The Claims Process

MSMM has established Claims Service Standards to ensure prompt contact with all interested parties. We promptly investigate all claims to determine the facts and identify issues of compensability on workers' compensation claims or liability and damages on all other claims. The early and equitable adjustment of all claims is our primary goal. Our Insureds are kept informed of the adjustment process and can follow the progress of claims via the Internet. (*See Claim Inquiry)

Workers' Compensation

We assign claims to knowledgeable and experienced claim professionals specializing in this field. Once a new claim has been received in the local Claim Office, the MSMM Service Standards mandate initial contact with the employer, injured worker and medical provider within twenty-four hours of receipt. Our claim professionals immediately review compensable claims to determine the severity of the injury. The representative, using MSMM guidelines, decides if the injury warrants the services of a Medical Case Manager. To provide this service, MSMM has partnered with CorVel Corporation, a national organization and leader in the field of Medical Case Management. This partnership is focused on providing the best available medical care to the injured employee while at the same time controlling costs. The ultimate goal of this partnership is the early return of the injured worker to the workforce. CorVel assists MSMM in controlling medical costs by selecting the most effective Preferred Provider Organization (PPO). Additionally, CorVel audits all medical invoices/bills and re-prices them to conform to state fee schedules, PPO discounts and/or usual and customary fees.

Liability

MSMM assigns claims to knowledgeable and experienced claim professionals located in our Warren, New Jersey office who specialize in this field. We mandate twenty-four hour contact with all interested parties. Claims are quickly investigated and evaluated for early resolution. Litigated Claims are referred to local counsel selected from the MSMM Approved Panel of defense firms. These approved firms have agreed to follow established MSMM Litigation Guidelines that include the submission in writing of an initial case analysis, agreed upon litigation plan, defense budget and reporting procedures. Our use of these guidelines helps to ensure that all litigated claims are continually managed for quick resolution and cost-effective use of legal resources.

Umbrella and Excess

MSMM Umbrella and Excess Claims are handled centrally in our Complex Claim Unit located in the Warren, NJ office. The personnel in this unit are highly experienced in dealing with potentially serious, high exposure and /or catastrophic type claims including environmental claims.

Auto Physical Damage

MSMM Auto Physical Damage Claims are handled by knowledgeable and experienced claim professionals located in our Cincinnati, Ohio office. Utilization of licensed professionals in the area of damage appraisals and repair estimates are key to our timely and effective handling of auto claims. We contract with a top-ranked nationwide rental provider which ensures competitive rates and convenience for our customers.

Property

MSMM Property Claims in the United States are handled from our Warren, NJ Property Claims Office. The Property Claims Office uses specialized appraisal service providers throughout the USA to assist in the adjustment process of first party property losses.

Ocean Marine

Ocean Marine and Legal Liability Cargo claims are handled by claim professionals in our Ocean Marine Claim Office in New York City. The Ocean Marine Claim Office uses an international network of marine surveyors to inspect cargo and investigate claims to ensure that the loss is properly mitigated. In addition to providing adjusting services, the Ocean Marine Claims Office has a dedicated subrogation team that pursues responsible third parties for recovery specifically for Ocean Marine and Legal Liability Cargo claims.

Third Party Administration Unit:

Some jurisdictions require in-state claims handling where MSMM does not have a claim office. In those cases, we utilize Third Party Administrators (TPA) who are committed to providing the high quality claims service to which MSMM's customers are accustomed. Our preferred TPA's are bound to follow the established service standards as outlined in the MSMM TPA Claims Handling Guidelines. All TPA claims are supervised by MSMM staff located in Cincinnati, Ohio and Warren, New Jersey.

MITSUI SUMITOMO INSURANCE®