Casey Anthony committed murder…or did she? That was the question 12 Florida jurors had to consider during the month-long trial of the mom who was charged with killing her two-year-old daughter. While we all may have individual opinions regarding guilt or innocence, what matters for the insurance professionals reading this is that the outcome in this case resulted from the quality of the investigation.
When it comes to conducting investigations, the devil is often in the details. This is often the case in claims, where adjusters and executives alike shake their heads in bewilderment at outcomes that seemingly defy the odds and expectations. During my tenure as a quality assurance process leader for a large multi-national carrier, I would often review claims and wonder, “How do these facts or damages result in this liability decision and settlement?”
From the first notice of loss to final disposition, the steps taken to investigate a claim will determine the ultimate quality. From contacting the appropriate parties and inspecting damaged property to determining liability and negotiating settlements, the outcome hinges upon the investigation.
While this is easy to say, the reality can be much different. Adjusters, like state prosecutors, have a tremendous workload. They have many competing priorities that can impede the quality of investigations and outcomes.
The key to success begins at first notice of loss with a process designed to enable adjusters to leverage both time and resources. When it comes to investigations, asking the right questions is critical to quality. Far too often generic questions supplant those that can drive a proper outcome. Often lacking are the answers to six critical questions: who, what, where, when, why, and how.
While the standards of proof in civil cases are lower than criminal cases, it is important to remember that there are two critical elements that must be established: liability and damages. Irrespective of damages, a person must be liable before owing any portion of the damage incurred.
As we learned during the Casey Anthony murder trial, there is also one wildcard lurking in the shadows: the unpredictable jury system. While this should always be a consideration, it should never be a crutch. While far from predictable, cases that stand on their own merit of both liability and damages tend to have the best outcomes. Then again, a thoroughly investigated and documented case isn’t likely to see a courtroom because the facts will have played out during the educational portion of settlement negotiations.
The prosecution lost in the Anthony trial not because of guilt or innocence, but because of lack of evidence. Likewise, insurers can lose monetarily not because someone was hurt or not, but because of a marginal investigation. It is a lack of attention to details that can lead to multi-million-dollar jury verdicts that seemingly defy logic.
Taking the time to thoroughly investigate a claim is the single most important aspect of the adjustment process. Not asking enough questions is a surefire way to be muddled in mediocrity, which has an adverse impact on both indemnity and expenses.