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.

Where we are looking to provide these deliverables to the market as output, we understand that some managing agencies will have their own views on tools, for example TPA agreements. that they have developed and want to use going forward. In some scenarios and for certain areas of the deliverables, we may request that managing agents incorporate elements of this work into their own tools to drive consistency on areas where we know there are pain points for delegated claims agents.

We have prepared a survey to help us coordinate feedback on these items. If you could please complete the survey via the link below we’d really appreciate any feedback – this will help us to make these tools as strong as possible and improve their use to the market as a whole.

Click here to access the survey 

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

Delegated Claims Administrator Agreement


The new DCA Agreement precedent is now available for market adoption and can be found here: LMA9188 .

Delegated Claims Agreement Administration FAQ

Background

In 2017 Lloyd’s conducted a thematic review of how managing agents were overseeing delegated claims, the result of which was that significant improvements were needed across the market.  

After a period of consultation, it was agreed by the market that a standardised approach to contracting with delegated claims agents would create a beneficial and consistent approach within the Lloyd’s Market, making it easier for our delegated claims agents to transact and operate with multiple Lloyd’s managing agents. 

It was also agreed that the adoption of a standardised set of service levels would assist delegated claims agents in providing a consistent level of service excellence focused on customer outcomes, aligning and bringing consistency to the variation of service levels and measures that are in place across the Lloyd’s managing agent community.

Deliverables

It was agreed that:

  1. The existing LMA TPA contract [LMA9008B] should be brought up to date and replaced by a new model contract: the Delegated Claims Authority Agreement (DCAA).
  2. Market standard service levels should be set and delivered, which could be utilised independently whilst also being included as a schedule within the DCAA.

Market-led working groups were established to focus on the delivery of each, before aligning the model contract terms and the SLAs in Q1 2020.

Outcome

During the course of 2019 both a market-drafted delegated claims contract and market standard service levels were submitted for Lloyd’s for feedback and support.  This coincided with the drafting of Blueprint One and consultation with the market on a risk-based oversight framework for DA, both of which saw Lloyd’s review and adapt its approach to DCA onboarding and approval in the Lloyd’s market.

The LMA has been working with Lloyd’s, market representatives, DCA stakeholders and external legal counsel to ensure that the model contract delivered to the market responds positively to the ongoing delegated claims approach and oversight framework that is to be adjusted and implemented in 2020/21. 

The new DCAA template, LMA9188, is now ready for use and can be accessed via the link at the top of the page and the LWR.  The market-led SLAs and SLEs have been incorporated into the schedules of the new LMA9188 and can be easily extracted by those who wish to use them separately to LMA9188.

Market Adoption & the LMACC

The engagement and adoption level by managing agents is critical. LMACC sponsors Nick Sinfield and Richard Foulger said: 

This process has been a great example of the market and Lloyd’s as our regulator working successfully hand in hand to deliver a set of outputs designed to improve the markets’ position to attract and retain business. The key ingredient is to achieve consistency within the market, removing the myriad of practices and protocols we all use, none of which give us competitive advantage individually or as a market. They are designed to make doing business with us easier and speedier and we urge everyone to adopt them and progress as one.

 

TPA & Coverholder Audit Framework & Scope:

Work in this area has focused on creating a standard audit scope for TPA audits, that is closely aligned to the 2018 coverholder audit scope, and that delivers the same benefits for TPA audits as the 2018 scope did for coverholders.

In essence, those key focus areas that relate to those activities undertaken by a TPA have been retained, and the claims content has been refreshed to ensure there is adequate guidance to the auditor, and where risks were missing in the coverholder audit scope (loss fund management and bordereau reporting), these have been added in. The claims testing template has also been overhauled to facilitate a robust technical file audit is undertaken, which was an area of focus identified in Lloyd’s Thematic Review of Delegated Underwriting Claims Management.

Where changes have been made when developing the new TPA audit scope, those enhancements have been copied in to the coverholder audit scope, so no matter whether the delegated claims entity is a TPA or a coverholder, the same audit approach will be followed.

  • TPA specific audit scope, allowing MAs to propose some or all of the following components, depending on previous audits and risk appetite;
  • a guidance document to support the auditors use of the TPA audit scope, with much greater clarity on expectation of the claims controls expected
  • an updated claims testing sheet for use as a technical file audit question set (from 38 questions to 61 questions), including an aggregation and reporting tool to group and analyse audit findings
  • an updated coverholder audit scope and guidance document , refreshed to include any new material developed as part of the TPA audit scope creation

Co-Lead Claims:

  • LMA model wording for Co-Lead Claims Agreement.

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.

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

 
Should you have any questions on the consultation or want to understand more about the context of these deliverables, please get in touch with either Clare Knight or Tim Bowling
What we have delivered so far:

 

Co-Lead Claims Agreement: Delivery of a model agreement that will wrap around a number of co-lead arrangements to a specific coverholder, replicating the processes within the Lloyd’s Claims scheme to ensure efficient claims agreement processes. This has now been published as LMA9157, and can be found in LMA Bulletin LMA18-046-TH.

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.

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

Contact us

Tim Bowling
Senior Executive, Claims

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Clare Knight 
Consultant, Delegated Authority

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Strategy document

Download Strategy Document


Activity tracker

Click here for timelines