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Chapter 10 Nature of the Insurance Industry
is reasonable. The loss adjuster is responsible for arriving at a final
settlement with the policyholder.
The insurance carrier has to balance two competing interests
when it receives a claim. It wants to provide good customer service
and be perceived as fair by its policyholders. At the same time, the
company wants to settle a claim at the lowest possible cost.
The way in which an insurance carrier processes claims is an
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and efficient will earn more trust and respect than one readily
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philosophy that their claims professionals follow. A stated philosophy
can be a useful marketing tool. Here are some examples of insurer
claims philosophies:
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accuracy and knowhow…Taking the time necessary to talk to
employees, answer their questions and ease their minds really
sets us apart. So do our speedy phone response time and prompt
payments.”
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“It is our policy to deal openly, ethically and promptly with
our customers. We are devoted to achieving excellence by
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and communication. Our goal is to be The Company of Choice® by
providing superior customer service.”
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“…We realize that policies issued by most insurance companies
have basically the same coverages and features. While we do try
to offer some special features to meet the needs of our members
we know that the manner in which claims are handled can make
the real difference in meeting those needs. We feel all of our
customers should receive the best and most professional service
we can offer…”
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Claims-Filing Pitfalls
What happens if the insurance carrier offers a settlement that
the policyholder thinks is unsatisfactory? When this happens,
the policyholder begins by filing an appeal with the insurer. The
policy should spell out the appeals process. After the appeal, if the
policyholder still does not agree with the settlement offer, the policy
likely spells out the next options. These options typically involve