Claims Process

A Structured Approach to Every Claim

From initial intake through claim assignment and resolution, ACA follows a defined process designed to ensure that claims are properly documented, evaluated, investigated, and handled in accordance with the applicable policy terms and claim requirements. Every claim begins with the same objective: understand the circumstances, evaluate the information available, and determine the appropriate path toward resolution.

The Claims Process: From Claim Intake to Assignment

Claims are received by ACA via email, phone, or fax and are initially reviewed by the management team to determine the appropriate next steps.

Claim Intake: Claim Received & Reviewed

1

Initial Claim Screening: Claim Review & ISO Screening

2

The claim is reviewed and processed through ISO as part of ACA's initial screening process, including a review for potential fraud indicators.

Claim Registration: Claim Entered Into ACA's System

3

Claim information is entered into ACA's database system, creating the foundation for documentation, tracking, assignment, and ongoing claim management.

Claim Assignment: Assigned to the Appropriate Adjuster

4

The claim is assigned to a desk and/or field adjuster based on the nature and requirements of the loss. The assigned adjuster then begins the appropriate investigation and claim-handling process.

An acknowledgement is sent to the client confirming receipt of the claim and initiating the next stage of the claims process.

5

Client Acknowledgement

Payments, Billing & Invoices

Evaluating the Cost of the Loss

When covered damage occurs, payment is issued in accordance with the applicable policy terms and conditions, including any applicable deductible or policy restrictions. An explanation of the payment is provided to the insured in accordance with those terms.

In utility damage claims, the company whose infrastructure has been damaged may respond to the incident and submit an invoice for the costs associated with repairing or replacing the damaged infrastructure. In some cases, the charges presented may exceed the actual scope of damage or include costs that require additional review.

ACA evaluates the charges presented, investigates the circumstances surrounding the loss, researches potential liability, and reviews the supporting documentation to determine whether the claimed costs are reasonable, necessary, and supported.

Where appropriate, ACA works with the involved parties to negotiate and resolve the claim based on the actual, documented cost of the loss.

I would use "may exceed the actual scope of damage" instead of "outrageous bill" and "require additional review" instead of "overcharged." It communicates exactly what you're trying to say but sounds much more credible for an insurance/claims audience.

  • Once a claim has been received, screened, entered, and assigned, ACA's broader methodology moves the claim through:

    Documentation Collection → Field Investigation → Damage Analysis → Cost Verification → Reporting → Negotiation → Resolution.

  • Gather relevant photos, invoices, timesheets, equipment logs, restoration records, and utility documentation.

  • Evaluate the circumstances and physical conditions surrounding the loss.

  • Determine the nature and scope of the actual damage.

What Happens Next?

  • Review labor, equipment, materials, subcontractors, emergency restoration, and other claimed expenses.

  • Present findings and support informed negotiations based on the documented facts.

  • Work toward an appropriate, defensible resolution.

The ACA Difference

ACA's role extends beyond receiving and assigning claims. Our specialized utility expertise allows us to evaluate the damage, documentation, liability, and costs associated with complex utility losses. We don't simply process the claim. We investigate it, evaluate it, document it, and help our clients determine the appropriate path to resolution.