Independent auditing for TPAs, Coverholders & MGAs

Claims Audits

Claims Audits

We conduct claims audits on Third Party Administrators and Coverholders or MGAs who hold claim settlement authority. Our claims auditors are independent and objective professionals with no ties to claims management firms.

Standard Claims Audit

Our standard scope of audit includes review of staffing, trust account management, IT systems, organization and management, use of experts, internal controls and authority levels, compliance with referral guidelines, salvage and recovery practices, handling of denials and ex-gratia payments, efficiency of settlement process and much more.

For Lloyd’s markets, our scope both meets and exceeds the Lloyd’s standard claims audit requirements.

Specialized Audit: Litigation Management

Litigation management audits focus on the effectiveness of insurance counsel appointed by Lloyd’s and/or company claims staff. A litigation management audit will determine whether outside counsel have a clear strategy and are proactively moving the case towards resolution. Reserves will be reviewed to ensure that they are reasonable and based on liability and quantum data in file. Counsel’s fees will be reviewed to ensure that they reflect the work performed and are in line with the local market. We will also check to see if the work is being performed at the right level, e.g. junior vs. senior counsel.

Specialized Audit: Loss Fund Repatriation

There are many instances where loss funds remain on deposit with Coverholders and TPAs, despite the binding authority agreements to which the funds are related having lapsed or been cancelled. Over a period of years, Managing Agents and syndicates (as well as the Coverholders and TPAs) may lose track of these funds which may also have been commingled with funds from other Lloyd’s syndicates and insurance carriers. Our audit team will conduct the necessary investigation and identify funds that can be repatriated. 

Benefits

  • Early detection of leakage has an immediate positive impact on the bottom line;
  • Regular claims audits ensure tight control of processes and loss funds;
  • Identification of weak internal controls allows you to implement changes to processes before they begin to cost you money;
  • Regular and consistent audits assist in fraud prevention and mitigation of losses related to claims fraud.

The AMA audit team works cooperatively with your clients to ensure that each audit is an opportunity for constructive change.