13 hours ago

The Professional Claims Handler
Post 5216

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry.
Standards to be a Professional Claims Adjuster

The Insurance claims professional should be a person who:

Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.
How to Create Claims Professionals

To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers must maintain a claims staff dedicated to what will provide “excellence in claims handling.” They must recognize that they, as representatives of the insurer, are obligated to assist the policyholder and the insurer to fulfill all the promises made by the insurer in the wording of the policy and all promises made by the insured when accepting the policy. An insurer can create a claims staff dedicated to excellence in claims handling by, at least:

Hiring well trained, educated and empathetic insurance claims professionals.
If professionals are not available, the insurer must train all members of the existing claims staff to be insurance claims professionals.
The insurer should train each member of the claims staff annually on the local fair claims settlement practices regulations.
The insurer must supervise each claims handler closely to confirm all claims are handled professionally and in good faith.
The insurer must explain to each member of the claims staff the meaning of the covenant of good faith and fair dealing from its inception in the 18th Century to the present.
The insurer must require that its claims staff treat every insured with good faith and fair dealing.
The insurer must demand excellence in claims handling from the claims staff on every claim whether small or major, whether an individual or a corporate insured.
The insurer must explain to the claims staff that the insurer is ready to immediately dismiss any claims handler who fails to treat every insured with good faith and fair dealing.
The insurer must, if any experienced claims professionals exist on the insurer’s staff, cherish and nurture them and use their experience and professionalism to train new claims people.
The insurer must, if no experienced claims professionals are available and employed by the insurer, the insurer has no option but to train its people from scratch using available materials produced by the National Association of Insurance Commissioners, the State’s Department of Insurance, Insurance associations, and professionals who have – for a reasonable fee – the ability to train claims personnel properly and effectively.

When the claims staff is made up of claims people who treat all insureds and claimants with good faith and fair dealing and who provide excellence in claims handling, fraud will be deterred and litigation between the insurer and its insureds will be reduced exponentially.

To keep the professional claims staff operating efficiently and in good faith they must be honored with increases in earnings and perquisites that they earn by their professionalism.

Conversely, those who do not treat all insureds and claimants with good faith and fair dealing must be dismissed and sent off to a different career.

Claims management must insist on excellence. There is no reason to accept less than excellence in claims handling. The insurer must make clear to all employees that it is committed to immediately eliminating staff members who do not provide excellence in claims handling and are ready to fire publicly and quickly those who cannot or do not provide excellence in claims handling.

Part Six of The Zalma Philosophy of Claims Handling will deal with the creation of an Excellence in Claims Handling Program.

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