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! 

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? 

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. 

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!