Here are six tips to help resolve claim situations in an
efficient and economical manner.
1. Define the Problem
First, it is necessary to determine what went wrong, how it
went wrong, and to what extent. This requires good investigation
skills coupled with excellent analytical skills. Used together,
these critical skills assist the claim professional in
determining the cause of the accident or event and the identity
of the responsible party. Obtaining statements from involved
parties and witnesses, analyzing the type and extent of the
damages, and reviewing official reports will inform the decision
as to who is liable for the loss.
A decomposition of the claim issues allows the adjuster to
break down the issues into smaller manageable parts—for
instance, facilitating a determination as to whether claim
issues are based on coverage gaps, questionable liability, or
undocumented damages. Determination of these issues focuses the
investigation on the important facts to be uncovered, saving
time and effort.
2. Define the Desired Outcome
Careful consideration of the facts uncovered during the
investigation will assist the claim professional in determining
the desired outcome. Deciding the desired outcome will focus the
defense of the case toward that end. Certain actions will be
initiated to achieve the outcome. By answering questions such as
"Is this a claim that should be honored and paid?" or "Should
this claim be denied and defended?" will assist the claim
handler in creating a theory of defense that is supported by the
investigation.
3. Remain Objective
Emotions can run high among the people involved in adverse
events. By remaining objective, the claim professional can keep
all of the stakeholders focused on the important issues without
resorting to emotional outbursts. Emotions can also lead to poor
decision-making on the part of the claims handler, thus
hindering attempts to reach the desired outcome. Emotional
maturity is a learned skill that can be relied upon to increase
the confidence of the claim professional in believing that a
resolution is attainable no matter how contentious the parties
may be.
4. Know the Options
Once the claim issues have been determined and a theory of
defense articulated, the claim professional must weigh the best
course of action for reaching the desired outcome. This is the
point at which knowledge of experts and vendors is very
important. Use of claim mitigation vendors can assist in
managing the scope of the damage; legal experts can assist with
policy and coverage review; qualified physicians or independent
medical exam experts can define injuries; and appraisers can
itemize damages. Knowing when and how to use vendors is only
part of the equation; knowing which ones will actually deliver
is the second half. The efficient claim professional will know
who can be relied on to deliver the service needed.
5. Develop the Expertise Necessary
Claim handlers fail because they do not have the expertise to
perform the work that is required of them. They can't make a
good decision about what to do if they don't know what needs to
be done. Designation courses such as the
Associate in Claims and the
Senior Claim Law Associate
programs provide excellent education on claims handling and
offer bona fide credentials that a certain level of knowledge
has been attained. In our ever-changing legal environment,
knowledge is power, and excellent adjusters strive to have as
much knowledge as possible.
There is no one single bit of knowledge that will ensure
success. Broad knowledge about a variety of subjects will serve
to assist the claim professional in resolving the claim issues
that are presented. For instance, knowledge of the legal system,
of repair techniques, of surgical interventions, and of fraud
indicators are all tools that will prepare the adjuster to face
a myriad of issues.
6. Maintain an Open Mind
It is difficult for the claim handler to solve a problem when
there is only one foreseeable way to do so. Claims professionals
require creativity to discover alternative solutions that will
lead to claim resolution. Just because something worked in the
past doesn't mean it will work now or ever again. Being open to
new approaches and new ideas will keep the claim professional
flexible in approaching claim issues.
Conclusion
Remember, claims are dynamic, occurring in an ever-changing
environment. Solving the complex problems that arise from
accidental or catastrophic events requires that the claim
professional be well prepared in a number of important areas. No
claim professional wants to be seen as the cause of a modern
version of
Jarndyce v. Jarndyce, making problem solving and
claim resolution a keystone skill.