The Art of Adjusting

Chantal M. Roberts

Description

Every profession has its unwritten rules which practitioners learn through on-the-job training. Being a claims adjuster is no different, except that insurers expect the claims department to shoulder more and more duties with less personnel-- leaving little time for training from seasoned adjusters. This is exacerbated by the "brain drain" of the Baby Boomers leaving and no clear educational process for adjusters.

 

The Art of Adjusting: Writing Down the Unwritten Rules of Claims Handling will help the adjuster:

• Write better reservation of rights letters
• Handle irate insureds and claimants in a more professional manner
• Understand how to read an estimate and medical records.

 

Chantal M. Roberts, CPCU, AIC, RPA, is a claims handling, standards, practices, and procedures expert witness with 20-plus years' experience as a multi-lined claims adjuster. In her first book, she attempts to bridge the gap between being a new adjuster and a seasoned hand by offering some of the lessons she learned so that adjusters can get back to doing what they are meant to do: settle claims quickly, proficiently, and economically.

The Art of Adjusting: Writing Down the Unwritten Rules of Claims Handling

Table of Contents

Author's Notes

Chapter 1-Insurance Concepts

Risk Management

What Insurance Covers

Insurance Regulation

Insurance Contracts

People Involved in Insurance 

Wrap Up

Chapter 2- Insurance Policy

Types of Policies

Parts of the Policy

Declarations

Insuring Agreement

Conditions

Exclusions

Endorsements

Covered Causes of Loss

Insurance in Action

Wrap Up

Chapter 3-Words Have Consequences

Real Life War Story

Where the Rubber Meets the Road

Insurance in Action

On the Home Front

Wrap Up

Chapter 4-The Claims Handling Process

Good Faith Claims Handing

First Notice of Loss

Reviewing Coverages

Discussing the Loss with the Insured

Discussing the Loss with Other Parties

Reserves

Assignment of an Appraiser

While the Appraiser's Away

The Next Steps

Closing the File

Other Handling Issues

Wrap Up

Chapter 5-The Next Steps

Suspicious Claims

Insurance in Action (Red Flags)

Reviewing Coverages (Again)

Reviewing the Damage Assessments

Insurance in Action (Reviewing Damage Assessments)

Disagreements with the Damage Assessments

Subrogation

Salvage

Wrap Up

Chapter 6-Introduction to Litigation

Threat of Litigation

Sources of the Law

Introduction to Litigation

Litigation Management

Choosing Defense Counsel 

Small Nuggets of Litigation Wisdom

Wrap Up

Chapter 7-Adjuster Ethics

Morals and Ethics

State Departments of Insurance

Organizational Ethics

Insurance in Action

Wrap Up

Chapter 8-Claims Will Always Be Adversarial

But Why Are Claims Adversarial?

Wrap Up

Chapter 9-Claim Notes

File Documentation

Writing File Notes

Getting Personal

Insurance in Action

Wrap Up

Chapter 10-Property Coverage Unwritten Claim Rules Written Down

Actual Cash Value

RCV and Coinsurance

Insurance in Action (Coinsurance)

Another Insurance in Action Example (Coinsurance)

Depreciation of Labor

But Wait! There's More!

Overhead and Profit

Three Trade "Rule"

Making a Profit from Insurance Claims

Insurance in Action (Depreciation)

Making Repairs...Or Not

Line of Sight Repairs

Rolling Totals

Insurance in Action (Total Losses)

Value Policies

Settling Without a Proof of Loss

Contents

Wrap Up

Chapter 11-General Liability Coverage Unwritten Claim Rules Written Down

Coverage v. Liability

50 Shades of Grey

CPT/ICD-10 Codes

If You Ain't First, You're Last

Insurance in Action (Negotiating Settlements)

Disagreeing with the Settlement Offer

Partial Bodily Injury Settlements

Insurance in Action (Partial Settlements)

Chiropractors

Time Demands

Wrap Up

Chapter 12-The Art of Adjusting 

You Are a Professional

Under-Promise and Over-Deliver

Over-Communicate

Conference Calls Are Your Friend

Why Am I Paying Premiums?

Always Prepare the File for Litigation

You Will Be Sued

You Will Have a Formal Complaint Lodged Against You

Just Like Grandma

Knowledge Is Power

Could You Lower Your Voice, Please?

Do I Need an Attorney?

Promise Keepers

Appendix

Sujets

• Droit et juridique
• Reservation of rights
• Denied
• Claims adjuster
• Appraiser
• Claim
• Liability
• Plaintiff
• Property
• Insurance
• Expert witness
• Law
• Coverage
• Médecine

Informations

• Publié par: Tilting At Windmills Press
• Date de parution: 01 août 2021
• Nombre de lectures: 0
• EAN13: 9781737426813
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Critical Acclaim for Chantal M. Roberts, CPCU, AIC, RPA
“You are such a wealth of knowledge!” — Leana Massey, CPCU
“To date, the best explanation in detail (of a reservation of rights letter) I have seen or read.” — Alex Shaw, AFIS
“Chantal is one of those women to watch in this decade and the next.” — Nancy Germond, MA, SPHR, SHRM-SCP, ARM, AIC, ITP
“Chantal Roberts is a passionate observer and commentator in the landscape of insurance claim handling. A seasoned practitioner who blends practical know-how with insights understandable to those within and outside the insurance claim industry, she has the rare ability to translate insurance concepts and terms and make them intelligible.” — Kevin M. Quinley, CPCU, ARM, AIC, ARe, AIM, RPA

Copyright 2021 Chantal M. Roberts, CPCU, AIC, RPA. All rights reserved.
You may not modify, copy, distribute, transmit, display, publish, sell, or license any information from this document without the expressed written consent of the author or copyright holder(s) except for the use of brief quotations for a book review. 1
The sample scenarios are an amalgamation of real claims. Since each is a combination of two or more claims, all examples are fictitious. Any similarity to actual persons, living or dead, is coincidental.
Information which is copyrighted by and proprietary to Insurance Services Office, Inc. or its affiliates (“ISO Material”) is included in this publication. Use of the ISO Material is limited to ISO Participating Insurers and their Authorized Representatives and other licensees. Use by ISO Participating Insurers is limited to use in those jurisdictions for which the insurer has an appropriate participation with ISO. Use of the ISO Material by Authorized Representatives is limited to use solely on behalf of one or more ISO Participating Insurers.
Includes copyrighted and proprietary materials of Insurance Services Office, Inc. Used with permission.
eBay photos are used for educational purposes only and are owned and copyrighted by eBay.
ISBN: 978-1-7374268-0-6 (paperback)
978-1-7374268-1-3 (ebook)
1 But it has to be a good book review. If it’s a bad book review, I’ll have to call your mother because you didn’t listen to her when she taught you, “If you have nothing good to say, don’t say anything at all.”
Disclaimer
I am not an attorney. The information in this book does not convey any legal or professional advice of any kind. Each insurer handles their claims differently, and readers should keep in mind this book is intended for informational purposes only.
The opinions expressed in this book are those of the author.
Nothing in this book is intended to recommend a specific course of action. If specific information is needed, please consult with an attorney or me. My opinions may change based on the specific circumstances of your situation. The coverage discussions are based on the standardized ISO policy forms.
Indemnity
You agree to defend, indemnify, and hold harmless the author and the copyright holder(s) from and against all the liabilities, claims, damages, and expenses (including reasonable attorney’s fees and costs) arising out of your use of this material; your breach or alleged breach of this agreement; or your breach or alleged breach of the copyright, trademark, proprietary or other rights of the author or copyright holder(s).
For information, please contact:
Chantal M. Roberts, CPCU, AIC, RPA
P.O. Box 4676
Olathe, KS 66063
TheArtOfAdjusting.com
Book cover design by Chantal M. Roberts
Interior design by Laura Orsini, Panoply Publishing LLC
Dedication
To all the claims I’ve loved before...
Contents
Author Notes
CHAPTER 1
Insurance Concepts
Risk Management
What Insurance Covers
Insurance Regulation
Insurance Contracts
People Involved in Insurance
Wrap Up
CHAPTER 2
Insurance Policy
Types of Policies
Parts of the Policy
Insurance in Action
Wrap Up
CHAPTER 3
Words Have Consequences
Real Life War Story
Where the Rubber Meets the Road
Insurance in Action
On the Home Front
Wrap Up
CHAPTER 4
The Claims Handling Process
Good Faith Claims Handling
First Notice of Loss
Reviewing Coverages
Discussing the Loss with the Insured
Discussing the Loss with Other Parties
Reserves
Assignment of an Appraiser
While the Appraiser’s Away
The Next Steps
Closing the File
Other Handling Issues
Wrap Up
CHAPTER 5
The Next Steps
Suspicious Claims
Insurance in Action (Red Flags)
Reviewing Coverages (Again)
Reviewing the Damage Assessments
Insurance in Action (Reviewing Damage Assessments)
Disagreements with the Damage Assessments
Subrogation
Salvage
Wrap Up
CHAPTER 6
Introduction to Litigation
Threat of Litigation
Sources of the Law
Introduction to Litigation
Litigation Management
Choosing Defense Counsel
Small Nuggets of Litigation Wisdom
Wrap Up
CHAPTER 7
Adjuster Ethics
Morals and Ethics
State Departments of Insurance
Organizational Ethics
Insurance in Action
Wrap Up
CHAPTER 8
Claims Will Always Be Adversarial
But Why Are Claims Adversarial?
Wrap Up
CHAPTER 9
Claim Notes
File Documentation
Writing File Notes
Getting Personal
Insurance in Action
Wrap Up
CHAPTER 10
Property Coverage Unwritten Claims Rules Written Down
RCV and Coinsurance
Insurance in Action (Coinsurance)
Another Insurance in Action Example (Coinsurance)
Depreciation of Labor
But Wait! There’s More!
Overhead and Profit
Three Trade “Rule”
Making a Profit from Insurance Claims
Insurance in Action (Depreciation)
Making Repairs…Or Not
Line of Sight Repairs
Rolling Totals
Insurance in Action (Total Losses)
Value Policies
Settling Without a Proof of Loss
Contents
Wrap Up
CHAPTER 11
General Liability Coverage Unwritten Claims Rules Written Down
Coverage vs. Liability
50 Shades of Grey
CPT/ICD-10 Codes
If You Ain’t First, You’re Last
Insurance in Action (Negotiating Settlement)
Disagreeing with the Settlement Offer
Partial Bodily Injury Settlements
Insurance in Action (Partial Settlements)
Chiropractors
Time Demands
Wrap Up
CHAPTER 12
The Art of Adjusting
You Are a Professional
Under-Promise and Over-Deliver
Over-Communicate
Conference Calls Are Your Friend
Why Am I Paying Premiums??
Always Prepare the File for Litigation
You Will Be Sued
You Will Have a Formal Complaint Lodged Against You
Just Like Grandma
Knowledge Is Power
Could You Lower Your Voice, Please?
Do I Need an Attorney?
Promise Keepers
Wrap Up
Appendix
Reservation of Rights Letters
Declination Letters
Subrogation Letters
30-Day Letters
Settlement Letters
Author Notes
I began to write this version of this book after my expert witness business, CMR Consulting, came to a complete halt due to the COVID-19 pandemic. Because of the pandemic, trials were delayed and there was no need for expert witnesses.
Wondering what to do with my time, and not wanting to learn how to bake bread badly enough to actually do it (although I would someday like to acquire that skill), I began to explore other experts in my field, many of whom have written books about our chosen specialty of adjusting claims. I have written articles and I started a vlog as a soft marketing campaign, so I felt it was time, again, to try to write a book.
Except that I didn’t want to.
I say again, as this is not the first time I have tried to write book about insurance adjusting. Fortunately, before I got too far on my first endeavor, I received a big assignment and gladly pushed the book to the back burner. Somehow, although I do love talking about it, I did not enjoy writing about insurance claims adjusting.
It occurred to me that the reason I didn’t enjoy writing a book about adjusting claims, but do not mind writing articles, might be because articles are short.
I have a formal writing style for which I blame the Registered Sisters of Mercy and Ms. Riley, my 9th grade teacher. Whilst endeavoring in a scholastic writing, one should be formal in one’s language. You should not jolt the audience by changing subject usage and thrusting them into the reading. Passive voice is frowned upon. And one should not start a sentence with a conjunction. One should not use a preposition to end a sentence with. Bad incomplete sentences.
Then there was the whole misconception of what a book was and the kind of book I wanted to write. And the new usage of “they” as a singular pronoun, instead of “he or she.” Which, by the way, I have addressed with the editorial decision to make the claims adjuster feminine and the insured (and other players) masculine throughout my book.
I wanted to write a book because it bugs me that the only aspects of insurance taught in universities’ risk management degree programs are sell ing insurance and underwriting. In the unlikely event you can find a class about claims