Should insurance brokers and executives running insurance companies stand up for their insurance customers? While the comments section is sometimes passed over, I noted that a premier insurance broker, Irene Ochoa, stood up for insurance customers when responding to an article in Claims Journal, Viewpoint: J.S. Held CEO Refutes ‘Claims Surrogate’ Label.
There is one sentence my marketing team certainly wants me to boldly quote from Held’s article:
William F ‘Chip’ Merlin is both a nationally known and a respected advocate for policyholders who raises timely issues in his blog.
I am certain there exist some skeptical insurance claims executives wondering what secret information I hold over Jon Held.
Still, the point of my blogs, The Big Insurance Claims Trend—Moving From In-House Adjuster Excellence to Surrogate Unlicensed Claims Professionals, and Is JS Held a Claim Surrogate? Do Not Miss Today’s Tuesday At 2 With Chip Merlin, is that property insurance claims adjusters are important. They are needed at the loss site immediately after the claim. They need extensive training and motivation to get the full amount of the benefits owed to the policyholder right away. Property insurance adjusters fulfill the promise of the policy when they promptly and properly fulfill the adjustment function.
So, where are they? Why are so many overworked and leaving the industry? Why do we more often see them leaving the claims function to others or making no decision at all? We need great property insurance claims adjusters. Their role is important.
Perhaps I should simply let others do the writing for me. Responding to Jon Held, insurance broker Irene Ochoa eloquently wrote:
Outsourcing is not new, but the use of ‘trend’ to describe increasing usage seems appropriate, from my perspective, as is Mr. Merlin’s use of ‘surrogate’ in an increasing number of instances. As a broker, I’m privy to both sides of the claim process and witness too many times a practice that, even unintentionally, encourages policyholders to perceive specialty vendors as adjusters or insurance company staff with an ethical and fiduciary duty to them, the policyholder. This is simply not accurate.
The insurance company adjuster must take unquestionable, full-ownership for these responsibilities.
Often, claims are a traumatic, confusing time. Therefore, it is imperative insurance companies make clear (verbal & written) the vendor’s purpose and limitations. It is equally important vendors make clear, as often as necessary, that they are NOT adjusters, they do NOT have authority to limit scope of damage. They CANNOT make coverage determinations or discuss policy coverages, limitations or exclusions. The insurance company adjuster must take full ownership for these adjusting responsibilities, and contrary to Mr. Held’s statement, I hold ‘deliver[ing] the news’ to policyholders in a clear, concise manner supported by policy language, as prescribed by state requirements is unquestionably one of an adjuster’s most basic, important and regulated duties.
Ideally, vendors would stay in their lane, but the simple, common act of limiting a policyholder’s damage description is an inappropriate coverage denial. Because all limitations must be reviewed in full context and supported by policy language. A simple statement of ‘that didn’t happen on the same day’ can also be an inappropriate coverage denial because it requires knowing and appropriately applying that policy’s definition of an occurrence. There are too many ways for a vendor to overstep to be listed here, but you get the idea why insurance adjusters must fully control the process.
Consulting firms may seek to provide clear unbiased opinions and pride them themselves on objectivity and indeed many do just that. However, there are many insurance articles written documenting a less than perfect record. Thankfully, Attorney William F Merlin, a nationally known and respected advocate for policyholders, is well within his lane bringing this issue to our attention. Whatever, our role, we can agree policyholder rights must be protected.
Understanding the view of another is important. Appreciating where another’s perspective comes from is relevant as well. The people selling and marketing the insurance product play just as an important a role, if not more so, than the claims function. After all, if the insurance is not sold, there can be no insurance claim.
In my opinion, listening to agents and brokers views can be very enlightening to those of us slogging through claims disputes.
Thought For The Day
We meet aliens every day who have something to give us. They come in the form of people with different opinions.