So I work in sales and I Don't really know much about claims or the claims department but I do see comments here and from friends that I know who work in claims
All my life the perception of claims has been a denial heavy one. They are looking for reasons to say no and get out of their obligation.
But honestly? Every claims adjuster I've ever actually talked to has expressed a genuine interest in appropriate restoration. Not naming names or companies but I have had this exact phrase said to me by a friend: "I try to approve everything I can, I try to be as generous as I can with what I have"
So what's going on here claims guys? So far My perception is that it must be a lot like sales underwriting- where the carrier has strict guidelines that make skirting the rules impossible, but otherwise I am legitimately trying to find anyway I can safely write a policy that will benefit my customers.
Is that what it's like for you guys? Do you often feel like carriers tie your hands which make you look like the bad guy or?
The perception of claims(?)
byu/TheAdventureClub inInsurance
Posted by TheAdventureClub
9 Comments
It’s a hell of a lot easier to pay claims than it is to deny them. When it comes to coverage, an adjusters job is to find coverage if at all possible. We don’t seek out ways to deny a claim, but we also need the truth.
When it comes to liability, that’s relatively straightforward. It doesn’t seem that way to the general public and that’s because most people don’t know the actual rules of the road. They don’t understand word vs. word scenarios, either. I always told people that there’s no dispute an accident happened, we just don’t have proof one way or the other and we can’t just flip a coin to determine who is at fault.
When it’s a BI claim, we pay what’s owed. Attorneys want to get the most possible, carriers want to pay the least possible. People tend to have an overinflated idea of what their injury is actually worth. They see the TV commercials and billboard of people getting six figure *verdicts* and have no context behind it. Every carrier and venue is different, there’s no magic book that tells me how much a neck strain is worth. It’s based on tons and tons of data and the adjuster’s judgment. For the most part, carriers try to keep the ceiling low but if I ever need a couple grand to settle a case and keep it out of suit, I’ve never been told no. Large value claims end up being more about a business decision than if the injury is actually worth what somebody is seeking. It can easily cost tens of thousands of dollars to defend a soft tissue case and it’s a huge risk. I’ve dug my heels in on tons of cases too and been successful. It’s about knowing what claims to play chicken on.
I don’t think I’m ever forced to be the bad guy or that my hands are tied. If it’s a coverage thing, it’s pretty easy to point out what part of the contract was violated. If it’s liability, there may be the rules of the road or a video that I can point to. Most of the time people are pissed no matter what, though.
(after I typed this it ended up being longer than I anticipated, but its an important topic)
I have no idea where you are, but I’m in Canada. We very much have the same perception here.
“Insurers are just looking for a reason to deny”
“Don’t accept the first offer because they will low ball you”
Etc etc
By law we have to act in good faith. Search for coverage over searching for reasons to deny. Denials are actually very unusual, even in cases of fraud and wrongdoing on the part of the client.
Nobody is lowballed and nobody is getting screwed over, barring the odd honest mistake.
The insurers are not responsible for this either, legal obligations aside. I can’t say there has never been a situation where maybe we should have done more, but 99% if the time the settlements and payouts are very fair and we regularly go above and beyond for clients who end up in unusual situations.
Personally, I suspect this perception is because of two major reasons, though they tie together.
First, I think we are living in a world that is quickly turning cold. People are less friendly, more abusive to others and much more selfish. I think most people just really don’t care or want to think about what’s fair or what they previously agreed to for deductibles etc, they just want to demand.
I think the second thing is that most people are just clueless on how insurance works. Got screwed by a dealership when you bought your used car? Why should that be the problem of all the rest of our clients. Insurance too expensive? Personal auto isnt even really profitable anymore – nobody is gauging you.
Older clients are usually some of the easiest to deal with because they haven’t lost their trust in institutions. So they are usually more inclined to listen to your advice and work with you as opposed to immediately working against you under the false impression your the bad guy.
I’m a manager now and no longer handle claims. I’ve got about 10 adjusters under me and I can speak for every one of them and myself included, we genuinely want to help and we enjoy doing so. We want to look out for people and be there when they need us to be.
Last comment. My experience, the people who have the worst experiences with insurance and who have the most negative stuff to say about their insurer are the ones who are awful to begin with. Either abusive behavior, attempting fraud, demanding more and more without any reason to it. I don’t have much sympathy for them.
What’s that old saying. If someone is unhappy with something, they’ll tell 10 friends, but if they’re happy with something they’ll only tell 4. That’s the way it is in claims.
people dont understand what they pay for or what the insurance covers. no one reads the fine print.
everyone at my company always says – we seek to afford coverage and pay. the issue is the sheer amount of fraud and people who stick their heads in the sand and dont want to hear that their policy doesnt cover xyz
I work on the service side in personal lines and I think most people are unhappy with claims because the claims rep has to explain to them, no, you don’t have coverage for X… or yes, you are 40% at fault. That, and needing multiple tries to reach the adjuster and they don’t want to hear that you all have huge caseloads. I get it but people outside of insurance don’t.
In my experience – I’ve worked for a district office and I now work in an agency for the same company; insurance is all about risk. There are guidelines in place for these risks to be accepted. Claims job is to verify the risk we insured is what we’re paying for.
A huge issue with insurance rates today is simply insurance fraud. You may think of the insured being shady, but just last week a nicely dressed man walked into our agency and asked me “May I speak with the agency owner” she wasn’t available so he says “well I wanted to bring by these business cards. We’re a hail repair company located right here in downtown! We aren’t storm chasers who are just coming through after a storm. We take really good care of your customers! We work the deductible into the total. An agent with your company a few towns over (*he name drops and I know this sleezball*) sends his clients to us all the time!”
I sat there looking at him like.. did you literally just tell me y’all commit fraud on the regular? And you’re marketing this? THIS IS WHY INSURANCE RATES ARE SHIT!
Apologies for the rant…
If you’re a third-party claimant and you’re nice to me, I’ll help you out as best I can provided there are no coverage or liability issues
If you try and play hard ball… I don’t care, but you’ve just made your life harder because I’ll stop giving you the benefit of the doubt and I will spend more money to prove I owe you less
I try to help people as much as I reasonably can. Of course, when it comes to liability, facts are facts, and we have to follow the facts no matter what an insured or claimant feels.
Besides total loss valuations and BI settlements being too low, the biggest issues I see that causes anger towards claims adjusters are:
1. Insureds do not understand what coverages they have and what their policy does and does not cover. They do not read their policy for exemptions. It will only get worse as it is getting easier and easier for people to get an insurance policy online. They do not have an agent and no one to talk them through what would be the best coverage choices for their situation.
2. People want to pay for bare bones coverage to keep their premiums down, but expect top tier coverage. I have had many people knowingly decline collision coverage get upset with me because I won’t cover repairs to their car. Their argument: the accident wasn’t my fault, so you should pay for my car to be fixed. Sorry, but you declined to carry collision coverage. As I say, you can’t buy an economy class plane ticket, then get upset when you can’t sit in first class.
3. The last issue I see that makes people hate claims is that many people are not financially literate and expect the insurance company to bail them out. If you buy a car with a lot of dealer markup, at a high APR, and rolled negative equity into your loan, it is not the responsibility of the insurance company to bail you out financially. If you are paid $3000 for your estimate to get your car fixed, but you spent the money on something else, we aren’t going to send another $3000 to your body shop now that they have completed repairs and won’t release your car to you until they get paid. You were paid for the repairs and chose to spend the money somewhere else, not your adjusters problem, but we will get blamed for it.
I was threatened with a DOI and BBB complaint because we paid an insureds lienholder for a total loss, in which the payoff was a little more than the vehicle value, but the lienholder accepted that payment to fully satisfy the loan balance. However, the insured was angry that we did not give them a check to cover their down payment from when they originally bought the car. And that’s how it was supposed to work because the last car they totaled, they got money for a down payment for another car. I was never able to get them to comprehend all that was wrong.
Denying something is way more work than paying it. If I can find a way to pay for something then I will do so 100% of the time if for no other reason than to save myself the effort of a denial. Plus you never have to worry about a DOI complaint if you pay something. Honestly nobody’s holding my hands to the fire of denial except the wording of the policy. I don’t deny anything. The policy contract denies things – I’m just the mouthpiece.