As you become more familiar with captives, you might be more aware of the structures and their operation. What tends to trip independent agents up is the moving parts inside the captive insurer. Don’t worry, you’re not the only person asking about this.
A hurdle for some to overcome is understanding how Third-party administrators (TPAs) work. They’re an essential part of captive insurers' functioning.
The sole purpose of Captive Coalition is to educate independent agents on all things captive insurance. We’ve seen firsthand how TPAs can help streamline the captive experience.
This article will teach you what a Third-party administrator is, why captives use them, how they differ from traditional claims processes, what to look for, and how you can stay connected to the claims process to support your top-tier clients.
A third-party administrator is an outside firm that handles claims on behalf of a captive. They’re not directly part of the captive. They’re a key part of how the captive functions, but they’re an independent, outside service.
In a captive, every piece of the structure is chosen with intention. The TPA is there to protect the integrity of claims management. They’re an essential link between the fronting carrier, the reinsurer, and the insured.
TPAs exist on both sides of the insurance world: property and casualty (P&C) and health. The idea is the same in both cases: bring in a licensed expert to manage claims. They’re specialists in this field.
In a captive, you’re looking for expertise in the claims process, and creating something new in-house is like making a whole new process. With a TPA, they have years of experience and a working process. They have a specific skillset, specialization, and established expertise in claims management. And with a TPA, they’re a more objective party between the claimant and the insurance company.
First, in certain states, a license is required to handle claims.
Second, in certain instances, there could be an apparent conflict of interest in the settlement of a claim. For example, in a workers’ compensation claim, employees are entitled to certain benefits. They don’t want to see that the business or captive is controlling the amount they’re entitled to. They want an objective, qualified party to handle the process.
Finally, claims are complicated. If you wouldn’t trust your CFO to perform surgery, you shouldn’t trust your HR manager to do a workers’ comp settlement either. You want someone qualified with experience who knows what they’re doing when settling claims.
This is what TPAs do:
Many TPAs offer additional services other than standard claims handling. Here are some examples:
Not every TPA offers this, and not every captive needs all this. That said, it’s worth asking a captive about these services for your clients when looking to get them into captives.
A good TPA will have:
TPAs usually charge in one of two ways:
Either way, captives want to know the contract covers everything from intake to closure. It’s what the industry calls “cradle to grave,” meaning they handle everything until the claim process is fully finished.
The best TPAs won’t always be the cheapest. The best ones keep your clients out of trouble.
The agent should be on top of the claims. Ensuring a good working relationship with the TPA is always good. Here’s how:
If your client’s claim experience turns sour, you’ll be taking the call. Better to stay in the loop and productive.
In traditional insurance, business owners rarely see much detail outside of a loss run. In captives, with a TPA in place, there is more visibility if everything is set up and you’re proactive as an agent.
You should have that relationship with a TPA to:
A third-party administrator is an essential piece of a captive program. You don’t need to engrain the details about how they work into your head. The main thing is to understand how they operate within a captive model and how they can influence profitability. After all, they handle the claims your clients care about. They help a captive function well.
Next, read about how claim management works between traditional and captive insurance policies. That way, you and your clients can better understand how claims are handled in a captive.
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