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6 Claims Handling Best Practices for Claim Adjusters

  
  
  

6 Claims Handling Best Practices With so much money spent on training claims adjusters, it makes sense to consider claims handling best practices that can help organizations achieve the best possible outcomes from such an investment. A July 2011 blog post by Chip Merlin on the Property Insurance Coverage Law Blog, entitled, “Public Adjuster Claims Handling Best Practices,” cited six specific claims handling best practices for claims adjusters that are beneficial to share. These include the following:

  1. They are in accord with mandated laws and regulations.
  2. Timeliness is paramount. Communications must be acknowledged within mandated time frames.
  3. Thorough and timely investigation of coverage and evaluation of damages are accomplished.
  4. Claims are settled. A "good faith" effort is made to resolve the claim.
  5. Honest and transparent communications (not misleading) are required.
  6. Written procedures are adopted and updated.

Chip Merlin, as an insurance industry expert in claims handling, has discussed these best practices in great detail in a paper, Public Adjuster Best Claims Practices and the Claims File. In it, he noted that:

“…written standards are warranted as part of our ethical obligations to ensure that policyholders are treated fairly…It is incredibly important for a public adjuster to understand ethical issues that can arise in presenting claims. In order to ethically represent policyholders when they are at their most vulnerable it is important for a public adjuster to appreciate and abide by the ethical rules and obligations under Florida Law. The ethical representation of policyholders is the foundation upon which the system of insurance is designed to operate. Without the system's ethical foundation it cannot achieve its purpose to protect the policyholder.”

As such, the main points in relation to claims handling are that:

  • The laws are the foundation for all decisions related to claims and treatment of claims.
  • Following a guideline for timing in delivery of claims is of the utmost importance.
  • Details and careful evaluation of all factors involved in the claim help to ensure accurate decisions.
  • The objective of a claims processor or manager is to resolve every claim that hits their desk.
  • Honesty should be the hallmark of every action related to a claim.
  • All changing regulations need to be followed, including staying on top of future changes that could impact a current claims process.

In Review

Here is a review of the main points found in this blog post:

  • Those within the insurance claims industry recognize the need for best practices to raise the standard of service and process within the industry, including those like Chip Merlin who wrote a blog post on best practices.
  • There is an emphasis on transparency, clarity, communication, and integrity in all decisions and actions related to claims.
  • Following all regulatory changes can be challenging but are a must for those in the claims industry because it will help to ensure a level of timeliness and accuracy in all work.
  • The other best practices are to resolve every claim and be detailed in efforts to make the best evaluation related to each claim.

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fig gungor

Fig Gungor is CEO of OneSource Document Management, a New York based company that offers a broad range of customized copy and scanning services that translate into a significant savings for insurance companies, hospitals and large medical facilities.

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