Desk Adjusting Catastrophe Claims

Adjusting catastrophe claims from the office, or desk adjusting, offers a number of benefits not only to customers, but also to insurers. For customers, the desk adjusting process allows them to have more control over the timeline, while insurers benefit from the reduced time and expense required to adjust a claim in the field. Desk adjusting claims that do not necessarily require an onsite inspection also can allow insurers to focus their field resources on larger and more complicated claims that require a hands-on approach.

While some insurers cringe at the idea of handling a claim 100 percent from the office, when certain parameters are met and guidelines followed, desk adjusting catastrophe claims can yield significant dividends for customers and companies.

A portion of desk adjusting relies on information from a number of sources, including the insured, contractors, preferred vendors, and the use of various technologies to secure the required information to complete the adjustment process. However, insurers should be certain that several key elements are in place before adjusting claims from a workstation is considered.

Insurers should verify that, at a minimum, the following systems and procedures are in place with their office adjusters prior to implementing a desk adjusting program.

Training – Staff must be fully trained on policy language, damage assessment, and the adjusting processes prior to being assigned to handle claims in the office. It is imperative that adjusting staff, including those taking the initial call, understand the process of handling the claim and have a clear appreciation of how a thorough on-site claims investigation and damage assessment is critical to evaluating a claim. They also must be able to explain the claims adjustment process to customers and have a clear understanding of when it is time to move a claim to a field adjuster.

Technology – Without proper technology, staff will be unable to complete the claims process, defeating the purpose of a desk adjusting program and leading to an undesirable customer experience.

Experience – Adjusters who handle claims from the office should have field adjusting experience, as well. Field experience is imperative to understanding and interpreting issues with the customer and any contractors or vendors while working through the full claims process.

Guidelines, Staffing, and Skill Sets – Any insurer preparing to utilize this process should set forth clear and concise guidelines, including when a claim should be sent automatically to the field, along with a list of qualified staff and their specific skill sets.

State Compliance Issues – Insurers should be aware of any state regulatory compliance issues that may be involved with the different types of claims they encounter to ensure that they are in full compliance with every applicable regulation. It is possible that individual states have unique situations that could prevent specific claim types from being handled in the office or denied based on information gathered other than through a licensed adjuster on site.

Part of any protocols regarding claims handling from the office should involve specific guidelines around loss types. These loss types include wind, hail, water (frozen pipe burst, sewer and drain back up), and wildfire. Each type of loss and peril brings a unique set of claims-handling issues.

Wind or Hail Damage

When dealing with a wind or a hail claim, a desk adjuster’s biggest areas of focus should be the type, extent, and location of the damage; the type of material that will require replacement or repair; and the accessibility of the damaged areas.

Suitable technology is a must in this area. The adjuster in the office must see exactly what the customer sees so she can make the determination of storm-related damage to the property. Technology exists to allow internal employees to have a full and current satellite view of the property, and it is a best practice that can be utilized in this situation. This technology also can be accessed to obtain measurements if a desk adjuster is unable to obtain them from a contractor or the customer.

Adjusters should look for or confirm missing or damaged shingles; missing or hanging gutters; tree punctures in the roof; and roofing material and other property damages, including vents, metals, windows, and fencing.

Water Damage

For claims-handling purposes, an insurer often will consider catastrophic water damage to be similar to that of water damage caused by a frozen pipe burst or a sewer/drain backup. There may be occasions when an insurer covers flood or surface water, as well.

The office adjuster must be able to determine the source of the water, determine the extent of the damages, the types of material damaged, and the possible presence of mold. An office adjuster may need to rely heavily on the expertise of mitigation specialists who go to the property for specific material recognition, photos, and measurements should the determination to manage the claim from the office be made.

Wildfire

When a wildfire occurs, a customer’s home may be located in the direct path of the fire or on the edge of the fire line. Depending upon the location of the home, the types of damage will vary greatly, as will the emotional state of the customer. It is imperative that the adjusters handling these types of claims have an acute awareness and sensitivity to the customer’s feelings and understand when sending the claim to a field adjuster is the right thing to do for the customer, regardless of their ability to handle the claim in the office.

Because evacuations often occur rapidly—sometimes even when they are not home—some insureds may have few to no belongings with them. Office staff should be keenly aware of the types of policies sold and their allowance for alternative living expense advancements based on evacuation. The office adjuster must first determine the extent of the damages and the likelihood of the claim being handled in the office. It may be likely that portions of this type of claim are handled in the office, while the physical assessment of the property damage to the building is handled in the field, but this determination will be made by an individual company’s guidelines and established processes.

Developing a Program

Clear and concise guidelines must be in place in order for an organization to be successful in handling claims from the office rather than the field. Training, technology, and experience must be a priority. The untrained or underexperienced may not be able to quickly identify the need for a claim to be moved to the field and could cause an unnecessary delay for the customer. Likewise, a lack of technology available to the staff could result in poor data, which will prevent the office adjuster from completing the claim properly.

Pilot locations should be identified in various markets to determine the best areas for the overall program once it is fully rolled out. Handling claims desk-side will not work in every situation, state, or environment, and it is important to remember that all factors must be taken into consideration prior to instituting such a program.

 As with any new program, leaders should look to develop a plan, set clear goals and guidelines, identify a target test area, and utilize experienced staff to test the program first. Once the pilot program is underway, staff can make adjustments to the guidelines, which allow them to reach the goals. This tested program then can be rolled out to additional staff and locations, as selected based on specific criteria and successes specified by the pilot group. Continued review, evaluation, and adjustment will be necessary to ensure continued success of the program.