Filed Under:Claims, Education & Training

Opinion: Aiming for Claims Adjusting Excellence

Improving Claims 'Bedside Manner'

One reason often cited for skyrocketing medical costs is the proliferation of malpractice claims. Physicians prescribe too many tests to avoid missing a diagnosis and inviting a lawsuit. Meanwhile, insurers charge high premiums to cover doctors in case they find themselves on the receiving end of a lawsuit. On the flip side, a tremendous amount of research goes into who is suing whom and why.

The results of this research and application to property adjusting may be surprising to many in the P&C realm, however.

In the study published in the Journal of the American Medical Association (JAMA), “Physician-Patient Communication: The Relationship with Malpractice Claims Among Primary Care Physicians and Surgeons,” Researcher Wendy Levinson reviews the legal records of hundreds of physicians, classifying them into two groups: those who had been sued and those who had not.

The results are eye-opening. Levinson found that a doctor’s experience with malpractice suits did not correlate strictly with medical errors or mistakes. The doctors who merely spent three minutes longer talking with a patient or explaining a procedure (18.3 versus 15 minutes) significantly reduced, if not eliminated, the number of malpractice claims by their patients. Simply using more statements of orientation (educating patients about what to expect), engaging in active listening, and laughing and using humor offered a dramatically different outcome. In other instances patients felt rushed or disrespected during an office visit.

The doctors, who were less likely to be sued even when they made a mistake, did not necessarily provide higher quality care or better services. The distinction was entirely indicative of how they spoke to their patients. Levinson’s study identifies primary care physicians who gave more specific and teachable communications with greatly fewer malpractice claims, and a much higher level of patient satisfaction, even with a poor medical result.

Claims Isn’t Brain Surgery

Indeed, handling claims isn’t brain surgery, but there is much to learn and adapt from the medical field when it comes to communications.

In the P&C claims industry, we often look at resumes and credentials such as post-nominal titles as the only qualifier of competence. We place more importance on testing an adjuster’s knowledge of how to measure a roof as opposed to interpersonal skills and their ability to connect with customers.

Technical expertise is vital, but we greatly underestimate the communication effectiveness of the claims handler during the process. This is the defining moment in customer retention and potential liabilities.

Walking in Their Shoes

If we look at claims through the eyes of the customer, then we can see an entirely different process. Which do you think a customer would choose?

  • A slightly longer claims cycle that would involve more collaboration and personal attention from the adjuster.
  • A 24-hour first contact and faster claims closure.

Most customers would choose the first option. To that end, it is crucial that adjusters take a few minutes to explain options upfront and patiently walk the customer through the process.

Just as doctors are the experts when it comes to medicine, we are the experts when it comes to claims adjustment. We know how the process works. If we take the time to explain the process using more facilitation (soliciting opinions, checking understanding, and encouraging a dialogue), then we will go a long way to ensuring that our customers are satisfied with the outcome and remain loyal to us.

It comes down to a matter of respect. To humanize the customer experience in claims, the adjuster must improve his or her bedside manner. The business culture must be changed to redefine customer satisfaction and alter the usual course of actions in claims that leads to unhappy customers. It is essential to encourage adjusters to spend more time with the customer so they better understand how the claims process works. It is also important to educate adjusters in active listening skills.

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