Our Role and Function as a Delegated Claims Administrator (DCA)

At Royal Claims Services, our primary function is to operate as a Delegated Claims Administrator (DCA). You might wonder, "What exactly is a DCA?" Historically known as a Third Party Administrator (TPA), this role has evolved in recent years.

Our mission is to facilitate and oversee the claims process for policies placed in the Lloyd's market. Given Lloyd's status as an international market, it does not always have claims teams where policies are written. This is where Royal Claims Services steps in. We serve as a local representative for these insurers, ensuring that claims are processed efficiently and accurately.  It is our responsibility to ensure that the promises made by insurers are honored and delivered upon at the time of a claim. Our goal is to seamlessly bridge the gap, guaranteeing that claims related to policies are managed in the most effective manner possible.

Our Role as the TPA

The operational role of RCS aligns with that of an examiner in a standard insurance company, albeit tailored to the specific requirements of the Lloyds market and its associated Managing General Agents (MGAs). This adaptation allows RCS to navigate the unique aspects of claims management in this context, applying specialized knowledge and processes to serve the needs of Lloyds entities effectively.

Typically RCS will operate as the Examiner rather than the Adjuster. This can create confusion as at times it feels like there are "too many cooks in the kitchen". However there are fundamental differences and each role has it's place in the claims process. 

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Examiner Vs Adjuster

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Insurance Adjuster

An insurance adjuster is often the first point of contact after a claim is filed by the policyholder. Adjusters are responsible for the initial investigation of the claim. This involves visiting the site of the incident (if applicable), assessing the damage, gathering evidence (like photos and witness statements), and determining the extent of the insurance company's liability. They can work as independent contractors or be employed directly by an insurance company.

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An examiner, on the other hand, handles the claim after the adjuster has submitted their report. Examiners review the findings of the adjusters, verify the details, and ensure that the claim complies with both the policy terms and applicable laws. They have the authority to settle claims or to ask for additional investigation if the information provided is insufficient or unclear. Examiners oversee the claims process from an administrative and regulatory standpoint, ensuring that the settlement is fair and within the bounds of the policy and regulatory requirements.

Settlement and Assignment of Claims

Claims Management Authority

Claims Management Authority

As a TPA or DCA, RCS is granted settlement authority by insurers entities to manage their claims within Canada. This involves assessing claims, determining coverage, and executing the settlement process. The primary goal is to ensure claims are resolved accurately and efficiently, mirroring the functions of an internal claims department within an insurance company.

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Local Adjuster Network

RCS does not typically conduct on-site claims assessments. Instead as examiners, our team relies on a network of local adjusters and experts across Canada. This network is meticulously curated to include individuals with the competence and skills necessary for thorough and professional claims evaluation. By delegating on-site assessments to these professionals, RCS ensures timely and expert handling of each claim.

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Network Maintenance

Maintaining a robust network of skilled professionals is a cornerstone of RCS's operational philosophy. This network ensures that RCS can assign competent individuals to handle claims, guaranteeing that each claim is managed with the utmost expertise and attention to detail. In doing so we have put a focus on assigning the right individual to the right claim. Our assignments are not bound by firms but are sent to the individual we find will be the best fit for the claim.