Insurance Claims

Over the years, a very large part of my practice has focused on helping the insurance industry adjust claims where accounting records were the best evidence available to document the accuracy of the claims. I have also accepted assignments from the insured to assist them in preparing and documenting their claims against an insurance company.

I have qualified in several courts as an expert and have testified numerous times where the claims have resulted in litigation.

Examples of instances where I have been able to assist either the insurer or the insured would be:

Business interruption insurance

This provides coverage to the insured to protect their profits in the event of insurable damage to business property during the recovery or reconstruction period. In one case that I worked on, a mobile home manufacturer's plant was destroyed by a fire. My task was to compute the amount of net income (in accordance with the terms of the policy) that the owners would lose while the plant was rebuilt and put into operation. As a result of my work, the insurer and the insured were able to settle the claim with a minimum delay.

Loss of earnings claims

These result from the claimant being injured and as a result is unable to be employed. I have been engaged by both insurance companies and the injured parties to calculate the actual amount of income lost during the period of rehabilitation, or over the remaining life expectancy.

Fraud, theft or embezzlement

These claims often require the services of an accountant because the only evidence of such a loss in contained in the accounting records. I have worked on claims of inventory theft, fictitious employees, embezzlement by dishonest employees such as bookkeepers, sales clerks and warehousemen.

Residual value policies

These are typically purchased by manufacturers to insure the future value of certain of their products at some time in the future. In one case that I worked on, a major automobile manufacturer guaranteed the automobile rental agencies that purchase their automobiles that they would have a certain wholesale value at the end of certain periods of time. At the end of the policy period the used car market was unusually depressed and the manufacturer filed a claim in excess of $60 million. By using various auditing techniques I was able to reduce the claim to approximately $20 million.

Medical Excess Reimbursement claims

Otherwise known as "Medical Stop Loss", these claims arise from employers who self insure their employee health insurance program and purchase a Medical Excess Reimbursement policy to limit their loss on either the entire program or on individual claims. My responsibilities in such examinations are to determine that the attachment point (that point in which the insurance policy begins to cover total expenses) has been properly calculated. Such attachment points are usually a function of total enrollment. As a by product, I am able to determine if the proper premium has been remitted to the insurer. Secondly, I determine the total claims actually paid during the policy year by the policy holder.

P.O. Box 4305, Fullerton, CA 92834 and 1501 N. Harbor Blvd. Ste 100., Fullerton, CA 92835
Telephone 714-870-0285
Fax 714-870-6234
Email SCH@Hensleecpa.com

Copyright © 1998 Stan Henslee, CPA