Setting
Expectations
I have not
mused for a time, the reason being summer being upon us and my expert
practice has been somewhat busy. But the other day after speaking with
an adjuster I recalled a conversation I had several years ago with a group
of management consultants, regarding the importance of the setting of
expectations by the claims adjuster.
A very talented young group of MBA's told me ( I was a claims VP then) you
know the most important thing we found in our study is that claimants and
insured want to know up front what they can expect. If you do that your
results should be more favorable and you will not lose that many cases to
counsel.
Really what they were telling me is that if you handle claims right, you
will build a favorable customer base, insured will renew their coverage and
claimants will be happy and you just might lower your represented case ratio
and lower your suit count. That is not something that is all that
earth shattering, after all are we not as claims people supposed to treat
people right, and is not telling them we will handle their claim promptly
and deliver on what we say one of our most fundamental roles?
I asked
myself If I really need to pay several thousands of dollars to be told that
(my share of the consultants bill ), I think most likely not. What brings
these comments back to me today is that by in large, at least from my
perspective when I audit cases in my role as an expert or consultant, I do
not walk away with a sense that the adjuster as a rule sets expectations
with the insured, or the claimant, be that claimant represented or not.
Mikes Rule : The claims representative should
articulate at first contact what the insured or claimant can expect from the
adjuster and when they will receive service and/or benefits. The represented
claimant must receive the same treatment.
By setting expectations up front people as a general
rule will not set their own expectations. More simply stated the adjuster
needs to articulate what any individual can expect in the handling of their
claim. For example in lets take a third party liability claim with a
claimant who has a minor injury and a property damage claim. The
following should occur, note in other claims the expectations will be
different and each claim may require the setting of different expectations
depending on the claim.
1. When you will complete the investigation to
determine liability. Also what investigation will be done and when it will
be completed. If liability is clear tell them it is. If it is not tell them
why it is not.
2. When
you will allow a rental car, what kind of car, what you will pay for
and how long.
3. Where
they can take their car for repairs, when the car will be appraised, who
will do the appraisal, what they can do if they disagree with the appraisal
done by the appraiser.
4. What
will happen if the car is a total loss and how the ACV will be evaluated.
Agree to furnish a copy of the total loss evaluation. What documents the
claimant should furnish if the car has special features or recent repairs or
modifications.
5. How
salvage will be handled, and the claimants options for salvage.
6. How you
will handle any disagreement regarding the total loss.
7. When they
can expect conversations to take place about their injury claim.
8. How injury
claim will be evaluated.
9. How medical
and wage authorizations are used.
10. Advise the
claimant that if they feel they need the advise of counsel at anytime to
please feel free to seek that advise.
At all times it is important for the adjuster to keep in mind that although
this may be one of many thousands of claims they handle it may be the first
claim for the claimant. So keep in mind that courtesy and empathy are
important at all times. Follow through and keep your commitments. Listen and
care is the keywords to remember.
My musing may not fit the reality of today's world in all cases. For
example I spoke with an adjuster the other day in Arizona, the file I
was consulting on had a demand outstanding for three months; called the
adjuster; he had transferred the file to adjuster B and adjuster B had just
taken over 60 new files in addition to her 150 files, since another adjuster
had quit. She just told me flat out, I cannot get to this for possibly two
to three weeks. I am buried and only have $3,000 authority.
Now this set up my expectations, but does it not in turn lead us to the
possible conclusion that more and more it is difficult if not impossible in
certain claim environments to set expectations? How can an adjuster in this
situation tell anyone he or she can get something done in a certain amount
of time? It is the old game of putting out fires and the squeaky wheel gets
the grease.
In balance this should not lead us from the fundamental role of the adjuster
, that is to solve problems for the insured, if they can set expectations up
front that leads us to an improved ability to function in that role of a
problem solver.
Mike Cerf
Expert Witness Insurance Claims
Sherwood, Oregon
503-925-1937
mcerf@teleport.com
