In prior years as a casualty claims adjuster for a major insurance company, I carried blank drafts which I could use to settle claims. While there was a limit in terms of a dollar amount, I as the adjuster had the authority to settle the claim up to that limit.
The company's desire was to not "lose control of the claim." The goal was to try and settle the matter with the claimant in a fair and equitable manner, and avoid litigation if possible. This is still the desire of many insurers today; however, the public sometimes does not see insurance companies in this light.
Adjusters and claims supervisors are where the rubber meets the road when it comes to settling claims. They are the true front line of the companies and their job is extremely important.
While an insurance professional is normally quite familiar with the policy, the claimant often is not. Frequently the adjuster needs to explain the terms of the policy to the insureds and why the loss may not be covered. The claimants may not be too happy, but if they understand the terms of the contract, they can better accept the decision as opposed to a flat denial of "we won't pay."
That approach almost always poisons the atmosphere of any discussion. I have also seen situations where an insurer's representative has found other policy provisions which may allow some degree of coverage. I am not suggesting that we just give away money, but that the policy may possibly allow for some legitimate compensation.
When the insured understands the situation, it may not only produce a settlement of the claim, but an appreciation of the company's concern for the insured. A continuing relationship may be created, and a claimant turned into a cheerleader for the company who says to others, "You know, X Company really cared about my problem and they helped. I could really recommend them. They don't just want your money."
Think about the potential value of this. What better advertising is available from the best companies on Madison Avenue?
I am not suggesting that all claims be paid. In reality some claims simply will not be covered under the insurance contract. In these cases the insureds must ultimately accept this fact, but if it is presented to them in a manner in which they understand and in where the adjuster expresses a sincere concern, it will make an impact.
Losses due to water damage from wear and tear versus sudden occurrence may well be a useful example, depending on the policy. Try to put yourself in the position of the insureds when explaining why the policy may not cover the loss. While not happy, typically the insureds will respect you and the company. They need to have a compassionate explanation.
This is something we all know but may simply forget under a heavy caseload of claims. Try to remember that the individuals involved in each of those files are people who work hard and have had a loss. Something unexpected has caused a serious disruption in their lives and they are relying on their insurance to help rectify the problem.
By definition 'empathy' is essentially identifying and understanding the feelings of another. In the business of settling insurance claims, this is extremely important. Think about how you would feel in this position. What would your concerns be? Would you expect your insurance company to help you? If you can look at the claim in this manner and genuinely express your concern, you will go a long way toward settling the claim in a fair manner. You will also leave a good impression of your company and hopefully create a continuing business relationship.
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