Documents matter. More to the point, Documentation really matter




This is part 1 of this post. Part 2 will post May of 2015. Documents matter. More to the point, Documentation really matters. A properly documented claim file should "speak for itself." Anyone reading the file should be able to understand the basic facts of the claim, the outstanding issues, and what is being done to bring the claim to resolution. A good rule of thumb is the saying "If it's not in the file, it did not happen." A well documented file is the key to making the proper decision on that particular file. These suggestions are just that, suggestions.

Your company guides is the best source to lead you collecting proper documentation. The investigative needs will also serve to help in these endeavors. Every claim file is different.

 

It is important that information related to claim decision  making be documented in the file. Decision support is best documented in clear, concise, relevant, professional (civil) statements that summarize in accurate fashion what was said, who said it and when as well on what information a decision is based and the explanation of the direction the claim is going - who, where, when, how and why.

In theory, the documentation should be to the level that anyone can look at it and clearly know what was discussed, what was resolved and whether or not there are open issues. If it does not meet this level, it is probably inadequate.

Why is this level of documentation so important? When looking at some claim files, is it evident there was a misunderstanding between what the customer told you and what you heard? What if a claim develops and the misunderstanding now surfaces? The goal must be to try to resolve any misunderstandings before the claim occurs. What is the best way to do this? Further, the legal ramifications of poor claim file documentation is staggering.

Things to document include, but are not limited to: 

·      Phone calls  (made and received)

·      Letters, memos & reports ( contact, status, denial, specific request etc)

·      Photos

·      Estimates - receipts - proof of ownership documentation

·      Diagrams or property or accident scene

·      Any legal documents - releases. suit papers, subpoenas, letters, opinions issued etc.

·      Conversations with anyone related to and of relevance to the claim

·      Explanations provided to insured, claimants, vendors, agents staff etc.

·      Coverage confirmation

·      Negligence

·      Exposure

·      Damages

·      Supervisor/Manager input

·      1^st & 3^rd party discussions and claim decisions

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Claims Best Practices (Part 1)
by Robert Carper

I spent years in property and casualty claims. Claims professionals are often referred to claims Best Practices as a guide on how to handle claims. What is "Best Practices"? Best Practices often serve a roadmap to achieving Quality Claims Outcomes.

The Best Practices may vary from carrier to carrier but the core intent is much similar. This is a two part series, after which, I will elaborate in detail on each Best Practice item in up-coming post. My background and experience affords me the opportunity to offer both property and casualty Best Practices assessment. Claims (property & Casualty) Best Practices typically consist of the following areas:

 

• Prompt, Meaningful Contact
• Special Handling Compliance
• Communication with all parties as needed
• File documentation
• Photos and estimates if needed in the file
• Policy Confirmed for property/car etc. on date of loss
• Coverage Analysis review
• Regulatory Requirements compliance
• Damage Evaluation assessment
• Claim file reporting requirements
• Reserves properly addressed for claim file exposures
• Assigned Authority (personal) with assigned position profile
• All necessary parties contacted
• Efficient claim handling utilized
• Negligence assessment determined and explained

Potholes Cost Insurers, Consumers $27B

March 12, 2015

As you may have found out the hard way, hitting a pothole could damage your tires, wheels, shocks, or struts. Repairing that damage can be expensive. According to AAA, repair costs can range from $50 for a simple wheel alignment to $500 or more for replacing a top-of-the-line alloy wheel. Over the life of a car, insurance agents say that a driver can pay up to $2,000 or more in repair costs due to damage from poor road conditions

Poor road conditions have cost consumers and the insurance industry at least $27 billion over a five year period, according to a 2014 survey commissioned by Trusted Choice and the Independent Insurance Agents & Brokers of America.

The survey also reveals that from 2009 to 2014 half of car owners experienced damage to their vehicles as a result of potholes.

“The snow, ice and freezing rain during the rough winter months left their mark on the country’s roads,” says Robert Rusbuldt, Trusted Choice president and Big “I” president & CEO. “Severe potholes have led to accidents which may impact insurance rates, as premiums are determined by past claims, accidents and driving violations. Potholes and poor road conditions aren’t just an inconvenience, they are an expensive and dangerous result of harsh winters.”

The pothole survey also found that 31 percent of car owners who reported pothole damage to their vehicles filed a claim with their insurance company. A surprising 65 percent of respondents who needed repairs said they (or a third party) paid out of pocket for the vehicle to be fixed. Only about 3 percent said local authorities stepped in to foot the bill. For about 40 percent of respondents, that bill was more than $500.

The Auto Black Box

Could you cars black box be used against you in court or by your insurance company?Did you know that your car, if it is a 2005 or newer car has a 64 percent chance that it has an onboard black box just like an airplane that is recording everything you do?

                                                             

   Recordedstatement.net

Recordedstatement.net is a growing digital destination
for insurance claims professionals. We serve as a guide
to enhance the investigative quality of the recorded statement
process. We seek to provide the content, process improvement
and skill enhancement in this area.

HOW TO ELICIT RESPONSES
Wait at least 20-30 seconds for responses. Silence is acceptable
during a Recorded interview to allow interviewee time to think about
the question and their response. The more time you give interviewee
to think the higher level answers you will receive. There will be increased
interviewee participation.

Ask clearly worded questions and speak clearly when you ask them.
Only ask one question at a time.
Rephrase a question only after the wait time.
Don't answer your own questions.
Remember - pauses and silence is not a bad thing if properly placed
Ask open-ended, not just close-ended questions.
Ask divergent as well as convergent questions
Repeat the question, paraphrasing it
Ask probing questions
Ask for detailed descriptive information
Ask the question and then shut up
Don't ask leading questions
Know when to ask yes or no questions
Feedback then feed forward for clarity
Be prepared to answer why you asked the question
Know what is considered a inappropriate question
Use questions to establish rapport
Don't interrupt the interviewee

Policy Fraud Checklist

Loss within first year of cover Loss shortly before renewal/expiry of cover Loss shortly after increase in cover Notification of claim after policy lapse/cancellation Existence of multiple policies covering same loss Premium payment abnormalities Pre-loss enquiry re cover/claims circumstances Non-disclosure/misrepresentation Frequent changes of insurer Gaps in previous insurance history Evidence of significant over insurance/under insurance Policy arranged via agent far away from insured's home Poor claims history Claimant appears to be different from policyholder Questionable use of property/occupation at time of loss Evidence of pre-loss business/personal and/or financial problems

THOSE LITTLE TERMSby Robert Carper
SIU, SUBRO, BI, IA, RAC, CP, BOP, ARB are some terms we as insurance professionals use on a regular basis. We are familiar with this lingo and it is commonly an efficient way to communicate.

However, sometimes the customer, insured and claimants and others typically are confused and put-off by such terminology. As we all seek to enhance and improve the customer experience, we should try to eliminate these or minimize these terms in our customer communication. Many of these terms aren’t understood by the customer. As we verbalize such terms we may find in some cases the customer will find someone who does understand them which could mean the retention of an attorney, public adjuster or others who will possibly perplex the claim path to resolution. Often times plain English works best.

Remember, unless you have educated the customer in this area, acronyms privy to the insurance industry sometimes results in puzzlement for our customers.

SIU - Special investigations unit
SUBRO - Subrogation
BI - Bodily injury
PD - Physical damage
IA - Independent appraiser
RAC - Report of accident claim
CP - Commercial Property
BOP - Business Owners Policy
ARB - Arbitration