Lloyd's Market Association Bulletin

LMA19-030-TB  |  08 November 2019

Delegated claims oversight - publication of delegated claims audit deliverables 

In September of 2018, we outlined a programme of work that we would be undertaking in relation to delegated claims (LMA18-043-TH), and provided an update on the programme in December 2018 (LMA18-052-TH) and 20 March 2019 (LMA19-011-TH) to carriers and third party administrators (TPAs).

Within that programme of work the delegated claims administrators (DCA) audit objectives were to:

  • create a standard, aligned and risk based TPA and coverholder audit approach for future DCA audits, implementing a common technical and operational audit scope, controls and process
  • enhance claims controls and the technical claims assessment criteria and question set
  • improve and deliver a qualitative and customer focused approach to the claims audit scope and assessment criteria

The delegated claims audit deliverables, which respond to these objectives are as follows:

The DCA guidance overview document for managing agents provides a high level summary of what has been developed by the market in collaboration with Lloyd's, and supports managing agents in understanding and adopting changes that will benefit all stakeholders in the audit cycle via:

  • a consistent and co-ordinated approach to scoping and conducting claims audits with DCAs
  • a qualitative and customer focused approach to assessing the quality of claims handling and management
  • reduced burden and cost on managing agents, TPAs and coverholders. The remaining deliverables from the DA claims programme of work, including the DCA Agreement, and the Performance Oversight SLAs, are currently being finalised, and will follow shortly.

Should you have any questions, please contact Tim Bowling.

Tim Bowling
Senior Executive, Claims