Quality Control Review Reminders

RMA Review Requirements

Conflict of Interest Reviews

RMA requires reviews to be completed for policyholders who have any payable indemnity (by crop/county) when there is a potential conflict of interest (as identified on the previously completed Conflict of Interest Disclosure Form). For Example: Policyholders who are Agents, Adjusters and/or their relatives.

$200,000 Claim

RMA requires reviews to be completed for policyholders who have a payable indemnity (by crop/county) that will equal or exceed $200,000. This is on a cumulative basis (by crop /county) and includes any revenue portion of a loss. Prevented planting claims are considered separate from production/revenue claims.

Components of Reviews

The APH Review

The APH Review portion directly involves the policyholder and requires them to produce hard copy records to
validate production and acres previously certified for their APH databases. A carryover insured will be expected to produce records for the 3 most recent years certified for the crop whereas a new insured will be expected to produce records for all years that were initially certified for that year.
 
Example 1: A carryover insured with a 2014 crop year claim would need to provide records of acreage and production from years 2013, 2012, and 2011. If no acres of that crop were planted in 2013 then he would be expected to provide records from 2010 as the third year.
 
Example 2: A new insured with a 2014 crop year claim would be expected to provide records for all years that had been initially certified for that 2014 crop year.

For Carryover Insureds: Once the review of the most recent year’s records has been completed we will determine if there is any error or omission.

  1. If an error or omission is identified in the most recent year of records used to support the APH that, when corrected, would affect the current crop year’s premium or liability, we must conduct a review and verification of all records required to be available.
  2. If an error or omission is identified, but when corrected would not affect the current crop year’s premium or liability (e.g. correcting the error or omission does not change the approved yield for the current crop year), we must determine whether the remaining years of records required to be maintained by the policyholder exist.

In either case the producer should have available (because we will need to see they exist) the records for all required years.

 

The Contract Review

The Contract Review portion requires us to review the policy documents applicable for the year being reviewed. This usually does not require any more effort on the part of the Agent or Insured because the documents being reviewed will be on file in our office. However, any documents missing (i.e. Acreage or Production Reports) retained in an E-Agents file that had not already been submitted will be requested at this time.


The Claim Review

The Claim Review portion requires the claim itself to go through a review process prior to payment.

Frequently Asked Questions

Third party documentation (i.e. summary/settlement sheets from the elevator) is required when applicable and available. Insureds are expected to have available hard copy records that will 1) support the total production raised for the crop/county/year being reviewed and 2) that can demonstrate how production was kept separate between various units, practices and types (if applicable).

Insureds will also want make themselves available to meet with the quality control reviewer as the reviews will need to be completed before the claims can be processed.

Agents can encourage their producers to begin assembling the production history documentation that will be necessary to complete the APH Review. Agents may also want to be sure all current year policy documents have been submitted to the FMH home office so that the Contract Review can be completed without delay.
Once a claim is reported, FMH adjusters will be in contact with policyholders and/or agents. They will discern which policies will need a review and take the steps necessary to initiate these reviews. At that point FMH’s Compliance Field Specialist will oversee the review completion to ensure that all the components of the review are completed by objective and unbiased persons and according to RMA procedures.