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!

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…

Why use an Audit Software Platform

How is your current audit system set up? How long does it take you to complete an audit and do you feel like you’re gathering all the information you need? What’s the point of auditing? Tough questions – I know! 

I recently starting getting involved in our audit product and let me tell you…how I’ve seen it help organizations is just remarkable! I’ve heard our owner, Mark, say that but he created the company and the software so it makes sense. But, honestly, it’s the truth! The amount of positive feedback I’ve heard from customers about how this software makes their lives easier, makes feedback to their adjusters easier, and saves them time – it’s actually all I’ve heard. The number of companies that are currently using spreadsheets to audit their adjusters is unbelievable. The formulas, the amount of time, how to translate the numbers into digestible reports – it’s actually quite impressive that people do it this way! 

I personally never really thought of the process companies use to audit their employees for efficiencies, following procedures and giving feedback using data but now that I’ve seen how our audit software really helps, I don’t know why anyone wouldn’t want to use it! Don’t just let me, an employee at Claim Toolkit tell you that, we have over 40 audit customers that can tell you that as well!

With Claim Toolkit for audit, you can customize our software to best suit your needs. What kinds of audits do you want to run, what kinds of reports, who has access to what – that is all up to you! Our software is a template and we provide guidance to help you get the best results possible.

Our goal for audit is that it helps managers see where their claims’ adjusters need more training. Isn’t that the point of auditing? What are we missing and how can we do better? It isn’t just to give someone a grade. It does give that but Claim Toolkit for Audit helps you really drill down to what’s being missed so you know EXACTLY what to train on!

We have continued to make improvements on this product as we are given feedback from customers to ensure that it meets every customer’s needs. We are currently working on an enhancement where managers can input goals for employees so they can compare results to the goals set.

If you are unsure if you really need an audit system, that your spreadsheets seem to be working just fine, it never hurts to just check us out. We can provide a quick demo so you can see if Claim Toolkit for Audit might just suit your needs and make your audit life a little easier! 

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. 

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? 

How to Choose a Claim’s Management Software

There are quite a few claims management software systems out there. How do you choose? Each company needs to make the right decision for them and what’s best for their team. If you are considering Claim Toolkit for your software needs, here are some things to know about us that could help! 


Claim Toolkit has been in business since 1997, with our founders/owners still very much involved in the day-to-day operations. Both came from P&C insurance companies so saw what the industry was missing and decided to create a company. The business has been in full swing ever since and every year we continue to bring on new customers as well as serving existing ones. We ask what our customer’s need so we can enhance our products to P&C insurance adjuster’s needs. Feedback has been an essential factor in our enhancement and creation of new products. 


We get asked quite frequently what insurers use our products. Though we can’t disclose names, we can tell you that some of our clients have great commercials! We also have customers that are smaller, local companies that are just as important to us. Big or small, we love our customers – they keep our wheels rolling!


No matter the size of the company or their current software, our products integrate seamlessly. All of our products are web-based application that are specific to the company using them. In the last couple of years we have even started to do single sign-on’s to make it even easier for claims adjusters to hop on our applications. They may not even realize that Claim Toolkit is a separate product/company because of this integration. We want to make it as seamless as possible to get your adjusters up and running using the product so their job is easier and more efficient. 


For the amount of adjusters using our products, you’d be surprised how few questions we get about how to use our products. We have hover help, so if you don’t know what something means just hover over it for an explanation. Our compliance product, which can be overwhelming to look at because of the amount of information, has a search tool! The adjuster doesn’t need to know exactly what a chart is called but can type in a key word and the charts related to that word will populate so they can select the correct one they are looking for. Don’t worry though, we provide training on all of our products – whether you’ve been a customer for years or you’re brand new! 


If you’re considering a claims management software system for your audit, auto or compliance needs – we can help! There is never any harm in learning more about how your company can become more efficient. In fact, we just signed a customer that reached out to us years ago but at that time decided to go with a different company. Sometimes, it takes comparing to realize that Claim Toolkit is what you need! Claim Toolkit was created by claims professionals for claims professionals, so maybe we can help you! 

First Impressions are NOT just for Tinder

Have a tough negotiation coming up? Take a minute to think of something you can genuinely say about the case that your adversary will see as a positive.


I am not talking about their alma mater’s victory. I am talking about something in the case that you can offer that benefits them.


“I have received authority to settle this case.”


“We have completed our investigation and we can close this today.”


“I received and reviewed your recent additional documentation, thank you, it was exactly what I needed.”


Social science research from the University of Iowa showed two things:

1.) Adversaries were 80% more likely to accept less advantageous results when the overall impression of the interaction was positive.

2.) They were 60% more likely to see the overall interaction as positive if the first substantive information they received was beneficial, or positive, to them.


This technique is easy and costs you nothing. It won’t work every time, but what does? It can’t hurt. Try it and let us know what happens:


Open every negotiation with a statement that your adversary will see as positive.


You might “swipe” a great settlement.


Mark’s Claims are meant to be denied! How do you open a negotiation?


Bringing the Most Up-To-Date Laws

On our website it states that our applications are updated over 20 times every business day with new laws and regulations. A common question we get it – is that true? It is! It’s probably double that at the moment with all the changes in each state due to COVID. The follow up question to that is – How?


Our typical response is that we have a lot of spreadsheets! But now we think it’s time for us to give you a behind the scenes look on our updating secrets. Are you ready?


1. We do have a lot of really good spreadsheets that we work off of. They can overwhelming at times because of the amount of information on them but they are an amazing tool. I’m sure you’re thinking…what information is on them? Great question! For each state, we keep track of active emergency orders and directives with the expiration dates and the corresponding links to websites where they information is kept. EVERY SINGLE DAY we go into that website and see if any new regulations have come out that impact the P&C insurance industry. Our spreadsheets keep track of expiration dates so we know when a regulation is expiring and know to look to see if there’s an extension. Yes, we do this every single day! 


2. We have a compliance team. Companies that have lawyers typically have lawyers to protect their business, but our team is a little different. Our team of attorneys review laws and decide which ones are applicable in our industry and then put them into simple terms for anyone to understand. Again, updating our applications for any changes in laws or enhancing our products by adding new content! Here’s a secret…what is an attorney’s least favorite season? Bill season! Could you imagine having to read 100 bills that were just signed to find what impacts the P&C insurance industry? Woo, what a job our team has! 


3. Our entire team is dedicated to keeping up with changes that impact claims adjusters. It’s our full-time jobs! Every day we check governor’s news, state news, etc. to see if there is anything that our customers need to know. If so, we update our applications! It really is a full time job keeping all the information up to date. Claim’s adjusters have to know so much and work with customers everyday, so we pride ourselves on keeping information up to date so an adjuster can just hop on the application and find their answer – quick and easy! Hunting down laws and regulations shouldn’t be what they spend hours doing. That’s why Claim Toolkit was invented! 


So yes, we really do update our applications over 20 times a day! I think most of us at Claim Toolkit have learned more than we ever thought possible about P&C insurance laws and regulations because of this! Why hunt down the information if we already have it in a database, ready to go? Out motto is, “Your team needs the right information so they can make the right decision, right now,” – and now you know how we hold true to that! 

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?”