Issuing Incorrect Payments and/or Liability Decisions

Everyone Has One

In a focus group of claimants who received less than full payment due to betterment, comparative negligence or depreciation, there was one determining factor in their satisfaction with the experience.

Their perception of the payment’s rationale. 

When they believed the payment was based on the contract, fats and the law, they were mostly satisfied.

When they believed that the payment was based on the company’s procedures, they were mostly not satisfied. 

When they believed that the payment was based on the adjuster’s opinion, they were fighting, spitting mad. These are the people who call your supervisor and file insurance department complaints. 

The lessons:

Claims decisions are never opinions! They are based on a reasoned analysis of the facts and the law. That’s why “Claims Means Never Having to Say You’re Sorry.”

Don’t explain a payment as being a “company procedure”. Nothing is ever just a company procedure. The company procedure is to satisfy a legal requirement – regulatory or contractual.

Drive out all personal pronouns such as “I can give you..”. “I think” or “We have decided”; instead, use “the car is worth”, “Negligence has been assessed…” or “the value of the damage is $12,500”.

Make sure every payment is rationalized based on the facts and the law – and never anything else!

Because, while we all have one, you must never expose it to any customer at work….your opinion, of course.

Mark’s Claim can be denied! Let us know your thoughts!

Always Make the Offer

“You miss 100% of the shots you don’t take.”

When I don’t think my offer will settle the claim, I always remember that saying.

Take the shot. Make the offer. 

If it is an auto case with a comp neg split, your offer effectively puts the claimant carrier on notice of your position: You’re not paying 100%. This really speeds the subrogation process because the other side is far less likely to ‘Just Say No’ when it is reported to them as having shared responsibility.

If it is a represented claimant, the attorneys have the duty to take the offer to their client. You never know people’s motivations. It has happened more times than I an count that the client overruled the attorney and took the money. Take the shot.

If it is a convoluted commercial question, your offer stakes your ground on where your coverage and liability applies. 

Once I made a really low offer on a suspicious BI claim where there was clearly an accident – but not as clear was if the claimant was in the car at the time. Their immediate acceptance was proof enough for SIU involvement leading to two arrets.

Other good things happen when you put your position out there:

Challenges can fine tune your argument;

Adversaries are forced to respond; and

The first offer generally results in a stronger position to dictate the terms.

So, even if you are pretty darn sure the claimant won’t take it – make the offer.

You miss 100% of the shots you don’t take. 

Mark’s Claims can be denied! Got a better way? Let us know!

Why would you NOT make an offer? 

Our Auto Total Loss Tax & Fees Story

Claim Toolkit’s newest product is Auto Total Loss Tax & Fees. If you’ve never heard of it, an adjuster puts in the amount of a total loss vehicle with all the vehicle and owner information and our product tells them what the taxes and fees are associated with that information. If might not sound that difficult, but it’s a beast! Did you know that taxes and fees can be different from your neighbor across the street?

So, how did Auto Total Loss Tax & Fees get started? A customer came to us asking if we could create it! So, we did. But, it looked very different than how it does now. We created the platform with the calculator but told the customer that they needed to update the taxes and fees themselves – that would not be something we would maintain. In fact, our President wasn’t about it at all! He said there would be no way for anyone to create this system and keep it up to date. The man power that it would take would be off the charts.

Our Vice President thought it could be done so pushed ahead! Along with our very talented developers, they created a platform that an adjuster could enter in the vehicle information and the final calculation with taxes and fees would populate. Again, at the beginning though, the customer had to keep up with the taxes and fees. 

If you’re like me, you might not really think about taxes and fees, but now take a second and really think about it. You need to keep track of taxes and fees for EVERY country across the U.S. And what do you need to calculate taxes and fees? The garaging address. If you’ve never lived in the mountains before, let me tell you, USPS hates our addresses. It might be hard to believe, but we actually don’t get mail to our houses because our addresses aren’t validated. Now, let’s put that all together…to figure out taxes and fees, we need to know the garaging address to figure out the county and not all addresses will validate. What does that mean though? Someone needs to manually check those addresses that won’t validate. I know, a beast!

When it became apparent that the customer wasn’t keeping up with the taxes and fees, plus more customers inquiring about the product, the Claim Toolkit team took over. We decided that our small (but mighty) team would take this on full time and keep track of the taxes and fees. It has been quite the undertaking but every day we have more insurers interested in the product. Why? Because it’s that difficult to keep track of taxes and fees and no one else is doing it!

What I hope you take away from this story is, if a customer asks for something, we will do our very best to make it a reality – no matter the obstacles! Here at Claim Toolkit, we take on big challenges to make claims adjuster’s lives easier. That’s why we do what we do. 

Information You Need to Know

It is amazing the amount of information a claim’s adjuster needs to know. I see all the information we have in Claim Toolkit for Compliance and it blows my mind that one person needs to know all this information to handle a claim! Let alone, handle different types of claims in different states that have different laws. 

When I started working in the property and casualty insurance realm, I looked for a class that would give me an overview of what a claim’s adjuster needs to know. Surprisingly, it’s a very hard class to find! So, if you are a new adjuster or if you’ve switched territories, what kind of training do you get? Do you have a cheat sheet that the company provides or is passed down from another adjuster? Is your desk covered in sticky notes?

Would it be handy to have a chart with specific information by state? For example, a chart with the med pay laws in Alaska? Or, a chart that details the laws around fraud in California? Claim Toolkit for Compliance has just this! I have learned SO MUCH by typing in key words in a search bar and having a chart populate based on that key word. Then, I select the chart I want to see the laws and regulations around the topic in a way that I actually understand. 

Yesterday I met with a manager to give a demo of this product. Multiple times she said, “I wish I had this product over the last 20 years. It would have made my life so much easier!” I think we all do.

Some examples of our top utilized charts are: General Duty of Care, Statute of Limitations, Communication Time Limits, UM/UIM and No Pay/No Play laws. This is just the beginning – we have over 60 different charts of information! If you are a new adjuster or new to a territory, we have a chart that is a made for you – State Compliance Overview. This gives you the top regulations you need to know when assigned a new state. Best part about this, you can download the chart and print it off. Just hang it on your wall by your desk to easily reference it at any time. *We do recommend reprinting it weekly as we are always updating the information with the newest regulations.

You tell us, as a claim’s adjuster, what is it that you need to know? How do you find that information? For Claim Toolkit, if we are missing information that you’re looking for – we add it! Just think…how much time could you be saving by entering a word into a search box to find the information need? How much faster can a new adjuster get up to speed? I’m going to leave those questions there for you to ponder…

One Answer is What You Don’t Know

It was the next to last interview for the big corporate job. Tomorrow I would meet the Executive VP who was the hiring manager. I seemed sure to get the position and while I expected this meeting to be perfunctory, it ended up profound. 

The wise head of auditing leaned back in the booth. We were at a tavern near Cleveland. (Yes, it is true young ones: in the 80’s, we would often gather in bars for interviews, meetings and fellowship.)

He listened to my life story respectfully and asked a few forgettable questions before he stopped me with this one:

“What’s the one thing you need to know to be successful in this job?”

One? I was perplexed. I rambled about integrity and purpose and while he nodded, he wasn’t satisfied. 

“Those things are necessary,” he agreed. “But what is the one thing you need to know to be successful in any job?”

Now the sweat broke out and I stammered. I admitted I had no idea. 

“You’ll be perfect,” he said. 

P.S.: Use this in your own interviews. There is nothing more important to know in claims or management then what you don’t know.