Filed Under:Claims, Education & Training

The ethics of ingenuity

Opinion

While a host of new tools are available to help adjusters, they still do not mitigate the need to use them ethically. (Photo: Shutterstock)
While a host of new tools are available to help adjusters, they still do not mitigate the need to use them ethically. (Photo: Shutterstock)

Editor's Note: This is the fourth article in a six-part series on adjuster ethics.

Over the last five decades, major changes in the way property, casualty and marine claims are investigated have undergone many developments. Telephone adjusting arrived in the 1960s, once courts permitted telephone statements taken with permission to be admitted as evidence.

In the 1970s, there were new ways of settling claims, like “open-ended releases” and the use of rehabilitation. Auto damage appraisals came into being despite automobiles becoming more complex. This eliminated the potential fraud in “send in three estimates” adjusting. In the 1980s, as the personal computer was just beginning to show up on adjusters’ desks, new methods of claim resolution such as structured settlements, came into being. Suddenly, adjusters spent more time at their desks than out in the field investigating claims.

The 1990s brought more changes with increased use of the internet, integrated computerized photography (for showing hail damage on roofs), medical cost containment procedures, and similar claim-related processes. By the 2000s the number of field adjusters started to decrease, and long-distance claims handling increased. Claims being handled “off-shore” from Asia or elsewhere was already being tested. Many important innovations included team and computerized claim handling, and pre-approved repair facilities, but whether these really enhanced the quality of claim settlement is debatable.

Looking for new techniques

Use of the internet may be a good source for useful data like court records. “When it comes to claims investigation,” suggests Matthew J. Smith of Smith, Rolfes & Skavdahl Co., “click your keyboards instead of your heels.” Discussing fraud investigation, Smith considers the electronic trail of funds transfer as a source of information. But over-reliance on data comes with a built-in hazard; data may or may not be accurate, and making decisions on inaccurate data can be dangerous.

Nothing beats a good photograph of the evidence. The camera has been an adjuster's tool for probably more than a century, and there is an art to taking the right picture in a correct and documented way. In the last 30 years additional photography has become available through closed-circuit television. Such filming may show accidents as they occur, or a still from a CCT may identify a car or person. As television news programs began “on the scene” interviews at accidents and crimes, their video films became evidence that might be used as res gestae at trial, recording what witnesses said.

What new tools may prove helpful in the adjuster's trade? One increasingly important tool is a drone, capable of taking photographs of almost anything that might be important in a claim, but which would be difficult to capture from the ground. It might be anything from a close-up of some flaw that allowed something to collapse, or it might be a busy intersection that would be impossible to fully assess from the sidewalk.

Attorneys also have recognized that “social media” is a great source of information, and may subpoena everything from corporate emails to personal messages that reveal what the sender was thinking. Facebook comments can become evidence and are available without a subpoena.

Be nosey in a legal & ethical way


Using initiative to find new ways to document claims is an ongoing effort, but it must be done ethically. The old trick of letting air out of a claimant's tires in order to film him jacking up the car was and remains unethical. Yes, courts have ruled that the defendant has a right to follow and investigate even a represented plaintiff, but it must be done in an ethical manner. The fact that Joe is claiming a disability does not necessarily mean that he has to spend every minute in bed, except while at the doctor's office. Adjusters may need to be nosey in order to find out what they need to know, but must do it in a legal and ethical way.

“Winning by the Rules” says, “The insurance specialist cannot simply be a fill-in-the-blanks and pull-the-handle type of employee. She [or he] must take the initiative to complete the task… and the responsibility for a correct outcome. That requires ingenuity, intelligence, imagination and fortitude.”

Ken Brownlee, CPCU, is a former adjuster and risk manager based in Atlanta, Ga. He now authors and edits claims-adjusting textbooks. He can be reached at kenbrownlee@msn.com. Opinions expressed are the author's own.

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