• core set of SLAs for use in delegated claims arrangements
• improved visibility of TPA appointments via BAR.

MI and SLA Reporting:

• implement straight-through processing and remove need for bordereaux submissions
• review and enhance existing claims data standards and monitoring tools
• integration of market agreed SLAs within DA SATS to enable automated performance monitoring reports.

Audit:

• overhaul of TPA audit scope to align with coverholder audit scope
• use of AiMS to co-ordinate TPA audit activity
• assess feasibility of auditor accreditation process.

Co-Lead Claims:

• LMA model wording for Co-Lead Claims Agreement.

Here you can find both the high level strategy and detail regarding the proposed output from the programme.

What we have delivered so far:

Updated Central Records: Lloyd's have undertaken a reconciliation exercise with managing agents to ensure that central records of delegated claims arrangements are up to date. Once these have been integrated with existing records they will be in touch with TPAs to further expand that reconciliation exercise – this should give clarity to all stakeholders about who is responsible for claims handling in all instances.

Claims Audit Testing Sheets: The LMA has now completed design work on updating the claims testing sheets to be used with the Coverholder (and shortly to be delivered TPA) audit scope. This increases the focus on technical claims handling and could either be used on site by a Coverholder / TPA auditor, or for desktop file reviews. 

If you’d like to see when work on individual deliverables are being worked on throughout the programme, you can track our progress on these here.

Should you have any queries about the program or would like to get involved, please contact either Tom Hamill or Tim Bowling.