Claims examiner

1. In industrial cases, a representative of the insurer who investigates, evaluates, and negotiates the patient’s insurance claim and acts for the company in the settlement of claims. 2. Individual employed by an insurance company who assists in settlement of claims by investigating claims, approving claims that are valid, and denying claims that are invalid or fraudulent. Some claims examiners are individuals who operate independently and are hired by insurance companies to adjust a specific loss. Also called adjuster, claims processor, claims representative, claims administrator, or health insurance adjuster.

Claims experience

The insured’s claims history with regard to the cost and frequency of previous claims. It is material for an insured to disclose his claims experience when proposing insurance. The term also describes the relationship between premium and claims experienced by an insurer for a particular class of business over a period of time.

Claims Experience Discount/Loading for Fire Insurance

Risks having sum insured (on buildings and contents of all blocks in one compound of one complex in one location) above Rs. 50 crore shall attract claims experience discount/loadings based on the incurred claims experience of all the policies covering the insured’s interest for preceding 36 months excluding the expiring policy period. If there be break available 36 months experience is to be taken into account.