The Mantle
of Indifference
Of late as I have posted my musings and at the same time sat and reviewed
cases in my expert practice and reflected on working with plaintiff law
firms on large cases I have been struck of late by what I refer to as an
indifferent attitude among claims people regarding those who present claims
against them. I refer to this development as the " Mantle of
Indifference", or what we could also refer to as a cloak of
indifference draped over the claims process.
If your in the inside game, part of it is paying claims, it is your job, you
must do it with professionalism and with an attitude that the majority of
those who present claims do so because they seek compensation for an injury
where there is entitlement. It is plainly and simply your role to pay
claims where there is exposure to your insured or under the policy on a
first party claim.
Now many will say, we do not pay claims we do not owe, well that is true and
that to is a clear function of claims. What is not a function, is the
creation of the mantle of indifference. By this, I mean an attitude of so
what you have a claim, stand in line, and when I can get to it I will, and
by the way it does not appear you are hurt in the first place.
We must first observe that the majority of claims people are not bad people,
and the mantle of indifference is often not a function of their own personal
make-up rather it is a function of an indifferent attitude to the claims
function by higher management. By indifferent, I mean the focus that a
claims operation must be first and foremost a profit center, or put another
way we come first, all others after that. Is not that a harbinger of
bad faith, the carrier takes their interests over that of their insured in a
consistent and regular manner?
Of course we cannot envision an insurance company without profit, we know
there must be profit, and making profit does imply the resistance of losses
you do not owe. But in that process you must not project indifference to
those who present claims of merit. All to often this occurs, this
ensures that claims operations become creators of conflict as opposed to
organizations that solve the problems of their insured.
The forms of indifference come about in many ways, the adjuster listens to
the young mother, no car, cannot get to work cannot get her children to day
care, but he says, we will reimburse you for your car rental and not direct
bill, the young couple with no medical insurance, whose husband has a burst
eardrum and needs medical treatment, but we do not advance pay, or your car
is worth (X) we offered it today no more rental car, your treated 22 times
with a Chiropractor and that is not acceptable, our outside billing review
service finds the treatment is not required or too high so sorry.
This attitude cannot in the long run ensure profits for the carrier that
adopts the mantle of indifference, it will ensure their demise, at least
that is my impression. Problems are not solved through indifference,
they are solved through a claims department that delivers promptly and with
equity the promises of the policy.
The true function of a claims department in society is to ensure that
members of society who are injured are compensated, but adequately so. A
claims department must not create conflict, they must create resolution, all
to often conflict is created not so much for the sake of conflict but for
lack of training, to many files on your diary, to many telephone calls, to
much responsibility and to little authority, unrealistic goals from
management, a prevailing attitude that they are the enemy.
Could not one ask as Pogo did so many years ago: " We have meet the
enemy and he is us"
I would think as we move forward that we need to reflect on the primary
function of claims, that is to provide resolution to the problems of the
insured, but not to
create profit through indifference to those problems.
Mike Cerf
Expert Witness Insurance Claims
Sherwood, Oregon
503-925-1937
mcerf@teleport.com
