Agents Walk Claims Tightrope For Clients
Honest communication and remaining the advocate for the customer are the best ways for producers to handle any conflict between clients with claims against insurers, independent agents suggest.
The primary role of any independent agent, they said, is to make sure the customer is being treated fairly by the insurer. However, it is equally important, agents contend, to make sure the agency maintains its reputation for integrity with its carriers.
"We do not walk much of a tightrope," explained Karen Oxman, vice president of Gelfand Newman Wasserman in Los Angeles. "There are times where we may disagree with the company, but my goal is that if the insurance company is being unfair to my client it is taken care of. I dont think [that thinking] jeopardizes my relationship with the carrier."
"We work for the client; the insurance company is considered the supplier," agreed Paul Verisario, president of All-Security Insurance Agency Inc. in Des Plaines, Ill., and the president of the Professional Independent Insurance Agents of Illinois.
"When we talk about our clients who have a claim, we work for the side of the client. We report to the company as fast as we receive the claim from the client. That is our responsibility," he said. "Our responsibility to our clients is to represent a sound and reputable insurance company to them. That is our job."
Speed of addressing a claim is the first concern. Depending upon the agencys philosophy, some like customers to report the initial claim directly to the company, while others prefer the customer to come to the agency first.
A customer dealing directly with a company avoids duplication of claims work and speeds up the process of getting authorization for repair or medical treatment, said David Bauer, president of Bauer Insurance Agency in Albany, N.Y., and regional vice president for the Independent Insurance Agents Association of New York.
"What insurance companies do is pay claims," he said. "I feel the agents value in the relationship is when problems arise and the claims process gets off track."
In some cases those "problems" may involve the agent educating the customer on the process. More often then not, Mr. Bauer said, most problems crop up from carriers who do not have up-to-date information for their adjusters to access. And often it is the agent who needs to step in and make sure the information is up-to-date.
Philosophically, Mr. Verisario prefers receiving the claim first–this way he remains on top of the process. The agency provides service to its customers continually and wants to be up front in providing service. It also helps to keep a handle on the situation, he said.
There have been cases where a company denied a claim when an endorsement existed, explained Mr. Verisario, and the insurer failed to provide the adjuster with the proper information.
Customers can complicate their own claims filing by not explaining the event properly, noted Scott Hauge, president of Cal Insurance in San Francisco. A customer might say there was a short in the electrical system that damaged their circuit board to a computer. That would not be covered under their insurance, he said. However, if, after discussing the incident with the client, the agent discovers there was a power surge that caused the short, that might be covered.
"Just try and get more detail," advised Mr. Hauge. "Customers dont know the policy language."
A bigger problem, however, is when a customer calls and asks for advice about whether an incident is covered, Mr. Hauge said. Under the states Fair Claims Reporting Act, if the customer calls looking for advice from an agent on whether to report an incident, that puts the agent in the position of reporting the claim to the company.
To avoid an awkward situation, he said it is best to advise the customer of the legal implications before they go too far.
Communication remains the vital key in any claims situation, observed Roosevelt Haywood III, president of Haywood and Fleming Associates in Gary, Ind. Mr. Haywood kept this in mind when he handled a claim that resulted when a school wall collapsed on a Gary Community School Corp. building.
As the agent, Mr. Haywood worked with the Hartford Insurance Company to expedite the claim, gaining quick access for the company to examine the damage and keeping the lines of communication open with the school bureaucracy.
It took almost a year to resolve the quarter-million-dollar claim, and throughout that time, Mr. Haywood said he never lost sight of the fact that his primary obligation was to make certain that his clients received everything they were entitled to under the policy that he sold to them.
"Dont allow an adversarial relationship to happen," he said. "When people trust you, then it makes it much easier to get things done. People know when you are looking out for their best interests. Being professional is the key."
Reproduced from National Underwriter Property & Casualty/Risk & Benefits Management Edition, November 5, 2001. Copyright 2001 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.
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