When handling claims, DCAs play a critical role as the face of the Lloyd’s market to many of Lloyd’s policyholders, providing a core service and representing and promoting the Lloyd’s brand worldwide.
Lloyd’s has introduced changes to the way that DCAs are appointed and managed. These changes support improved policyholder outcomes and reduce operational expenses for managing agents and DCAs. From 30 September 2020 all DCAs require Lloyd’s approval before they can be appointed by managing agents to determine claims. Lloyd’s has put in place a standardised due diligence process for all DCA approvals.
These changes form part of Lloyd’s vision for delegated authorities: to create a seamless and well-managed ecosystem that enhances customer experience, making it easier, faster, and more cost-effective to do delegated authority business.
The DCA approval framework and process is summarised below.
Full details can be found in the Guidance available here.
What is a DCA?
The Intermediaries Byelaw provides a list of who managing agents can delegate authority to in order to determine claims. Firms that are appointed by managing agents that do not fall into one of the other categories listed in the Intermediaries Byelaw require prior approval by Lloyd’s as a DCA. This will include most third party claims handling providers.
The following do not require approval as a DCA:
- Managing agents
- Law firms*
- Coverholders handling a claim on a policy the coverholder has underwritten
*Law firms that are appointed to handle claims do not need to be approved but should continue to be registered with Lloyd’s by informing email@example.com of their appointment.
Only firms that are appointed to ‘determine’ claims require approval. The definition of ‘determine’ means all claims handling activities necessary in order to (i) accept or deny a claim in whole or in part; (ii) agree any amount payable; or (iii) resolve finally any open matter by agreement or, if necessary, dispute resolution. Loss adjusters and other service provides that merely advise or support claims handling but do not have authority to determine the claim do not require prior approval.
What is the significance of Lloyd’s approval?
Managing agents are not permitted to appoint a DCA to determine their claims unless the DCA has been approved by Lloyd’s.
Once a DCA has been through the standardised due diligence process any managing agents wishing to appoint that DCA will use the centrally held due diligence information to assess the DCA and to support any decision to outsource claims handling to that DCA.
DCAs appointed prior to 30 September 2020
DCAs notified to Lloyd’s prior to 30 September 2020 under Lloyd’s previous requirements will not initially be required to go through Lloyd’s standardised due diligence and approval process and have been ‘grandfathered’ onto Lloyd’s register of approved DCAs.
During 2021 and 2022 all grandfathered DCAs will be asked to provide Lloyd’s standard due diligence information to onboard them onto the Delegated Compliance Oversight Manager (DCOM) system. Lloyd’s will confirm during this exercise that the DCA remains suitable to be an approved DCA. They will then be subject to Lloyd’s ongoing compliance oversight.
Lloyd’s will work with managing agents and DCAs to develop this process and more information will be provided in due course.
DCAs new to Lloyd’s
A managing agent that wishes to engage the services of a DCA that has not been approved by Lloyd’s should commence the approval process by arranging for the DCA to complete the due diligence questionnaire and provide supporting documents. The managing agent should assess this due diligence information to ensure that the DCA has adequate capabilities, systems and controls to provide the outsourced claims services required. Lloyd’s will carry out a risk-based overview of the managing agent’s assessment before approval is confirmed.
Once a DCA is approved it may refer to itself as a “Lloyd’s approved Delegated Claims Administrator”.
If a managing agent is considering appointing a DCA that is already approved the managing agent should base its decision on the due diligence information provided to Lloyd’s as part of the approval process.
Before appointing a grandfathered DCA that has not been through the standardised due diligence process, managing agents will need to undertake their own due diligence exercise.
Managing agents should inform Lloyd’s once they decide to appoint an approved DCA.
Managing Agents that are unsure which process to follow should email firstname.lastname@example.org for assistance.
Appointing a new DCA
The process for appointing a new DCA will depend on whether the DCA is already known to Lloyd’s or not. When a managing agent wishes to appoint a new DCA they should first check the Decision Tree (page 12). The process will vary depending on the answers to the decision tree and detailed guidance on each process is contained within this document.
If you’re unsure which process to follow, please email email@example.com for assistance.
Under the amended Intermediaries Byelaw third party firms that have authority to determine claims need to be approved. Determining claims means to (i) accept or deny a claim in whole or in part; (ii) agree any amount payable; or (iii) resolve finally any open matter by agreement or, if necessary, dispute resolution.
The definition includes firms that have authority to make the decision to provide assistance to the policyholder, for example under travel or health insurance.
The definition applies regardless of the class of business or how the risk was written. It therefore includes, for example, DCAs appointed under line slips, group policies and any open market business. It also includes firms appointed in a delegated lead role.
The activities carried out by firms appointed only to receive first notification of loss, or to advise on coverage or quantum, are not included in the definition and these firms do not require Lloyd’s approval to be appointed. Managing agents should nonetheless carry out appropriate due diligence on any firm with a role to play that impacts the claims service.
Law firms do not need to be approved even if they undertake the role of a DCA and have authority to determine claims. They are excluded from the DCA approval requirements under the Intermediaries Byelaw. Law firms acting in the capacity of a DCA (ie they have authority to determine a claim) should, however, be registered with Lloyd’s by sending the name and address of the firm to firstname.lastname@example.org. Law firms that wish to can apply to be approved as DCAs and will receive the benefit of being a DCA, including ongoing compliance oversight checks from Lloyd’s.
An approved DCA can only sub-delegate its authority to determine claims if the managing agent agrees to this and Lloyd’s gives its prior approval. Requests to Lloyd’s for permission to sub-delegate will be considered on a case by case basis. In most cases, DCAs will only be permitted by Lloyd’s to sub-delegate to another approved DCA or to a law firm. If the sub-delegation is agreed, a written Delegated Claims Administration Agreement must be in place between the DCAs.
Coverholders that are to be given claims authority in respect of risks that they write under a binding authority are excluded from the DCA approval requirements. Any approval for claims handling authority will be dealt with as part of the coverholder approval process. However, once the Delegated Compliance Oversight Manager is operational, the coverholder due diligence and approval processes supported by that system will include the same claims due diligence questions as the DCA due diligence questionnaire, where the coverholder is to have claims handling authority. This will not be before the second half of 2021.
If a coverholder is to be appointed to determine claims notified to policies not written by that coverholder, they will be subject to the DCA framework from 30 September 2020.
Managing agents should always carry out their own assessment as to the capabilities of a DCA to service a managing agent’s book of claims before appointing them, in accordance with Lloyd’ Minimum Standards.
If the DCA that the managing agent wishes to appoint has already been approved by Lloyd’s and the DCA has provided to Lloyd’s the standardised due diligence information as part of the approval process, the managing agent should request this due diligence information from Lloyd’s and base its decision on this information. Managing agents should avoid supplementing the due diligence obtained as part of the Lloyd’s approval process with their own additional requirements. The information available from Lloyd’s will include an indication of the answers provided by the DCA which indicate increased risk.
If a managing agent wishes to appoint a DCA that has been grandfathered and Lloyd’s does not hold the standardised due diligence information for that DCA, the managing agent should request appropriate due diligence information from the DCA,
Once the managing agent has assessed the claims due diligence information and decided that it does wish to appoint a previously approved DCA, the managing agent should inform Lloyd’s by emailing email@example.com so that this relationship can be recorded by Lloyd’s.
For every DCA that is captured in the DCA Register, there is a record of which managing agents have a relationship with that DCA. When a managing agent is no longer using the services of a DCA, the ending of that relationship is recorded. If, as at 30 September 2020, no managing agents are using the services of a DCA that had been previously notified to us, that DCA will not be grandfathered.
The Insights Hub is available via Lloyds.com to managing agents that have signed up to it, which most managing agents have. If you as an individual do not yet have access, please ask your organisation’s user administrator to provide you with this access. Please email InsightsHub@Lloyds.com if you don’t know who your user administrator is.
The DCA Directory, in the Reference Data section within Data Feeds, provides a list of all approved DCAs.
Also available in the Data Feeds section in the Insights Hub are DCA binder details which provide, for each managing agent a list of the DCAs that that managing agent has appointed under binding authorities. This information is provided at binding authority level.
You may use the Lloyd’s Delegated Claims Administrator logo for promotional material: for instance on your website homepage, corporate letterheads, and publications. It may also be used when promoting claims services provided to Lloyd’s policyholders. Detailed guidelines for use of the logo and including guidance for how DCAs can refer to their relationship with Lloyd’s are available via https://www.lloyds.com/conducting-business/requirements-and-standards/lloyds-brand/brand-guidelines and master artwork files of the logo can be requested via firstname.lastname@example.org.