Claim Files Incomplete or Not Properly Documented

Required Compliant Notices

As we continue to solve the top insurance problem, this week bring us to: Required compliant notices and/or disclosures not being provided.


An adjuster has all kinds of disclosures to worry about: total loss settlements, salvage, and policy limit disclosure, just to name a few. So as of today, how do they keep track? Well, it seems that most aren’t which is why it’s a top problem! 

Processing Total Loss Claims Correctly

This week we are getting into one of the biggest challenges: Processing total loss claims correctly.


We actually had a customer approach us with this problem and asked us to come up with a solution. At first, we didn’t think is was possible but Claim Toolkit for Auto Total Loss Tax & Fees was born! 


It has taken us years to perfect this product but now we can say with confidence that Claim Toolkit for Auto Total Loss Tax & Fees is your solution to handling total loss claims properly. Out of all of our products, this one has been the most popular this year. Why? because everyone has this problem but there aren’t many solutions out there!


We calculate tax and fees so you know exactly what is owed for a total loss, no matter the garaging address. We even have team members dedicated to keeping the taxes and fees up to date and making sure all the calculations run smoothly. 


Do you think you’re a total loss expert? Send us your answers to these questions to find out (no cheating!):

Issuing Incorrect Payments and/or Liability Decisions

Communication Time Limits

At Claim Toolkit, we keep all our information up to date by staying in the know. One of the ways we do this is by looking at market conduct exams, talking with customers and reading articles. We’ve been seeing and hearing P&C insurance problems that have easy solutions to them so we want to help!


We are going to kick off with: Paying, investigating, acknowledging and/or denying claims outside of the specified time frames.


We’re sure that no is surprised that this is a top issue for insurers! As an adjuster, how many time frames do you need to keep track off? That’s why Claim Toolkit for Compliance create a Communication Time Limits chart.


This is one of our most popular charts as it outlines time frames for everything you need to know when handling a claim – in every state, plus DC. 


How many days does the insured have to make proof of loss after a blank form is supplied by the insurer? For North Dakota, its 60 days

How many days does an insurer have to make a decision on claims/benefits within receipt of a valid and complete claim? In Colorado, 60 days


Claim Toolkit for Compliance can’t ensure that you meet these time frames, but we can give you all the information you need to try! 

Calming Customer Anger

Ever have someone angry with you about a claim you handled? Occupational hazard, right?


A 2020 Harvard Law School study confirmed again that Active Reflective Listening is the most effective conflict resolution took when the outcome is out of the hands of the customer service agent. It’s the tool of choice when the flight has left, the item is damaged, or the hamburger does indeed have a hair.


Or, in our case – when the claim is worth what it’s worth, and they don’t like it.


Active Reflective Listening has various incantations but generally four steps:

1. Carefully listen to the complaint – that’s the Listening part

2. Test for understanding to identify the exact emotion and it’s cause – that’s the Active part

3. You repeat – REFLECT – both their emotion and the cause of it

4. You offer any solution you can and an apology if you or the company are erred


Since often, claims means never having to say you’re sorry, number 4 is pretty much out. That leaves the simple technique of carefully observing their emotion and holding up a mirror to it.


“You’re angry that the matching siding is not covered under the policy.”


That’s the technique: Name the emotion accurately and the reason for it. Say nothing else. 


If you can’t name the emotion accurately, test for understanding. “Am I correct in assuming you are angry that the matching siding is not covered under the policy?”


If they respond with, “No, I’m angry that my agent did not tell me it was not covered,” you MUST name the emotion accurately and the reason for it.


“You’re angry that your agent did not tell you matching siding is not covered under the policy.”


By naming the emotion and its cause accurately, you are using the most effective conflict resolution tool when dealing with an angry person. You are reflecting to them you are aware of their anger and the reason for it.


By saying nothing else, you are not so subliminally telling them that no matter how angry they get, they are not entitled to more money.


This technique works in any human interaction, with any emotion. When dealing with an emotional person:

-Accurately name their emotion and the reason for it

-Say nothing else


You’ll be amazed at how often that emotional person becomes more rational and moves to resolution.


Mark’s Claims can always be denied! What techniques do you use when calming customer anger?


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? 

How to Disagree (Part III): Silence is the Space Between the Notes

Recently on an extended beach vacation, I demonstrated that I am among the best in the world at doing nothing.

I can do nothing all day long.

I don’t mean what a lot of people might think is nothing: watching a movie, reading, napping or cleaning a closet.

I really mean nothing. My companions can tell I am not catatonic because I will appear alert and observant and will reply to most questions. But, I will not move for hours except for the most basic of functions.

If I was practicing Zen, you would think it’s an art carefully honed over years of practice, but it’s not.

I am just naturally doing what I am best at: nothing.

So, it will come as no surprise that one of my favorite negotiation techniques is Silence. Silence in negotiation is doing nothing.

When does silence help? I use Silence in three main ways:

1. To give an air of suspicion, finality or drama after a definitive statement such as a settlement offer or liability assessment

2. To deal with an emotional person

3. When I am jammed and need time to come up with a creative solution

In the first case, when someone makes a ridiculous offer, a long silence can show your suspicion or frustration. After your incredibly fair and well-explained offer, the silence means you have ‘said it all’.

In the second case, after correctly identifying the person’s emotion and the reason for it, silence helps move the person to resolution by implying there is nothing else you can or will do.

It is the final case where silence is truly golden. In a study released by the Sloan School of Business at MIT, researchers found silence improves outcomes for all parties to a negotiation. 

“When put on the spot to respond to a tricky question or comment, negotiators often feel as though they must reply immediately so as not to appear weak or disrupt the flow of the negotiation,” said the study. “The research suggests that pausing silently can be a simple yet very effective tool to help negotiators shift from fixed-pie thinking to a more reflective state of mind…which in turn, leads to the recognition of golden opportunities to expand the proverbial pie and create value for both sides.”

Many people think of Negotiation as an Art, and I am one of them. The great artist and composer Claude Debussy said, “Music is the space between the notes.”

In negotiations, silence is the space between the offer and the acceptance, the Space Between the Notes.

My mom always said someday I would elevate doing nothing to an Art Form.

And now, I have.