Jeff Raizner, Steve Badger and Chip Merlin at IAUA San Antonio Conference

Speaking at the IAUA Conference in San Antonio yesterday, I suggested that every insurance company should be demanding from their field adjusters and claims managers that they deal with their customers who ask these four questions:

  1. How much am I fully entitled to?
  2. When am I going to get those benefits?
  3. Are you certain that I am not entitled to more, and what are those benefits?
  4. Is there anything you can do to speed up getting what I am owed?

Claims managers, insurance regulators, public adjusters, attorneys for policyholders, and the media should be asking these four questions. These are questions I am demanding our Merlin Law Group attorneys and staff answer to our clients. It is the same question insurance companies should be asking from their own employees serving their own customers.

Does this happen? I would suggest that often it does not. It is almost as if the insurance customer after making a claim is the enemy and the amount demanded is fraudulent.

Claims managers should be asked whether they agree these four questions are the basis for good faith claims handling and that they should be penalized for failing to adhere to them.

I bet a big waffle answer will happen.

Thought For The Day

Criticism in good faith is good. When it’s targeted solely to destruction, I’m not interested.
—Andrea Bocelli

  • shirley heflin

    Dear Chip:

    I agree that Insureds – the “Customer” in a claims setting – deserve answers to the posed questions from its own insurance company. You’re right that the Insured is all too often treated as the “enemy” by its own insurer after submitting a claim. This type of behavior seems primitive in light of the education, seminars, professional associations, case law, public opinion, etc., established in the past three decades regarding how insurance companies should treat their Insureds. Indeed, insurance companies need not guess on how to treat their Insureds in good faith and fair dealing as it is etched in stone and available for all to see. This type of good faith claims handling should be an “automatic response” from an insurance company towards its Insured.

    Tampa, FL

    • Chip Merlin


      Thank you for your comment.

      Being an insurance adjuster for an insurance company is a hard and demanding job—even for a less complicated residential adjuster. You have to know so many
      different fields—construction, construction pricing, construction specifications, building laws and ordinances, contents valuation, housing availability and pricing, insurance coverage, insurance case and regulatory law impacting the written coverage, have a high degree of interpersonal skill sets to deal with a lot of different people, be a very detailed person and comply with all kinds of insurance company managment and control requirements.These people are very important to making the insurance product work.

      They need to be properly motivated, have sufficient support and training, have
      sufficient authority to pay claims right away and not be overworked so they can
      spend a sufficient time to quickly get the insurance benefits to the customer.

      This person I just described might exist with parts of these characteristics, but this total adjustment person rarely exists in reality. That is the root cause for the claims crisis we face after each major catastrophe.

  • Chantal Roberts

    Hi, Chip. How can the ‘Big Waffle,’ as you say not occur?

    ‘How much am I fully entitled to?’ As an adjuster, I won’t know until the investigation is complete. I am required by the DOI good faith claims handling regs to inform policy holders what their limits are, which one could argue that’s the ‘full amount.’ However, I don’t think that’s the question’s intention.

    ‘When am I going to get those benefits?’ Is even harder to answer. Is it a catastrophe? Are appraisers backed up in sending estimates? Am I slammed getting 20+ new claims a day (in which I have to make contact, explain policy provisions, set up assignments for inspections, etc)? Do those policy holders think they are just as important as your client? Can I have the night off to see my son’s basketball game? Have I discovered a coverage issue? Is the public adjuster trying to run up the cost to cover his fees and the insureds’ deductible which makes more work for me because I then have to pick the estimate apart due to non-covered items? That definitely slows down the process.

    So as an adjuster am I ‘waffling’? No. Just like attorneys do not ‘waffle’ when you say, ‘Is this legal?’ Or ‘Am I going to get in trouble if I do XYZ?’

    • Chip Merlin

      Chantal Roberts,

      Thanks for your comment.

      If you are being slammed for 20 plus claims a day, that is not good faith claims
      managment. There is no way you can handle 20 plus claims per day properly. If
      that is the normal course of operations, no wonder there are so many poorly
      adjusted and delayed claims.

      The policyholder signed up to have full service right away with people dedicated to
      provide the full amount of money right away. Not excuses for delay and excuses
      from adjusters showing that they are more concerned about finding ways not to
      pay and not having time to do a timely investigation—which means right

      If the insurance company does not provide this type of service after a loss, it
      should not be in the business of selling insurance policies in the first place.
      It is simply ripping off the public and causing the types of problems we
      find in the Panhandle of Florida and elsewhere.

  • Aaron Stutman

    Mr. Merlin, I am a Public Adjuster and have met you a few times. Are you saying I should be asking these 4 questions to the field adjuster and/or staff adjuster in respect to the insured that I am representing? Are you also saying that the insured should be asking me these 4 questions as well?

    • Chip Merlin


      I am glad to know you and when you run into me again, let’s talk. Indeed, here in my
      cell number 8136958733.

      Your client is asking or at least thinking these questions!! Your job as a public adjuster is to help get him the full amount of benefits as past as possible.

      The customer of the insurance company who has a loss is thinking these questions
      when dealing with any of us in the business of promising help regarding the
      insurance claim.

      I am suggesting the insurance company claims side, except for some insurance
      companies and claims managment, rarely demonstrate this attitude which I used
      to find all the time from experienced general adjusters who had some real large
      line authority to get claims paid fast. Those days are long gone for most
      insurance companies.

      I had a lot of old time independent adjusters talk with me about this last night
      at the IAUA cocktail party. It was their discussions and stories as well as me
      telling our Merlin Law Group attorneys and management that these are four
      questions our clients want to have answered, which lead to publicity write the
      blog you commented upon.


  • Bruce Holmes

    The only way to get a handle on this is to use IT to automate the info, claims filing, etc. so the info for the claim can be seen by the ins. co., the property owner, PA, etc. Kind of like a site for sharing info. I really don’t seeing this happen soon, but USAA is doing this for their auto claims. I have as many problems with them over casualty loss claims as other ins. co’s. and I have been a member for 45 years.

    • wmerlin

      Bruce—appreciate your view. I came from a military family and most of military friends swear by USAA. I personally think AMICA does a better claims handling job, but giving good claims handling credit where credit is due is always something I like to do.

      Insurance is a wonderful product and one I believe in. We just have to make it better for the policyholders.

  • This is reminiscent of an article I wrote called “5 Important Questions to Ask an Agent About Your Insurance Coverage”:

    From the standpoint of claims, the single most important step at the beginning is to give the customer a good idea of what to expect…how the process works, how long it is likely to take, etc. Then, if the procedure is not followed or steps are delayed along the way, keep the customer informed.

    COMMUNICATION is the key. Last year I had my first auto claim in 50 years. I used a nifty phone app to submit the claim details, including photos, was told within 24 hours that the repair estimate was $1,200 and the time to repair was 3-4 days. 31 days and over $5,000 later, I got my car back and that was only because I resorted to calling the repair shop twice a day during that last week. No one — adjuster or repair shop — every followed up with me beyond that initial estimate.

    I can order a pizza at Dominos and watch the process unfold on my phone, tablet or computer. I realize that the claims process is far more complex and involves multiple parties, but it’s the communication that is key, however that is conducted.

    • wmerlin

      Bill Wilson—thanks for commenting. Adjusters can learn a lot from you and your book, “When Words Collide.”

    • I won’t disagree. I tried to drill into my adjusters to communicate when I was Director of Claims. I think Bill and I agree some of this ‘new fangled’ technology is not all it’s cracked up to be. Think of an insured who is not as savvy in the industry as we! It’s no wonder insurers get a black eye.

    • And I might mention that, when our home was hit by a tornado (a ‘little’ EF0 one), the process went smoothly and the adjuster was excellent. Frequent communication and a willingness to negotiate fairly on both sides. I attribute that experience with the quality of the individual adjuster whereas my lesser auto wreck experience seemed more of a systemic issue.