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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My Antenna Is Up

I was speaking to a client the other day when something hit me. She was telling me that since the insurer she had in 2005 had cancelled her; the “new and improved” insurer has inspected her home with each renewal. Several other people have expressed the same observation. It seems that insurance companies are inspecting houses on a regular basis here in South Florida.

Now my curiosity is piqued. I am inherently suspicious of insurance company motives. Rarely if ever, to they operate in an altruistic manner, so the question arises, why inspect the risk yearly?

Here is one possible explanation. Many times in the claims environment insurance companies will inspect a loss and assert a position that this damage or that damage is caused by wear and tear or long term water leakage or some other gradual cause of loss. In effect the insurance adjuster examines the damage and pronounces a pre-loss condition to a post-loss inspection. A counter argument to these pronouncements can be made: that the company is engaged in post loss underwriting in order to limit claims otherwise payable. Proving this argument may involve obtaining a copy of the underwriting file, prior claims files and the hiring of expensive experts to establish the condition of the property pre-loss. It certainly adds a level of complexity not contemplated by an insured who simply wants to get their house repaired.

The question that arises is this: Are pre-loss inspections an attempt by the insurance company to limit claim payments in the next hurricane or catastrophe? Consider this: by conducting pre-loss inspections and uncovering loose or missing tiles, an insurance company may try to assert that wind damage to a roof is wear and tear or demand that an insured affirmatively state which tiles were missing or loose before the storm. A failure to correctly answer might then result in a denial based upon insurance fraud.

Only time will tell.