‘Beat Cop’ Adjusters Can’t Treat All Claimants Like Criminals

No one is more important in establishing or maintaining an insurance company’s reputation than a claims adjuster.

Yes, insurers spend gazillions of dollars creating a brand image via advertising campaigns. They have public relations departments to drum up positive press and respond to any negative publicity in the mainstream media. If they are forward-thinking, they have a program in place to monitor social media for negative buzz and respond to misinformation or random attacks on their integrity that could go viral.

Yet when it comes down to it, how an insurer manages its claims goes a long way towards defining how that company will be perceived. No amount of advertising or media play about charitable or community work will matter if policyholders feel they have been handled badly in their time of need.

Paying claims is the one service that policyholders count on, particularly when it comes to personal lines. After having your car stolen or being involved in an accident or seeing your home damaged or destroyed, the last thing you want to deal with is an unprofessional or even unpleasant claims adjuster.

The same goes for commercial lines. Business policyholders might receive services beyond coverage from their carriers, such as loss control surveys or risk management support. But the bottom line is whether or not a carrier will be there when it counts after a loss occurs.

Are your adjusters easy to reach? Do they respond quickly to voice, e-mail, and text messages? How quickly do they arrive at the scene of a loss? What are their attitudes like? Are they overly suspicious or openly hostile? How quickly do they deliver on their promises? How soon do they get cash into the hands of those suffering losses?

This is a tough balancing act. Adjusters are the beat cops of the insurance police force, with claims managers their precinct captains and those in special investigative units serving as detectives. They are trained to be the front line of defense in the battle against insurance fraud, both hard (the type of criminal behavior that can end with someone in handcuffs) and soft (those otherwise honest folks who think they are entitled to embellish their claims to recoup deductibles or past premiums paid in years without losses).

But just as a police officer’s attitude towards the public that they are sworn to protect could be tainted by the number of criminals they have to deal with over their careers, so too could an insurance adjuster fall into the trap of routinely treating claimants as scam artists looking to rip off their company.

I’ve experienced this kind of cold customer service firsthand of late when dealing with the healthcare system. For the most part, the doctors my family and I use are decent people who patiently take time to speak about what can be, of course, life and death issues. The same can be said about another important medical specialist: the nurses who do most of the dirty work.

But those employed by doctors and hospitals to process the patient load—receptionists, telephone customer service operators, insurance claims filers, and other clerical workers—often seem to forget what business they are in: handling people who may be ill, nervous, frightened, and likely in pain. These are often the conditions adjusters must deal with, as well.

This negative experience is by no means universal. I’ve dealt with very cheerful, helpful, and sympathetic individuals in these medical support roles. But I’ve also encountered enough of the bad seeds to make me leery of the whole system and to complain about it to friends, relatives, business associates, and readers like you. My family has gone so far as to change doctors if their office staff is particularly lacking in professionalism, courtesy, and sensitivity.

This is a cautionary tale for insurance companies and their adjusters. If an adjuster is rude, unresponsive, gruff, overly suspicious, or otherwise unprofessional it reflects badly on the whole insurance company—indeed, on the entire insurance industry! And you can bet that poor experience will be shared with family, friends, colleagues, and anyone else someone who feels wronged can reach via the social media megaphone. In a worst-case scenario, bad behavior by an adjuster can result in a complaint to the local insurance department, a call to a consumer affairs reporter, or even a bad-faith lawsuit.

One solution is better training. When it comes to medical care, for example, I often wonder if doctors are taught bedside manners in medical school, let alone how to manage their office and staff to enhance the “customer experience.”

Are insurers teaching their adjusters and other claims management workers the proper “bedside” manners? Just as with healthcare workers, to be successful an adjuster needs to be part psychologist, particularly after an event that may be as challenging emotionally as it is physically and financially for the claimant. They have to be able to read people and look for red flags in client behavior without mistreating them or jumping to negative conclusions. (President Ronald Reagan’s Cold War policy of “trust, but verify” when dealing with the Russians on arms control jumps to mind.)

Adjusters also have to be able to defuse volatile situations when a claim isn’t progressing as quickly as the policyholder might like. If everyone looks like a nail to an adjuster, the only tool they’ll use is a hammer. There are less destructive tools at the adjuster’s disposal.

Of course, these days there are many new analytical instruments available to support adjusters and claims managers in spotting potential frauds. These predictive models can revolutionize a claims department by targeting investigative resources where they can be most effectively employed, but they are not a substitute for interpersonal skills. Their utility is not an excuse to abandon critical thinking, active listening, empathy, and service quality on the part of the adjuster on the ground or the claims manager back at the office.

There’s a reason why insurance companies that have high claims satisfaction and service are held in such high esteem by the general public. They haven’t neglected their duty to identify and investigate potential fraud, but they continue to invest heavily in the customer experience via call center and adjuster training programs and ongoing quality control supervision.

Ultimately, however, customer service must be part of an insurance company’s culture to be truly effective. Just as those working in the medical profession can have their sympathies numbed by constant exposure to sick, frightened, and even hostile patients, so might insurance adjusters have their sensitivities challenged after years of dealing with policyholders unfamiliar with their coverage or looking to line their pockets at the insurer’s expense. An insurer’s culture should influence adjusters to resist this temptation.

Claims management training must therefore emphasize the human element. We’re not just numbers on an insurance policy or claim form. We’re people, and we’re often not at our best when reporting a loss.

An insurer whose adjusters can deal with claimants both professionally and humanely will keep its stellar reputation for good service intact, avoid costly lawsuits, and earn referrals for new prospects without sacrificing the integrity of its fraud-fighting mission.

Sam Friedman is an insurance leader with Deloitte Research, part of Deloitte Services LP in the U.S. He has been a fellow with CLM since 2011, and can be reached at samfriedman@deloitte.com.