CUSTOMER SERVICE FOCUS
By Rod Rezac, CIC, CPCU, ARM, and Carol Middlekauff, ARM
Good service on claims is a constant battle
As it turns out, regardless of their frequency or severity and whether or not they are the most time-consuming part of your job, claims are the most important part of your job, the real reason your agency is in business.
Your troops are outnumbered and boxed into a dangerous situation. Reinforcements have been called, but none are available. You and your fellow warriors are tired and overwhelmed from unrelenting attacks that seemingly come from every direction. Sick Bay is full. Phone communications are unending. Important decisions must be made, and teamwork must be implemented to make the decisions work.
No--this is not a battlefield report from Iraq; it's a report from the frontlines of an insurance agency. The warrior in the thick of the battle is the customer service representative (CSR), upon whom so much depends.
When you took that job as a CSR in an insurance agency, you knew they were looking for a multi-tasking, personable person who could handle a high volume of work. Maybe you didn't realize that, unless your agency has a separate claims department, a good bit of the job would be helping people with claims, a frontlines task if ever there was one.
The real reason your agency is in business
As it turns out, regardless of their frequency or severity and whether or not they are the most time-consuming part of your job, claims are the most important part of your job, the real reason your agency is in business. People pay insurance premiums for the peace of mind they get from knowing their losses will be covered. Insureds want to know someone will be there to tell them what to do next and to smoothly transfer their information to an adjuster who will make everything right.
Well, the adjuster might not make everything right--if the claim isn't covered. However, as a CSR, it is not your job to tell the insured or claimant whether or not the claim is covered. You are simply taking the information and reporting the details to the insurance company, which will assign a claim representative to investigate the facts and determine whether the insured's policy will respond.
Promising or denying coverage is not your job
Most states have Unfair Claims Practices acts that may haunt you if you give the wrong information by assessing coverage when you take a loss report. Instead, send the report to the company where an adjuster will do a proper evaluation and make a determination of whether coverage applies or not.
Usually within a short time, the insured will receive a letter stating that an adjuster has been assigned and giving a time frame for adjustment of the claim. A reservation of rights letter may also arrive, advising the insured that the company may or may not cover the claim, but that it is reviewing the evidence.
After all the evaluation, the adjuster may deny the claim. However, given what you know about the policy and endorsements, you may think that coverage should be available. If so, you may lobby on behalf of your client; but again, do not tell the insured or claimant that there is coverage, or even that you think there should be coverage.
A complete loss report
Beyond offering your clients the broadest coverage they can afford, your paramount responsibility in the transaction is to get as much information as possible when you take a loss report. This will make the adjuster's job much easier. Making the process easier will assure a quicker settlement or answer. For instance, if you convey the estimated size of the loss, it will help the carrier to assign the appropriate claims representative. Some simply call claimants on smaller losses, while others personally inspect damages on larger ones.
Your first step is to complete a loss report immediately so that you can submit it to the insurer that same day. A few companies require their own forms, but for the most part you will be submitting an ACORD form.
Every answer blank on a claim form is important, and any one you leave empty causes a concern or question for the adjuster, slowing down the process. So, don't leave any blanks. If you don't have an answer, say "unknown." If the question doesn't apply to your situation, say "not applicable" or "n/a." Otherwise, include the most complete information you can gather. If necessary, start a second sheet.
First, show you care
When an insured or claimant calls to report a claim, your first question should be, "Is anyone hurt?" This question shows that you care, but you also are able to determine the seriousness of the claim. If someone is injured, express concern, and perhaps you will want to start at the lower part of the form and ask for those names first. You also should be thinking of e-mailing or faxing any injury claim to the insurance company. Then follow up that same day with a phone call to make sure the company has received your report and that an adjuster has been assigned. For future reference, ask for the name and phone number of the adjuster, as well as any claim number they have assigned.
Handling automobile claims
1. Take the names of everyone who is injured, including their ages, or approximate ages. If a minor is injured, also include parents' or guardians' names.
2. Make sure you include phone numbers, including area codes, for all parties. Remember to include home, business, and cell phone numbers, along with e-mail addresses, so the adjuster will be able to contact them at any time of the day or week.
3. Where can damaged property be seen? Include street numbers and phone numbers. Also, the insured or claimant may have had a vehicle towed to a garage.
4. Has the insured/claimant received an estimate? If so, include the amount so the adjuster can quickly grasp the severity of the damage.
5. For automobile accidents, ask for the case number on the police report, or ask for the officer's name or at least the police department that responded (e.g., state patrol, police or sheriff's department).
6. Include information on whether a vehicle is drivable or if the insured can still enter his or her property.
7. With an auto claim, you may find out that the other party does not have insurance or left the scene of the accident. This is important because it will affect the way you report it. It may be an uninsured and underinsured motorist claim, and if your state has an uninsured motorist property damage endorsement available, you may need to gather additional information.
8. Get the names of any witnesses. A well-known insurance adage is: "One witness is worth a lot--a car full of nuns is even better." With this in mind, when you deliver a policy to insureds, instruct them to make sure they get all possible witnesses' names if they ever have an accident or incident.
Handling property claims
On property claims, you're still completing every section of the ACORD form. Make sure you include:
1. In addition to the date of loss, show the time of loss.
2. Indicate the location. If it is a secondary location, or the insured has moved property to protect it from further damage, the address of the damaged property may not be the same as the insured's address.
3. In the notes section indicate:
a. Whether or not the cause of loss is still a threat (e.g., water damage, mold, etc.).
b. If any corrections have been undertaken (e.g., window has been replaced or boarded up, carpet has been taken up, etc.).
c. Whether the claim is preventing the insured's ongoing operations, which will worsen a loss of use or business income claim.
4. If any part of the loss is a hazard to passersby, ask the insured to put up signs warning them of the danger.
5. Advise the insured to protect property from further damage and replace it if necessary to contain the amount of loss, but to keep all damaged property so the adjuster can see it later.
Handling general liability claims
Because general liability claims always involve injury or damage to others, the nature of these claims is entirely different from automobile or property claims. Because of differences in insureds' operations and the types of claims resulting from those operations, each claim is different from the last, as well. You may be dealing with a premises/operations claim from a contractor, a retail store, or a business office. Or, you may be dealing with products claims (e.g., a broken tooth in a restaurant) or completed operations claims (e.g., a contractor's plumbing job leaks).
Taking information on general liability claims will involve an understanding of the coverages because different claims fall into different parts of the ACORD forms. They also take some creativity in dealing with the person reporting the claim. It is not unusual for first reports on general liability claims to come in the form of a letter or a summons from an attorney.
In any bodily injury claim, submit the loss report immediately by fax or e-mail. Follow this up with a phone call to make sure the claims department has received it, and get an adjuster's name and phone number to include in your file for future contacts. If the demand comes in the form of a summons, you'll also need to send the original document to the carrier by certified mail (return receipt requested) that same day, as well as report it by phone or fax. This will give you a way of tracking the original to make sure it arrives. Because a summons usually has a short time period for a response from the insurer, you need to make sure the insurer receives it and responds as soon as possible.
In a general liability property damage claim, the claimant often demands immediate answers and satisfaction. This claimant is often your insured's customer and must be handled carefully. People with property damage may try to force you to agree to let them buy another "widget" now or to know exactly when they'll be paid. Do not make any promises or agreements with this claimant on behalf of the insurer.
Finally, in any premises liability claim, if there is a possibility that another injury or damage may result from an unsafe condition or procedure, the insured needs to take immediate steps to correct it (e.g., mop up the water or fill in the hole in the parking lot) or to post signs if it can't be corrected immediately. But have the insured bear in mind that on some claims, making major changes in operations or to premises may be admitting an unsafe premises or operation and the adjuster may be able to offer guidance about the best way to proceed with any revisions.
After the loss
One thing you need to tell insureds or claimants is that they should carefully protect their property from further damage. If a window is broken, they need to board it up or cover it immediately. If it is safe to do so, the insured may move property away from a fire or any other peril. With water damage especially, it also can mean moving property so the water can be cleaned up.
However, if at all possible, they should keep the damaged items in order to allow the insurance company an opportunity to inspect them. If the damaged property must be removed for some reason, take pictures of all damaged property from all angles. Pictures can be worth not only words, but also money.
Do unto claim representatives as you would have them do unto you
You are trying to help your client receive the best possible claims service. The best way to do this is to put yourself in the adjuster's place. Which file would you pick up first--the one with the most complete information, including policy number and phone numbers, witnesses' names, and all of the rest of the blanks filled in, or the one that contains not much more than the insured's name? Adjusters can make you look good in your client's time of greatest need and anxiety. Claims representatives are the medics on the battlefield who will come to your aid, but they can still use your help. So do unto claim representatives as you would have them do unto you. *
The author
Rod Rezac is a regional director, and Carol Middlekauff is a program administrator at the National Alliance for Insurance Education and Research in Austin, Texas. The National Alliance administers the Certified Insurance Service Representative (CISR) program, including CISR Online and Dynamics of Service courses. For more information on The National Alliance programs, visit their Web site (www.TheNationalAlliance.com) or call (800) 633-2165.