Monthly Archives: February 2013
Pile of Denial
Denying a claim is never easy. After all, our job in claims is to look FOR coverage. So when it’s time to have to tell a customer that we cannot pay for something, it always feels like we are piling on even more despair than the original loss. And since we claims people are an empathetic bunch, we can feel down ourselves when our customer is sad.
The answer to feeling better? Our original Pile of Denial tasty dessert. This dessert has so much piled on it you are going to need two spoons and three hours to eat it.
The nice thing about the Pile of Denial is, that while you are eating it, you can deny that eating 4,000 calories in one sitting is fattening. You can also deny that you’ll be up all night; deny that sugar is bad for you; and even deny that you were rude to not offer any to your spouse.
Added Suggestion: Perhaps make an extra one for the customer whose claim you just denied. They have a right to feel better too, don’t they?
• One scoop chocolate ice cream
• One scoop vanilla ice cream
• One scoop cookies and cream ice cream
• One waffle cone
• One fudge brownie
• 2 tablespoons milk chocolate chips
• 2 tablespoons white chocolate chips
• 1/4 cup chocolate syrup
• 1/4 cup caramel
• 2 tablespoons chopped pecans
• 3 sliced strawberries
Place the brownie in the middle of a large soup bowl. Next, pile the three flavors of ice cream on top in your preferred order. Next, crumble the waffle cone on top of the ice cream. Then top it with the milk chocolate and white chocolate chips, pecans, and strawberries. Lastly, drizzle the chocolate syrup and caramel on top. This is a delicious way to end your day.
From the Claims Cookbook by Carl Van and Laura Wimsatt
Carl was in Toronto this week as the Keynote Speaker at the Canadian Independent Adjusters’ Association (CIAA) and the Ontario chapter of the Canadian Insurance Claims Managers’ Association (CICMA).
Claims managers must remember importance of customer service, good faith
By: Greg Meckbach, Associate Editor
Carriers may deny claims on occasion, but speakers at a conference Tuesday advised claims professionals to never forget their first job is to provide customer service business and to take heed to judges’ rulings on what constitutes good faith.
“It’s a hard beast to pin down,” Stephen Scullion, the Kitchener-Waterloo, Ont. branch manager of Granite Claims Solutions, said of the legal definition of good faith. “There are many definitions of it.”
Scullion made his remarks to a room full of claims professionals at the 46th annual joint conference of the Ontario chapter of the Canadian Independent Adjusters’ Association (CIAA) and the Ontario chapter of the Canadian Insurance Claims Managers’ Association (CICMA) in Toronto.
Good faith requires claims professionals to, among other things, to refrain from nullifying claims without adequate justification and to undertake adequate investigations, Scullion said, referring to a 2001 ruling of an Ontario Superior Court judge, who awarded damages after finding an insurer and an adjuster did not act in good faith.
When assessing whether an insurer acted in good faith, Scullion suggested, the courts will look not at whether the claim was paid, but on the conduct of the insurer throughout the process.
“An adjuster’s job is to properly indemnify the insured as per the provisions of the insurance contract. I want to drill that into your head, ‘as per the insurance contract,’ Scullion said. “Never forget that.”
In a presentation titled “Of Red Flags and Good Faith”, Scullion walked attendees through the salient points of several legal decisions involving disputed claims. In one case, for example, a carrier denied auto liability coverage to a claimant who had been charged with impaired driving. The problem was, the claimant pled guilty to the lesser charge of failing to provide a breath sample and the crown dropped the more serious charge of drunk driving, but the insurance company did not have proof the claimant was actually driving drunk.
Scullion also warned adjusters not to judge claims just because there are “red flags” on a client’s file.
“You must change your way of thinking,” he said. “Here’s the biggest one. Correlation does not equal causation. Just because every time it rains you see a pigeon in your backyard, that pigeon didn’t cause the rain.”
He illustrated by way of example how this applies to claims.
“If someone has a post office box address, or someone has increased their limits just before the loss, does that mean it’s a fraudulent claim? It does not.”
He suggested judges would take a dim view of an insurance carrier who assumed a claim was fraudulent simply based on a red flag.
“If you pre conceive, (a legal judgment of) bad faith is sure to follow,” he said. “There is ample, ample case law on this.”
Claims adjusters also need to remember their primary job is customer service, said another speaker at the CICMA/CIAA Ontario chapter joint conference.
Carl Van, president and CEO of the International Insurance Institute, told several anecdotes about companies he advised. In several cases, he listened to recordings of adjusters’ calls.
In one case, he said, an adjuster received a call from an agent following up on a report from a claimant. Instead of taking the information from the agent, the adjuster said she had not received the information and suggested the agent call the 1-800 number, though the agent already had.
Van said the firm had no rule prohibiting the adjuster from taking information directly from the agent, but she wanted the agent to call the 800 number anyway.
“I went up to her, and asked, ‘Why didn’t you take his loss report?'” Van said. “She is not stupid, and she wasn’t lazy. She was there until 6:00 at night working. You know what she said to me? ‘It’s not my job.’ I said, ‘What is your job?’ She said, ‘I handle claims’ and she gave me a nice long list. Guess what words never left her lips? I provide customer service. She doesn’t know she’s in the customer service business.”
He said some carriers look at their customer satisfaction scores and only compare themselves to other carriers, rather than to other industries. He also suggested some customers who report they are satisfied with their carriers might still take their business elsewhere.
“Don’t be bragging about your customer service,” Van said. “I don’t care what your customer service scores say, if your own people don’t even know that they’re in that business, it’s very unlikely that you’re delivering extraordinary customer service because they’re going to make the same decision that adjuster made and not help that agent.”
Customer service fundamentals
Delegates at the 46th Annual CICMA/CIAA Joint Conference learned how to improve their customer service
“What do we do? Do we explain the policy? Yes, we have to do that. Do we explain how the claims process works, the time it takes. Yes, often,” he said. “What we really do is work to calm people down. Engage their ability to listen. Look for ways to give them a sense of control and put them at ease.”
The GIO receives roughly 3,500 calls a year and, in 2012, only five calls escalated to mediation, said Maltman.
To demonstrate how best to serve consumers, Maltman had two GIO volunteers act out a scripted consumer call in which the consumer was quite frazzled with how her adjuster handled the claim.
The exercise stressed the importance of setting consumer expectations, validating their concerns and establishing trust.
“Fairness, going that extra distance, is not just about throwing money at a claim. When people feel that they are being listened to, respected, and treated with patience and kindness, that translates into fairness in the consumer’s mind. It doesn’t have to cost more money,” said Maltman.
Steve Scullion, branch manager at Granite Claims Solution, then delivered a presentation on good faith.
“An adjuster’s job is to properly indemnify the insured as per the provisions of the insurance contract,” he said. “How and when you communicate, convey and apply these provisions to a claim separates good adjusters from, well, the not so good adjusters. Failure to do so may lead to the actionable claim of bad faith against the adjuster and/or insurer.”
Scullion provided this definition of good faith from Comunale v. Traders & General Ins. Co. California Superior Court, 1974, “… there is an implied covenant of fair dealing in every contract that neither party will do anything which injures the right of the other to receive benefits of the agreement.”
To avoid claim files being used against an insurer in a bad faith suit, Scullion said, “Pretend everyone you meet has a secret camera.”
Assume that what you say and what you do is going to be seen by everyone in the world. If you do, he said, you won’t go far wrong.
He also stressed that adjusters should not include what they think in their claims reports. Only include what they know.
The keynote address was delivered by Carl Van, president and CEO of the International Insurance Institute Inc.
Van’s energetic presentation was dedicated to giving adjusters tools to improve their customer service.
“[Customer service] is what we do. This is all we do. We don’t actually do anything other than provide customer service,” he said. “The only problem is, we don’t describe our job that way. We describe our job in terms of our tasks. The truly great customer service companies are the ones where every employee, when you ask them what their job is, they say, ‘I provide customer service.’ ”
An important step in providing excellent customer service, of course, is understanding what customer service actually is.
“Customer service is meeting or exceeding customers’ expectations. It’s not their wants, it’s not their needs, and it’s not their desires. If you meet peoples’ expectations they’re basically satisfied. If you fall short of their expectations they’re basically dissatisfied. That’s all there is to it,” he said.
Claims adjusters have an opportunity to set expectations, he said. They just need to let customers know what to expect.
“Loyalty depends on customers getting what they expect,” he said.