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Philosophy

Mitsui Sumitomo Marine Management (U.S.A.), Inc. (MSMM), the manager of insurance services for Mitsui Sumitomo Insurance Company of America, Mitsui Sumitomo Insurance USA Inc., and AIOI Nissay Dowa Insurance Company of America (The Companies), and the members of the MSMM claims staff subscribe to the following principals regarding the management and handling of claims presented under insurance contracts issued by The Companies to its customers and policyholders:

MSMM will provide timely and informed claim services to all policyholders, third party claimants, injured employees, and other members of the insurance community and public (claimants), as claims are reported to MSMM by The Companies policyholders and brokers. All reasonable and justified claims will be paid promptly, along with other appropriate services provided in a fair, equitable, and timely manner. Full compliance will be provided by MSMM and its representatives with all requirements and guidelines of the various Unfair Claim Practices Acts enacted by the various jurisdictions where MSMM provides claim services. In those jurisdictions where an Unfair Claim Practices Act is not in place, MSMM and its representatives will be guided by and adhere to the provisions of the NAIC Model Act (National Association of Insurance Commissioners). A copy of the model act is part of MSMM's Claim Handling Manual.

Claim Policy Activities Required
1. Enlightened and informative claim services are to be provided for all customers and claimants by MSMM, and its representatives, at all times.
  • Compliance with MSMM's Claims Handling Philosophy
  • Compliance with MSMM's Claims Handling Guidelines and Service Standards
  • Compliance with MSMM's various Claims Operational Guidelines
     
2. Achieve and maintain Strong Customer Satisfaction attracting and attaining new customers for The Companies.
  • Immediate response to the needs of our Customers
  • Thorough and timely investigation of all claims
  • Prompt contact with customers
  • Timely response to all inquiries
  • Professional and timely completion of customer claim reviews
  • Create Special Claims Handling procedures to accommodate the specific needs of our insureds
3. Fair and prompt claims settlement
  • Strict compliance with the various state Unfair Claim Practices Acts
  • Prompt evaluation of compensability / liability to ensure timely posting of reserves to reflect full exposure
  • Prompt acquisition of settlement authority
  • Prompt payment of all justified and reasonable claims
4. Provide and maintain a strong workforce of highly qualified personnel.
  • Completion of internal audits to ensure compliance
  • Offer internal/external training opportunities for employees
  • Pursuit of Continuing Education
5. Minimize case backlogs
  • Compliance with MSMM's Claims Handling Philosophy
  • Strict adherence to Diary Management
  • Completion of Internal Audits
  • Completion of Financial Audits
6. Effectively utilize the systems and information platforms provided by the MSMM IT Department
  • Continue to make strategic use of IT in servicing our customers
  • Promote the utilization of Claim Inquiry with our Customers
  • Accurate and timely completion of system claim records
7. Provide strong internal controls and quality analysis of all claim handling policies and procedures
  • Compliance with MSMM's Claims Handling Philosophy
  • Compliance with MSMM's Claims Handling Guidelines and Service Standards
  • Compliance with MSMM's various Claims Operational Guidelines
  • Thorough and timely investigation of all claims
  • Completion of Internal Audits
  • Completion of Financial Audits

Uniform Claim Handling Guidelines

MSMM staffs its Claim Offices with experienced and knowledgeable claim professionals. We established Claim Handling Procedures to guide the staff while providing supervisory oversight to ensure compliance with the established guidelines.

Claim Offices are required to report large exposure files to the Home Office located in Warren, NJ. There they receive the benefit and experience of the Home Office claim staff. This group of seasoned claim professionals provides additional supervision and guidance to the local staff through the final resolution of the claim.

We can accommodate the special needs of our customers with customized claims handling procedures. (See *Special Handling Instructions.)

Important Claims Documents

MITSUI SUMITOMO INSURANCE®