| Author |
 Topic  |
|
Newt
USA
657 Posts |
 Posted - 09/17/2002 : 07:57:03
|
Is our sole purpose in claims only to enforce the policy?
I think not, and if I thought so I would rather find something I enjoyed. My concept is get the insured back up and running according to the guide lines of the policy. Explain in such a way they understand, without a lot of policy jargon. They are complicated, even for adjusters and have to be,in order to be legal.
In my first phase of educating myself to be an adjuster, I have weighed the options, and considered, the ways I can relieve the customer of problems the policy can not or does not cover.
First, never make a promise you can not keep or have no power or authority to see it through. Above all, make sure the customer understands, the final descision is not yours and the carrier will do what is right because they also have a higher authority.
When the customer understands and only then, there are suggestions and resourses you can point to, that will get them more relief.
In order to find these resourses it takes a little effort. I spent several hours studing the FEMA manual and the SBA has a disaster unit for home and auto. There are so many resourses out there and
absoulutely no reason why we shouldn't see that our client is informed of whats available.
To name a few, ALE, roads, bridges, culverts, tree removal, fences,
water damage. In fact they will pay for just about anything insurance doesn't cover including auto. FEMA has an 800 number and a call to the them will reveal a whole new world of options.
This option is only available when a disaster is declaired.
This is your demonstration of concern for the state of the insured.
This is of utmost importance in the retention of customers for the carrier and a good relationship between you and the customer.
I have always thought of the customer that I was dealing with as my best friend, think about it he is providing your livelyhood, you owe him big time. Look after his/her welfare as you would a family member.
If you happen on a customer who is up set, show concern for his anger and more importantly his problem, assure him that you are going to help and if you can't solve the problem you will get others who can. And do it.
Yesterday was a cancelled check.
Tomorrow is a promisary note.
Today is cash in hand, make the most of it.
If you would like to add to or comment on this, I am listening and learning I hope.
|
Edited by - Newt on 09/17/2002 08:48:32 |
|
|
Newt
USA
657 Posts |
Posted - 09/17/2002 : 09:08:03
|
Here is info on Contacting FEMA HELP LINE 1-800-525-0321
any other info you need let me know, I have the manual and have taken the course for housing inspector. I will try to find the answer for you.
We can do this by email so that we do not tie up the forum. I think this is a great tool to improve the image of the adjuster and since we are looked on as the carriers rep., hopefully it will improve their image at the same time. |
 |
|
|
CCarr
Canada
1200 Posts |
Posted - 09/17/2002 : 09:35:47
|
Newt, from your FEMA manual, could you clarify something? Let's say that due to a weather related loss, a homeowner has a loss to his property (house, contents, other structures). Then the insurance policy he carries does not respond to any or all the elements of damage, but he does have that homeowners policy in force. Please confirm whether or not FEMA would respond with compensation to a homeowner that has an insurance policy, but either the damaged item is not covered by a peril of that policy or limitations restrict the amount of indemnity.
I have always had the notion that FEMA will only respond to homeowners where no insurance policy exists, for losses to their home or contents.
With regards to your comments on "image", notwithstanding my above question, I would be reluctant to start talking to an insured about what FEMA might or might not do - after I have determined and told an insured that the policy they paid for is of no value to their damage. I don't think that specific conversation would improve the image of the carrier. |
Edited by - CCarr on 09/17/2002 09:43:36 |
|
|
|
John McMennamy
USA
20 Posts |
Posted - 09/17/2002 : 10:19:14
|
Mewt,
I agree with you completely. When I go on an inspection, if the insured is there, I sit with them and explain coverage. I wil sit there answering their questions as long as it takes. If for some reason I do not know the answer or there is a coverage issue I explain this to the insured. I try to make friends with them on the first contact and explain the claims process.
This may not close claims as fast as slash and burn adjusters can, but the time I spend up front explaining policy and process saves me many hours on the phone latter.
This was especially helpful when I was handling mold claims in San Antonio. When I left the insured they felt they had been included in the claims process and were educated on their policy. So many times the adjuster tells the insured after 15 minutes at the risk, " I have to leave I have another inspection scheduled".
The insured is not our enemy, if it were not for them we would not be working in this great profession. Without the insured there would not be State Farm, Farmers, Allstate or any of the other great carriers with work for us.
We have guide lines to follow set up by the State Department of Insurance in which ever state we are working in. I have never been told not to pay what was owed by a carrier. I have been advised some things are not covered and if I could not find coverage or an exclusion I would go back and review it with the carrier and come to an agreement. I would them log and explain my findings with the insured.
The policy is confusing to many adjusters and the insured is more confused. The policy in many cases is open to interpretation and each and every one uf us can interpret it differently. I beleave if I educate the insured, as best I can, I am also educating myself and will have fewer problems down the road. The insured in most cases just wants what is owed. The carrier wants to pay what is owed. By educating the insured we are doing our jobs. In most cases we get paid a handsome fee for our sevices, we do have expences, and it is our responsablity to do our jobs in the most professional way. Too many adjusters see only the fee schedule and want to inspect/ close as many files as they can. This works out fine for a total of claims cloaed. The trouble is, as I've seen in the past, money is left on the table and the claim is reopened. By educating the insured you are getting information from them that may increase the fee schedule. Everybody wins, the insured is paid what is owed, the carrier has paid what is owed and the adjuster can walk away knowing they did the best they could and with possibly a higher fee schedule with claim closed. I may not have closed as many claims as Joe slash and burn, but I may have made more by just talking to the insured.
As an independent I work for myself first, the carrier, the vender and last but most important the insured. I am going to do the best I can for each and everyone I work for. We are guided by the policy and it's guide lines and must enforce it. We owe it to the insured and carrier to follow the policy. I am an independent adjuster, this means I am a temporary employee for whoever I work for except myself.
Newt you have the right idea. Educate the insured by explaining what is covered or not covered and this in turn educates you. I hope to meet and work with you some day, maybe we can learn from each other, wouldn't that be nice.
Just my oppinion and thoughts.
Johnny Mac
|
|
|
|
Newt
USA
657 Posts |
Posted - 09/17/2002 : 12:26:27
|
The fema program will pay for anthing that will restore habitability, it does not cover out side buildings but it will pay for resoration of the three s'es safety, sanitary,and secure. It covers, wells, septic tanks, utilities, water damage etc and It will cover things insurance does not, in case you have an HO policy or you rent or own. I wish I had copies of my manual that I could pass around.It was an eye opener.Maybe I can reproduce portions of it if I get permission.
I key point I made and hope every one understands don,t EVER make a recommendation of alternate solution until the customer understands that he /she is not covered and they completely understand and agree. You must be on friendly terms.
Another point you do not have be in poverty, and if you are insured thats fine.
They will remove trees and pay for disposal, even standing trees that may pose a threat.
Fences are replaced if there is a security or safty threat such as kids. They will replace an auto to drivable condition if it is used to get to your job. As i said in the previous post, one of the great things I learned was the road, bridges and culverts, some of these are not in the foot print of the insureds property and normally not covered by insurance.
I guess the perimeter of my training is doing Ok now I have to dig into policy, risk and the gillion other subjects.
Be nice to meet and talk to some top hands ,and would sure like a get together.
I don't think improving my image is going to harm the carrier, after all I am the insurer in the eyes of the insured. Other than the Agent we are the ones to hold his hand when a disaster occurs. I think I would always include the AGENT when I could, he can also sell the adjuster and be a valuable source of information. I say that like I know, I am just thinking out loud. |
|
|
|
ChuckDeaton
USA
373 Posts |
Posted - 09/18/2002 : 08:20:13
|
The Fair Claims Practices Act in Arkansas requires that the policy be explained to the insured.
All adjusters explain the policy and so do most claims reps. |
|
|
|
RJ
32 Posts |
Posted - 09/18/2002 : 13:12:50
|
Newt:
First of all FEMA does not and will not address any damage after any event until the event is accessed and a determination is made that triggers the event to qualify for disaster status. Once this step has been completed the president must declare the event a disaster witch will define the localities that are included in the disaster. Then and only then will FEMA accept applications for disaster assistance. The level of assistance offered will depend on level of disaster that has been declared.
For the sake of this discuss lets say that a major flood event has occurred and Fema has opened their disaster field office and is accepting applications for assistance. To further limit our discussion we will address those applications for individuals that own their homes that may or may not have an insurance policy.
As part of the question and answer survey on an application for FEMA assistance the applicant must state if they have an insurance policy or not. It does not matter at this point in time what type of insurance coverages that the policy covers or does not cover.
The individuals that answer no will have their personal information entered into a file search to determine if no is the correct answer or not. The reason for this is that a prior event may have occurred in which a group flood policy was issued and the applicant may have purchased the dwelling unaware that a flood policy was in force. If not policy coverage can be found then the individual’s application for assistance is processed.
The individuals that answer yes will receive a denial letter in the mail informing them that they are not entitled to assistance due to having an insurance policy. At this point most individuals will no longer pursue assistance from FEMA. They do this because they believe that FEMA has determine that they do not qualify for assistance.
Under FEMA guidelines any application for assistance must be denied when it is shown that an insurance policy exists. FEMA then is required to inform the applicant of this decision. The problem is that most everyone, including adjusters, do not understand that FEMA can not help if there is any chance of help being derived from any other source, primary an insurance policy.
The reason for this is because the division that handles the grant assistance programs is only suppose to help individuals back on their feet to a minimum level of quality of life. FEMA is not insurance that restores one in the way that insurance policies do in indemnification of damages.
Therefore, if it is demonstrate that a deficiency still exists after the insurance investigation is complete the applicant can re-approach FEMA to readdress these deficiencies. This is especially helpful to those individuals which are under insured.
The general public views FEMA assistance as being available to only the poorest of individuals. That is totally false, FEMA in conjunction with state grant programs will provide assistance to anyone in a declared disaster that can demonstrate the need and requirement for financial help. The help can be in the form of FEMA or state grants and/or low interest rates loans through the SBA.
One additional benefit from FEMA is in the form of temporary housing assistance. As any flood adjuster knows or should know is that the SFIP (Standard Flood Insurance Policy) does not include coverage for additional living expenses. However, FEMA will provide for temporary housing need (nothing else for food, phone, travel ect.) as demonstrated by the applicant’s need after a declared event.
As an example lets say that an insured under SFIP has a dwelling insured for $250,000.00. A major flood event occurs requiring the insured to obtain temporary living quarters. The insured’s income was just enough to support his current life style. However, the expense for temporary housing causes him to exceed his income & other financial resources. FEMA at this point can and will provide financial assistance for this deficiency as long as the applicant can document and prove his need for the assistance. FEMA can proved this temporary assistance for up to 18 months.
For you flood adjusters that are not aware of this available help to your insured’s this could help relieve some of the pressure and make the settlement process go a little smoother.
Newt, this is just one example of what field experience brings to the table. You will have a hard time finding any of this information in a manul and if you did it could be very hard to understand. Remember this is only an example. The amount of help anyone can receive will depend on their financial needs and abilities to take care of their own problem. The amounts of help can vary as wide as there are in numbers of individuals seeking help. Remember just as in claims where every claim stands on it’s own merits so goes FEMA applicants. |
|
|
|
Newt
USA
657 Posts |
Posted - 09/18/2002 : 13:23:32
|
| That is a good law, and explaining should include so that the insured understands. If you tell a coon dog how to hunt coons he may not understand. That is a good subject Chuck and in my opinion one that deserves a lot of consideration. This should be done , I think, just after you talk about his or her expreriences in the disaster, In other words what happened, is everyone OK , how did the neighbors fair. Sorry I could not have been here sooner. We need to go over the policy and find out what we got and get you everything you have comming. Believe me the carrier is concerned that we get this claim right and get you back to the same condition you were before the storm. Is that a way to handle the first meeting Chuck or is something left out. You should know in most cases there is a covered loss before you get to the site. (If it is a cat site.) |
|
|
|
CCarr
Canada
1200 Posts |
Posted - 09/18/2002 : 13:44:23
|
RJ, thanks for the good summary, in essence that was what I was looking for.
Newt, your last post today at 13.23, I strongly suggest you do not rely on the last sentence of that post.
Aside from that, the "style" you suggest in your early dealings with an insured, is what I have characterized to other adjusters as a "cookies and milk" approach. I have found over the years that those utilizing your concept, have a much lower productivity level (all other issues considered equal) than an adjuster who uses more "business" focused customer service initiatives. Dealing with staff adjusters, the object was to maximize productivity with the combined skill set and numbers. As an independent contractor, your concept will burden your ability to close files to generate sufficient cash flow to make your efforts economically feasible. |
|
|
|
Newt
USA
657 Posts |
Posted - 09/18/2002 : 15:08:51
|
RJ I think I mentioned this was in case of a declaired disaster. And it is a solution in some cases, and FEMA is not the end of the road. Low interest loans and outright grants from IFG.
You are right every application stands on it own merits , if one fails there are other options
and we should know these options, There is SBA,DHA,IFG, and don't forget to remind them of IRS casualty losses. The easiest way to do this would be to run off some reminders for them with a list of agencies phone numbers. It just may prove your concern. Many people involved in a disaster either have no job or have no income from a lost business, they may qualify for many programs.
Experience is a good teacher, where mistake and achievements are not for gotten. The written
words in books are subject to mis-interpretation. However this is where most of our knowlege comes from. |
|
|
|
KileAnderson
USA
875 Posts |
Posted - 09/18/2002 : 16:02:30
|
I have to agree with Clayton on this one Newt. While empath is important in this line of work, it is also important to remain objectively detached. While it is hard to see a family loose the safety and comfort of their home and belongings it is important to remember that you could have as many as 100 other families who are also depending on your professional attention to rebuild what's left of their shattered lives. Every minute you spend holding a hand and playing social worker is a minute longer that you delay getting much needed financial assistance to those other families. Even if there is nothing you can personally do to help those families in the form of insurance proceeds. FEMA and the Red Cross will not release what assistance they can give, in many cases, without a denial letter from the carrier.
Don't be cold and uncarring, but don't get too personally involved either. Get in, do your job, and get on to the next one because it is volume that pays the bills in this line of work. If time wasn't of the essence on cat duty, they would just keep loading the staff guys down with the back log and we would be out of work. Remember fast, fair and accurate is what they want from us.
|
|
|
|
Newt
USA
657 Posts |
Posted - 09/18/2002 : 17:17:58
|
| Kile, I didn't intend for this to be a time consuming effort, and I would have to disagree that fifteen or twenty minutes in one direction or approach opposed to the same amount of time in the other could cause a problem. I doubt any two adjusters go at a claim the same way. I just don't want the carrier being hassled with phone calls and my being so business like that the insured wants to argue or worse beat me up. I think you make a point about the time and think it is a race against time and we shouldn't waste it on trivia. Fast,fair,acurate and retention you want that customer for the next cat. |
|
|
|
Newt
USA
657 Posts |
Posted - 09/19/2002 : 01:14:22
|
| The statement was made that if you had insurance fema would not consider a claim, That is not true, they will honor the claim. They will not cover items covered under the policy. That is what I tried to explain in my original post. And as I said in my original post, there has to be a declaired disaster. That didn't come from experience it came from the book. |
|
|
|
Linda
USA
127 Posts |
Posted - 09/19/2002 : 19:28:19
|
Newt, there is one point you made concerning IRS casualty losses I would like to expand on a little. While it is true there are IRS casualty losses, i.e., what insurance doesn't cover, keep in mind that the insured will look to you, the adjuster, to give them a full and complete estimate for repairs whether they are covered or not. Example: You are working a cat loss and you know it is a constructive total, you know (usually from experience) the $100K limits will be surpassed, you are working on a % fee schedule, it will take approximately $150K to repair it. So far so good, EXCEPT the carrier will only pay you for 10% over policy limits. Who is going to pay you for time it takes to write an estimate for the other $40K??
I have asked this question before and got no takers: Does the carrier owe the Insured for a total and complete estimate to repair or just up to the limits of liability. The carrier doesn't owe more than the limit so do they owe for the estimate of all repairs? They usually will allow you to go over by some but not by much.
I would not say one word to the Insured about anything concerning IRS--that is the job of their accountant and if they demand a full and complete repair estimate from the carrier, which has happened and the carrier provided, it is usually long after you are gone and a staff person does the balance of the estimate. |
|
|
|
Newt
USA
657 Posts |
Posted - 09/20/2002 : 09:00:09
|
This should not be a detailed statement, just a comment about when this is over don't forget you may have some tax exemtions. Most working people do not have the luxury of an accountant looking out for their interest. Items I can think of would be boats and vehicles or those item that have specific limits like collectables. Linda , this is a judgement call on the part the adjuster and I figure most adjusters would pick up on who not to mention it to. If you detect the slightest hint of greed you would have to be all business and hope you can close the file and keep it that way. If you talk too much to the greedy they will come back and hammer you with it. Most adjusters that I have had dealings with use more or less the same tactics as I mentioned, I never had a bad experience. Maybe I sound a little on the mushey side in dealing with insureds and most of you are really nice to them and get their respect more or less in that way. The phone adjusters are a whole new breed . I have no knowlege of how they deal with people. In my opinion most are efficient, effective and have not affected the retention of customers for the carrier. You brought some good topics and options to the table and hope we get some more input.
|
Edited by - Newt on 09/20/2002 09:02:31 |
|
|
|
CCarr
Canada
1200 Posts |
Posted - 09/20/2002 : 09:35:13
|
Linda, I suggest no one is going to pay you for the incurred time taken to prepare an estimate that goes beyond available indemnity, nothwithstanding the 10% you mention in excess of policy limits. My exposure with this over time, is that a carrier does not owe the insured an estimate (substaniation) beyond that for which indemnity is available. Where such demands are made, and they are not frequent in the few losses that exceed policy limits, they are usually made through the incumbent agent, and that demand is usually 2 to 4 months after resolution of the contract indemnity. The decision to comply with the request has seemed to always be a political one; i.e. a strong supporting and loyal agency with a large volume, mixed carefully with considerations for the time and resources available to do this "in-house" at that time.
I agree wholeheartedly about not mentioning The IRS or any other such entity. I refer to my comments on "milk and cookies" for the foundation of that opinion.
".... who not to mention it to .... if you detect the slightest hint of greed ...." Greed - the wanting of more. Who doesn't want more? This is a dusty and dirty trail to invite an insured down. |
|
|
|
Topic |
|
|
|
Customer SERVICE
Forum Locked
