Follow-up Contact. Follow-up contact shall be conducted by the EBS until enrollment occurs or the client is automatically assigned to a PCP/plan. The EBS shall make reasonable efforts to contact those clients who have been automatically assigned but who have not had the benefit of an explanation of the NHC. Follow-up contact may include, but is not limited to, the following:
(a) Face-to-face visits;
(b) Telephone calls;
(c) Home visits;
(d) Informational mailings; and
(e) After hours/evening meetings.
Follow-up Contact. It is vital that the adjuster has ongoing contact with the insured or their representative(s) during the life of the claim, including the following: • One (1) calendar day response to insured’s or their representative’s, emails, phone calls. • Five (5) calendar day response to written notifications. • Periodic status updates and anticipated future activities should be documented in the file notes. • Notify and update insured or their representative(s) of any upcoming or scheduled events, inspections, requirements, due dates, etc. • Communicate Citizens' ongoing expectations and policy-required duties of the insured or their representative(s). • Clearly explain why additional information, documentation, items or actions are required of the insured or their representative(s). • Contact the insured or their representative(s) to discuss settlement, prior to the issuance of any indemnity payments. • Document in file notes the details of voice-to-voice and/or written communications with regard, but not limited to: o Full or partial payments o Vendor and contractor payments o Settlement explanations and/or coverage denials, etc. • When closing claims, with or without payment: o Citizens’ contact information is relayed and the process for reporting new or undiscovered damages is explained. o As appropriate, informal, and formal dispute resolution options are explained to the insured or their representative(s) and documented in the file notes. Written Communication - The following requirements should be followed in the preparation and submission of written communications: • All outgoing Outlook® emails should be carbon copied to xxxxxx.xxxxxxxxxxxxxx@xxxxxxxxxxx.xxx. • Citizens approved SmartCOMM® letter and ClaimCenter email formats and letter templates should be always used for consistency. • SmartCOMM letter templates should be used when available. • Specific claim-related information, as required on a claim-by-claim basis, should be added to the letter template in sections where revisions are allowed. • Letters are to be addressed to the named insured(s), any additional insured(s) as listed on the policy, and insured’s representative(s): o Letters should be mailed separately to each additional insured(s), including a spouse, unless the spouse and/or the additional insured(s) reside in the same household. ▪ This includes system generated letters, i.e., Bill of Rights/Initial Duties letters o When an insured is represented by an attorney and/or a PA, with proper...
