What Is A Claim To Insurance Companies?

       

I am working with Mitchell on a claim, and his claim and my post yesterday got me thinking about claims from the insurance company’s perspective. By way of some background, in the claim that Mitchell is working on the supervising adjuster is being very aggressive and demanding to the point of being insulting and demeaning to both him and the insured. Needless to say it’s gotten off to a bad start and letters have been flying back and forth. But still it got me to thinking about what a claim is to an insurance company.

Now a lot of you may be thinking that a claim is an expense and you’d be right, but I think it’s much more than the money that’s going to be paid out. It gets back to understanding why people buy insurance in the first place. Yes, I know you have to buy insurance if you own a car or mortgage a house, but why purchase from one company as opposed to another? Why do folks say I’ve got State Farm Insurance or Allstate Insurance as opposed to just saying I’ve got homeowner’s insurance or auto insurance? I think it’s because there is a perceived value in the company who sold them the policy and a hope that value will be expressed at the time the claim is made. So when I think of claims, I am thinking of opportunity.

A claim is an opportunity from the company’s vantage point to deliver upon that perceived value. To deliver value in the adjustment, to deliver value in the evaluation of damages, to deliver value in the payment of the claim, to deliver value in the relationship that is established between the parties. However, Mitchell’s experience seems to indicate that the insurance company doesn’t look at a claim as a way to deliver value. They are just pissed off at having to pay. In reality what occurred is that the insured is being perceived by the company as trying to get something they don’t deserve.

And that mindset is a wasted opportunity to deliver on that perceived value.

Imagine how different the relationship between insurance company and insured would be if the insurance company fostered and nurtured the concept that a claim is an opportunity to deliver value in the adjustment process. Imagine if the adjuster were more concerned with building a relationship instead of letting the policyholder know what wasn’t covered and what the insurance company couldn’t do. Imagine if they brought to the table solutions rather than objections. I think the bottom line would actually improve. Sure indemnity might increase slightly, but legal and experts expense would certainly drop.

“Would you like a latte with that drywall?”

Bill

Insurance Claims: No Insured Is An Island

I was speaking with a friend of mine today regarding a potential referral for business. A friend of his has an insurance claim and was apparently having difficulty with their insurer. In short they were out matched and out gunned at every angle. It didn’t help that the insurance company was one of those who hate paying out claims. Now you might say that all insurance companies hate to pay claims, but I am not sure that is correct. I think the vast majority of companies, while not liking to pay claims, see claims as a way to fulfill the promise made when they took the premium. Getting back to my potential referral story: this insurance company hates to pay claims. They are at war with their policyholder and the only one who doesn’t know it is the policyholder. 

This got me to thinking about Benefit Bill™. One of the points that I advocate on that site is team building. You would never consider playing football team without 10 other people on your side (we’re not talking about pickup games here), why do you consider going up against the insurance company without your team in place? Think about it a minute. Your insurance company has a readymade team at their disposal: claims managers, supervisors, adjusters, contractors, engineers, accountants, contents experts, attorneys and the list goes on and on. You do you have?

If you said me, myself and I, and you are going up against the insurance team, my monies on the insurance team. Maybe that’s why so many insured’s wind up settling for pennies on the dollar. If you’re not sure how to build your team, keep checking back with Benefit Bill™ from time to time. We are putting together lessons on team building, one team member at a time. When you begin putting your team together, the odds swing dramatically in your favor. Happy team building… and

Have a Great Day!

Bill

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New Upload At Benefit Bill™

Just uploaded a new workbook entitled Cause of Loss v Resultant Damage to Benefit Bill™. Be sure to check it out at http://www.benefitbill.com/Cause_v_Resultant_Dmg.html 

It's All About Money

Insurance companies keep two sets of accounting records. No the second set is not the set that details all the money flowing into their accounts from policyholders, rather it’s the set that tells regulators how solvent the company is. While insurance companies use Generally Accepted Accounting Principals (GAAP) accounting to track money, they also use Statutory (Stat) accounting as a litmus test of their solvency. What’s the difference? Broadly speaking the two accounting methods address what can be called an asset and how the company handles liabilities. The following caveat applies for all you accountants reading this. This is a broad simplification and is not meant to be a treatise on insurance accounting.

With GAAP Accounting almost anything of value is called an asset. However when statutorily accounting for assets only those assets of high quality are counted. Liabilities in GAAP Accounting can be amortized over the expected lifetime of the liability. However with statutory accounting liabilities must be fully funded upon their recognition. This is where your claim begins to go astray.

You see insurance companies set aside money to pay claims. This money is collectively referred to as reserves and reserves are accounted for on a file by file basis, so reserves allocated to one file can not be transferred or reallocated to another file. Now you may be saying to yourself … blah, blah, blah… what does this have to do with me?

If the insurance adjuster assigned to your claim does not recognize the severity of your loss and as a consequence does not accurately report that severity back to the insurance company, not enough money gets set aside to fully reimburse you for that loss. Or to put it another way, if the insurance company under reserves your claim, chances are they are also going to under pay your loss.

Think about this. The insurance adjuster is the eyes and ears of the company. What that adjuster sees is what the company sees. What that adjuster hears is what the company hears. Now add to that a propensity towards minimizing the claim payments so as to maximize shareholder profits and you have the makings of a perfect storm. Unfortunately, you’re the one being tossed about in your time of greatest need. If you have the financial resources to repair your home and fight it out with the company great, but if you’re like most of us and need the insurance money to make repairs, this can be very intimidating.

Nothing is so difficult as to get someone the see damage when their job depends upon their not seeing damage. There are some things you can do. First and foremost, like the scouts, Be Prepared! Do your pre-loss homework: take pictures of your property, collect and save receipts for major purchases, make a home inventory. When a casualty loss occurs photo document the post loss condition of your property. As you are taking photographs try to take pictures from the same angles as your pre-loss photographs. This gives you the ability to compare and contrast the two sets of photographs. Take close ups as well to document the nature of the damage. Put together a list of everything damaged by the event and then make a copy of that list to give to the adjuster. Get the adjuster to review the list with you and document any disagreements. Get repair estimates that respond to the list you developed rather than the damages the adjuster develops. If you feel you are being ignored, don’t take it personally, get professional help. Call a Public Insurance Adjuster to assist you in the claims process. You can find on by going to your states public adjuster association. In Florida it’s the Florida Association of Public Insurance Adjusters www.fapia.net . If your state doesn’t have a public adjuster’s association go to the National Association of Public Insurance Adjusters www.napia.com

The object is to get the company to set aside sufficient money to pay your claim fully. If they don’t, chances are you’re going to need help. If you make the decision to seek assistance seek it sooner rather than later.