Dealing with irate insureds
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Dealing with irate insureds - 2/18/2006 8:07:02 PM
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Homer Simpson
Posts: 26
Joined: 12/23/2005
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Greetings all
I had 8 denials last week, alllll of them long-term seepage or improper drainage issues. Most of them took it OK, but it seems like about 1/4 just become overwhelmingly out of control and threaten to sue, kick me out of the home, etc.
To date, my strategy has been:
1. Validate their feelings ("I understand why you feel this way")
2. Explain the situation as clearly and thuroughly as possible, tailoring language to the level of insured's knowledge of insurance terminology ("I understand that you feel this way, but the policy only provides coverage for sudden and accidental damages, not for problems that have been going on for 18 months.")
3. Ride out whatever storm remains.
Anyone have any other strategies or patterns? The more experienced (jaded) adjusters seem to interrupt them when they start going off, answer any questions they have, advise they will receive the denial letter, then walk out. I'm not really sure which way is best.
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RE: Dealing with irate insureds - 2/18/2006 8:22:15 PM
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tiwiii
Posts: 111
Joined: 6/3/2004
Status: offline
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I think your way is better than the latter.
I typically do not absolutely deny damage at inspection, unless it is a full denial. The reason I don't at the scene is not because I want to avoid confrontation (well partially...jk); but because I want to make sure that coverage or lack of coverage is verified and I want to determine what I can help the PH with. I do always advise of what the potential coverage issue is and why, but I don't get into specific partial declinations until I have the claim completely investigated and damages have been determined. Then I can get specific and sometimes will meet again with the PH to review if they want or I feel is necessary.
I always send a ROR letter if known after contact there could be coverage issue. This opens the discussions once I am out there.
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RE: Dealing with irate insureds - 2/18/2006 10:41:17 PM
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Wes
Posts: 616
Joined: 4/19/2004
Home base: Deerfield Beach, FL
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It would be my opinion that if you are handling claims for a carrier through an adjusting vendor that you should not be denying claims in any way shape or form. You may elude to the insured that there may be coverage issues with their claim and you will complete a full report to the carrier with all the facts and the carrier will base the coverage decision on your report. If you are working as an independent adjuster and you deny a claim you will be setting your self up for a possible fall. Let the carrier direct employees make this kind of coverage decision. I don't know what is currently going on in the insurance loss department of the carriers here in Florida but I am seeing more and more claims allowed coverage that would have never been a covered loss in the past. Imagine you denying one of these claims, the insured hires a lawyer who sends a nice little letter to the carrier and finds out that the carrier policy is to not deny this type of particular loss. It will be you that receives the next letter from the lawyer and probably one from the carrier as well for causing this situation. Now if you are a staff guy then deny as you see fit.
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RE: Dealing with irate insureds - 2/18/2006 11:04:56 PM
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katadj
Posts: 684
Joined: 4/19/2004
Home base: New Hope, PA
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A) You do NOT have the authority or right to deny anything. That comes only from the carrier
B) You DO NOT understand or feel what the insured is feeling. (This is a MAJOR mistake by many of the younger or inexperienced adjusters, you are not them and cannot know what they are feeling)
C) Did you take a reservation of rights before you inspected the claim? What are your directives from your IA or carrier regarding these issues?
D) Do you wear a flak jacket, or take other protective measures?
So many claims, so much to learn, but it does take a long time.
_____________________________
"Excellence often first appears as error. It is only in retrospect that wisdom emerges from ignorance and success from failure." Abraham Lincoln
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RE: Dealing with irate insureds - 2/18/2006 11:14:37 PM
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tiwiii
Posts: 111
Joined: 6/3/2004
Status: offline
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I understand that most here are Independent Adjusters. However, some of us are staff CatAdjusters. This is Catadjuster.org, not Independent Catadjuster.org.
Secondly, empathy is an important aspect of dealing with complication in telling someone that they are going to have to bare the uninsured loss. This is all situational and is determined by so many variable surrounding the claim. That is part of what makes you good. Customer service is key, and while I have to always maintain a professional distance, I exhibit empathy when needed.
Any human who sees another suffering no matter what the circumstance should exhibit this trait. Even if they are claiming something that is not covered.
< Message edited by tiwiii -- 2/18/2006 11:25:47 PM >
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RE: Dealing with irate insureds - 2/18/2006 11:48:53 PM
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ChuckDeaton
Posts: 181
Joined: 4/19/2004
Home base: Little Rock, AR
Status: offline
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First thing is that very few are "adjusting" claims. It follows that very few have the authority to deny a claim, any claim.
Most if not all claims are denied by properly signed letter on appropriate letter head. Some claims warrant a total denial and some claims warrant a partial denial, in either case denial is done in a prescribed manner.
I can imagine that the insured might become angry and even threaten to take legal action.
Document, document, document and report asking for guidance re a defensible company position.
_____________________________
Artificial Intelligence usually beats real stupidity.
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RE: Dealing with irate insureds - 2/18/2006 11:52:58 PM
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swink_d
Posts: 259
Joined: 4/19/2004
Home base: Lexington, NC
Status: offline
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If you carry a copy of the policy with you , and show them the policy as you tell them, it eliminates you as a target of their animosity, but a few will always go completely off the deep end no matter what you do.
I generally will do my best to calm the person down, then answer any questions they have to the best of my ability. sometimes its better to just leave.
If they are just a Jerkwad and continue yelling and threatening. I will advise them that If they continue to yell I will terminate the call, . If they remain in attack mode. I ask them to call me back when they have calmed down. <Click> then immediatley let my supervisor know, and thoroughly document the call in my notes.
And this does not come from being jaded. It comes from just knowing that there is nothing left to talk about about after someone threatens you. I guess after having been a deputy , I just know there is that small percentage of folks that there is no reasoning with.
and I would say that only 1 in 100 or so are like that, and they will usually recover from their panic attack or whatever their problem was and calm down and call you with an apology and desire to continue the process.
< Message edited by swink_d -- 2/19/2006 12:29:04 AM >
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RE: Dealing with irate insureds - 2/19/2006 12:06:20 AM
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olderthendirt
Posts: 567
Joined: 4/19/2004
Home base: homeless
Status: offline
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I do not issue a ROR letter unless I have been instructed in writing to do so. I am not an officer of the company, I am an independent.
_____________________________
Still sliding down the razor blade of life
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RE: Dealing with irate insureds - 2/19/2006 8:02:30 AM
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okclarryd
Posts: 612
Joined: 4/19/2004
Home base: Oklahoma City, Ok
Status: offline
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Our job as cat adjusters is confrontational by nature. When I am involved with a very upset insured, I do not participate in the confrontation. I do not "feed the fire". A calm and professional deamonor will help you depart from the area.
The real denial is the letter on the carrier's letterhead. If it's not in writing, it didn't happen.
Let's not forget that the agent should be involved in this as well. Many times the agent can calm the insured to the point where they might listen to reason and policy wording.
Don't, and I mean, DON'T argue with the insured in this scenario. It's kinda like wrestlin' in the mud with a pig. The only one that gets any pleasure out of it is the pig.
_____________________________
LARRY D HARDIN
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RE: Dealing with irate insureds - 2/19/2006 8:19:45 AM
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John_Pendergrass
Posts: 24
Joined: 4/19/2004
Home base: Fort Wayne, Indiana
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I always explain that I am an independant, and that I am basically the eyes and ears of the inside aduster. I further explain that I do not have any authority to approve or deny and that I will report all of my findings. If an argument is starting, I remember what I was told years ago, take control. DO NOT get in the argument. If the ground work is set properly at first, via the phone call, or upon arrival, most of the times, it goes smooth. If the insured is having a bad day, work your way to the door, say thank you Im done and leave. Staff adjusters have more lee way, but it is hard to explain later why the adjuster was the one arguing. It is their home, not yours. Picture the argument from the eyes of a child watching dad and the adjuster. Just my thoughts
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RE: Dealing with irate insureds - 2/19/2006 9:51:41 AM
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MAYDAY DAVE
Posts: 24
Joined: 11/14/2005
Status: offline
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Just remember that the insured has every right to complain..whether they are right or wrong. You do not have that luxury. They will utilize anything you say against you when they complain..and most times imbellish it.
Document the damage, explain how the claim proceess will proceed..and let the carrier determine how to go forward. If you are told to do otherwise..DOCUMENT WHO INSTRUCTED YOU & WHAT YOU WERE TOLD TO DO.
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RE: Dealing with irate insureds - 2/19/2006 11:10:20 AM
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linloy
Posts: 174
Joined: 5/30/2005
Home base: Oklahoma and Florida
Status: offline
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Agree. Choose your words carefully when addressing an insured and closing an inspection or telephone conversation.
Larry, the pig example is very good.
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RE: Dealing with irate insureds - 2/19/2006 12:15:06 PM
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adjustorlando
Posts: 34
Joined: 5/11/2005
Status: offline
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Agree with what most before have offered. Don't get into an argument with the insured, you won't win. Be a better listener than a talker. Unless the carrier has given you explicit authority to make coverage decisions and issue denials, you cannot do so. You may know it's not a covered loss, but let the carrier make the final decision. They can then issue a denial letter or instruct you to issue one. The burden is on them as it should be. Staff adjusters have more leeway in making coverage decisions and they ARE the carrier. As an independent adjuster representing a carrier anything that you say or do can come back to haunt (bite) you later, so be cautious regarding conversations with the insured.
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RE: Dealing with irate insureds - 2/19/2006 3:01:00 PM
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Homer Simpson
Posts: 26
Joined: 12/23/2005
Status: offline
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quote:
ORIGINAL: katadj
A) You do NOT have the authority or right to deny anything. That comes only from the carrier
B) You DO NOT understand or feel what the insured is feeling. (This is a MAJOR mistake by many of the younger or inexperienced adjusters, you are not them and cannot know what they are feeling)
C) Did you take a reservation of rights before you inspected the claim? What are your directives from your IA or carrier regarding these issues?
D) Do you wear a flak jacket, or take other protective measures?
So many claims, so much to learn, but it does take a long time.
Actually, I do have the authority to deny claims, as I am a staff adjuster. My supervisor sees every full denial letter before it goes out, but I make the decision and, 90% of the time, make the decision on site. I've never had a file come back and state that I made the wrong coverage decision; I have been dinged for failing to make appropriate use of experts, sometimes for paying for an expert on a denial when I didn't need one, sometimes for not paying for an expert when I needed one, but never for the decision. My company wants me to make my coverage decision on-site, unless an expert's opinion is needed or there's some very unusual circumstance.
My primary concern is maximizing the customer experience; it ****s when your claim is denied, and methinks it iss a worthwhile effort to take reasonable steps to minimize the emotional distress associated with a denied claim. Perhaps this is too bleeding-heart for adjusting, but I, and my company, prefer that I take these reasonable steps, even when the insured's claim is absurd. The only time I basically go into "it" mode is when I have reason to believe that the insured's claim is fradulent.
Complaint calls are inevitable in what I do, and my supervisor recognizes this and almost always backs me.
Thank you all for the generally excellent advice!
< Message edited by Homer Simpson -- 2/19/2006 3:10:12 PM >
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RE: Dealing with irate insureds - 2/19/2006 7:17:40 PM
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jge1978
Posts: 11
Joined: 4/19/2004
Home base: New Orleans, La
Status: offline
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"How to Win Friends and Influence People" Author Dale Carnegie. In my past life as a sales manager, every floor manager that worked for me and all of the top salespeople were required to read the previously mentioned book. I have been involved in insurance work now for 7 years, all of them as a G.C. (4th generation) and 4 of them as a property adjustor. I have met many insureds, contractors, and adjustors that could use the skills taught in that book. In my experience, its not what you say, its how you say it! Good luck to all!
_____________________________
JG Eldridge
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