Claim Files Incomplete or Not Properly Documented

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! 

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!

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. 

How to Disagree (Part II): As It Turns Out

In our last Mark’s Claims, we started this series on how to disagree without being disagreeable.

If you are a professional golfer, you practice a lot of putts. If you are a professional basketball player, you’re going to shoot a lot of free throws. These are the skills needed to succeed.

As a professional adjuster, since our job is protecting a large pile of money from people who don’t deserve any or all of it that they want, we are going to have a lot of disagreements.

Think of it like putting or free throws: you need to disagree well to succeed as an adjuster – it’s a basic skill you should constantly practice.

This blog is all about giving you actionable items – simple little tips to improve your performance as a claims professional. 

Here’s another disagreement tip from the world of Visual Linguistics.

Visual Linguistics is the science of studying how the mind reacts to words and images. Simply put, to further our understanding we turn words into images and imagines into words. 

As an expert in disagreeing, we want to avoid words that provoke images of conflict and instead use words that visualize the absence of conflict. This brings me to the star of this column:

As it turns out.”

What do you “see” when you hear or read these words?

The visualization of this phrase conjures the image of a near -miss, a collision that didn’t happen or that a turn occurred before impact.

Another popular visualization is a surprise ending – that the souffle didn’t quite rise or the new bedroom paint didn’t work like you expected.

But it is not judgmental in any way: Might not be what you expected but it’s just the way things turned out. 

Perfect for a disagreement professional!

Let’s try it!

“As it turns out, both regulators and the repair industry know that aftermarket parts are a safe and economical way to put your car back in pre accident condition.”

“As it turns out, the medications that you submitted for reimbursement are for breast cancer, not the accident, so they are not eligible for reimbursement.”

“As it turns out, your policy doesn’t cover the custom awning you installed without an additional premium.” 

“As it turns out, the value of the damage is significantly less than first reported.”

“As it turns out, the law places some responsibility on you as the icy sidewalk is considered an ‘open and obvious’ hazard.”

When you speak, people are seeing images in their mind. Draw an image of the avoidance of conflict: use “AS IT TURNS OUT.”

Stay tuned for more tips on how to disagree!

How to Disagree (Part I): The Power of And

I love the Godfather series of movies. One of my favorite scenes is the one where Al Pacino is lectured: “This is the business we have chosen.”

If you are a working adjuster, someone will disagree with you on every day that ends in a “Y”.

This is the business we have chosen.

It follows that being able to hold your own in any argument is a necessary survival skill. Over the next several weeks, Mark’s Claims will be here with simple – but effective – techniques on how to disagree without being disagreeable.

Today’s is the simplest of all:

Never use the word “But”. Instead, use “And”.

Social science research at the Ottawa Institute for Advanced Linguistics found using the conjunction “but” was far less effective (as much as two thirds less effective) in resolving a dispute, compared to the conjunction “and”. 

In the experiment, students received a false but official-looking notice that they would not be allowed to graduate because they had unpaid tuition. They were told to visit an office bringing proof of payment where the researchers waited. In each case, regardless of the student’s proof, they were met with 1 of two statements:

But you can’t graduate without paying all of your tuition.”


And you can’t graduate without paying all of your tuition.” 

The subjects were evaluated on their reactions to each statement. Statements with “but” were evaluated to be 64% LESS EFFECTIVE than statements with “and”. “However” showed a meager improvement to 47% LESS EFFECTIVE.

My own experience proves this technique works! Let’s try it!

“I know you believe your car to be worth $10,400 and the market value is $10,200.”

“Yes, you indeed had the right of way and you were too fast for the conditions based on the law.”

“Your demand of $55,430 remains a mystery to me and the actual value of the case is not even the same number of digits.” 

So simple!

Get rid of “But“. Use “And” instead.

Stay tuned for more tips on how to disagree! 

Like a Good Neighbor

Need to reach someone in a hurry but can’t track down a phone number? 

If you have their address, use one of the many online reverse directories to find numbers for neighbors and call them! A recent Gallup Survey said 72% of all Americans would consider passing information to a neighbor – but only if it was a “clear benefit” to their acquaintance. 

The quality of these internet cross reference services seems to change with the wind but at Claim Toolkit, we current like 

Lets acknowledge that this technique won’t work in every neighborhood and cold calling is tough to do. But you can do it and you should! It will increase your contact percentages – guaranteed. Surprisingly, apartment building can be fertile grounds.

In the days where we can easily Venmo someone a cup of coffee, managers should think how they can empower their claims reps to thank people who help. 

My best success has come when I’ve given a quickly spoken request that emphasizes that I am not a salesman and their neighbor needs my help. I string everything together, talking fast – and hope they don’t hang up.

“This is Mark Fay with Acme Insurance on a recorded line. This is not a sales call. Hey, do you know Sue and Bob across the street? I’m their insurance adjuster. I don’t have their cell, could you get them our number?”

“Mark Fay with Acme Insurance, not a sales call. Did you notice Bob’s silver Mazda across the street was damaged? We’re the insurance company responsible – can you have him call us?”

“Mark Fay adjuster with Acme Insurance here – not a sales call. We’ve been trying to reach your neighbor Sue in Unit A1 to take care of some medical bills she has, could you stick a note on her door? Happy to send you $5 for a cup of coffee.”

While social media and snail mail are also effective tools, when you need to reach someone in a hurry, call people who live or work near them.

Like a good neighbor, many Americans will pass your info on. 

Try it!

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

Why would you NOT try to call a neighbor? 

The Most Important Question to Ask

When taking a statement, many of us don’t pay attention to the answer to the most important question. Or, we might not ask it at all.

In training, investigators FLETA, the Federal Law Enforcement Training Academy, says the most important question is the “Framing Question”:

“In your own words, can you tell me what happened?”

That’s it! Sounds easy, right? It is anything but.

The skill comes when you listen intently to the answer and respond – after they have finished – with follow up questions.

You must not interrupt the person. Allow them to completely ‘play back’ the memory. Encourage them to keep talking until there is nothing more they have to say. It turns out our brains best recall things if we can speak without stopping.

Take good notes. Look for holes where follow up question are needed. In Auto Liability, listen for speed, look out and avoidance. After they have finished, ask why questions: Why did you not slow down? Why did you not see the other vehicle? Why did you not attempt to change lanes or take other avoidance maneuvers? Why could you not avoid this crash?

In injury claims, listen carefully to descriptions of the injuries and the causes of them. Follow up with questions like: Why did you not immediately seek treatment? What visible signs of injury were there immediately after the crash? When did you know you were hurt?

FLETA studies and their deep experience shows that the most accurate, complete and truthful answers are given the first time the question is responded to, and the quality of the memory and testimony degrades both by the day and the number of times the story is retold.

So, be quick to take the statement and get it right the first time. 

The key point of the ‘Framing Question’ is that by allowing your interviewee to fully play back the description of the incident without interruption, they will be more truthful and more likely to include their own culpability in the statement.

FLETA trains every investigator to ask this question FIRST – before even the identifying information: that’s how important they think the question is.

What’s the most important question?

“In your own words, can you tell me what happened?”

Distracted Driving – Who’s at Fault?

In honor of April being National Distracted Driving Awareness Month (we promise it’s real), let us tell you about Claim Toolkit for Auto. But first a story – which may or may not be true. You decide!


A college student was driving through a campus parking structure, going around and around to get to the bottom exit. She took a turn a little wide in the narrow structure and collided with another car coming up the parking rows. Thankfully, no one was hurt, it was just a little fender bender on the front left bumper of each car. No one was around to witness and no cops were called. Who was at fault?


Who decides who’s at fault? What questions do you ask to determine who’s at fault?


In this scenario, the girl coming down was at fault (she was going too fast and taking those turns too wide) but the claim was deemed 50/50. Could this have been ruled differently if more questions were asked? Was someone looking at their phone? Maybe reading comments on a graded paper they just got back? Or talking to a passenger about the happy hour they are going to?


Maybe this is a true story, maybe it’s not, but we’re sure as a claim’s adjuster -or anyone in the P&C insurance field – you’ve heard thousands of stories similar to this one.


It’s not a surprise – there are all kinds of distractions these days. April has even been declared National Distracted Driving Awareness Month! Are you capturing all these distractions with the questions you ask when a new claim comes in?


Did you know that 34% of all crashes have more than one driver at fault? What’s your percent? If it’s 10%, that could mean you’re giving out money that you shouldn’t!


Claim Toolkit for Auto provides accident type tips and evaluation techniques to improve claim rep skill. We give fast, accurate assessments of realistic ranges for settlements. Don’t pay out more money than you have to! I bet if you were to do a cost analysis, the cost of this product wouldn’t even be a blimp on the radar to how much money your company could be saving. Don’t worry – we can help with that. We even help with training claim reps!


Maybe your company would have won this claim in the scenario above and not have had to pay anything out. What do you think? Well, if you had Claim Toolkit for Auto then yes, maybe you wouldn’t have had to pay anything because you had the software to ensure you were asking all the right questions and your adjusters have been trained on evaluation techniques. Just think….have you been giving away unnecessary money? That’s a thought that could keep you up at night! But don’t let that thought distract you while you’re driving – or we’ve taught you nothing today:)

Introducing Mark’s Claims

Something happened when I wasn’t paying attention. I have become an insurance claims expert. As a matter of fact, I have spent a lifetime learning to adjust.


In 35 years in the business, I have been an appraiser, auditor, investigator, adjuster, manager, regional manager and Corporate Claims executive while working for a carrier. I also spearheaded major projects including new claim systems and changing a 5,000-person organization to a 24 X 7 operation.


As a vendor, I have benefitted from the experience of the 25,000 adjusters I have met in the 47 states and 4 countries I have traveled to for my job. Collectively they insure everything from cruise ships to Corollas to coconuts falling on your head. Much of what I know they taught me.


Along the way I invented five software applications in wide-spread use and today we support 80 P&C carriers, TPAs and self-insureds. Because of my career in Claims, this kid from Atlanta, Illinois (pop. 1,700) considers every day Thanksgiving. For real.


Recently some super smart team members encouraged us to expand our social media presence. We have and it has given me this platform.


After literally millions and millions of claims, I have learned a few things a long the way. The purpose of Mark’s Claims is to share some of those tips with you. I’ll be back to illuminate and share one little corner of the claims worlds I have been fortunate to have visited.


You’ll learn:

The most important question to ask in every loss;

How to deal with angry people;

The best way to disagree; and


Overall, little tricks to help you investigate, assess and negotiate any claim.


I hope to challenge you, educate you and entertain you. If you feel Mark’s Claims could benefit your team or colleagues, please like, share or message us!


Because one day – and it won’t even take 35 years – you’ll realize you are an expert.