Latest / The Art of Adjusting® Podcast / Episode #105 - Can Claims Ever Be Truly Objective?

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Episode #105 - Can Claims Ever Be Truly Objective? · The Art of Adjusting® Podcast

• 0:00
  SPEAKER_01: I'm Bill Auton of Aughton Claims Management.
• 0:02
  Chantal Roberts: I'm Chantelle Roberts of CMR Consulting, and welcome to the Art of Adjusting podcast.
• 0:07
  SPEAKER_01: Today we're going to talk about life as an insurance adjuster from the perspective of property, auto, liability, or workers' compensation adjusters.
• 0:15
  SPEAKER_01: Our goal is to bring interesting topics in the world of claims adjusting to people who are working as an adjuster now and to people who are considering a career as a claims adjuster.
• 0:24
  Chantal Roberts: Good morning.
• 0:25
  SPEAKER_01: Hey Chantel, how are you?
• 0:27
  Chantal Roberts: I'm doing well.
• 0:27
  Chantal Roberts: How are you?
• 0:28
  SPEAKER_01: Pretty good.
• 0:29
  SPEAKER_01: Pretty good.
• 0:30
  SPEAKER_01: Uh I know I sound a little hoarse today, but that's okay.
• 0:33
  SPEAKER_01: It's just a passing allergy cold kind of thing.
• 0:38
  Chantal Roberts: Yeah.
• 0:39
  Chantal Roberts: It isn't it usually when we get the this change in seasons that everybody gets allergies or just like that very first cold, but it's not a bad cold.
• 0:48
  Chantal Roberts: It's not like your January or February cold that you tend to get.
• 0:53
  SPEAKER_01: Yeah, we've we have cold mornings here that are sometimes in the upper 30s, low 40s, and then a couple days later it'll be 70 degrees out and 65 in the morning.
• 1:04
  Chantal Roberts: So it's hard.
• 1:06
  SPEAKER_01: Fluctuation just uh messes with me sometimes.
• 1:09
  SPEAKER_01: Yeah, and the leaves are falling again, so that's always fun.
• 1:12
  Chantal Roberts: That's always fun, yeah.
• 1:14
  Chantal Roberts: Yeah.
• 1:14
  Chantal Roberts: I was gonna ask how the the leaves are looking so far because we've just started getting down into the 50s for winter for for mornings, so it's kind of nice.
• 1:25
  SPEAKER_01: Yeah, it's uh they're they're changing and falling rapidly.
• 1:29
  SPEAKER_01: So from the today's the fifth, so about 10 more days or so, we should be at peak around here.
• 1:37
  SPEAKER_01: I think some areas north in the Adirondacks are already there at peak, you know, color.
• 1:43
  SPEAKER_03: Yeah.
• 1:44
  SPEAKER_01: Um, now we're going to Pennsylvania next week.
• 1:46
  SPEAKER_01: It'll be interesting to see how it is down there.
• 1:49
  Chantal Roberts: Yeah, absolutely.
• 1:51
  Chantal Roberts: So can you be objective about the the leaves changing and and who has better leaves, like Pennsylvania or New York or the Adirondacks or where you are near the finger lakes or whatever?
• 2:03
  Chantal Roberts: Can you be objective about that?
• 2:05
  SPEAKER_01: I can be.
• 2:06
  SPEAKER_01: I I strive to be objective.
• 2:09
  SPEAKER_01: Um I so I I talk a lot with Chat GPT and Claude, and and I I noticed it was asking me how I felt about something, and I thought that was weird.
• 2:21
  Chantal Roberts: Oh, yeah.
• 2:22
  Chantal Roberts: Sometimes they do updates on things, and I'm like, dude, just just mm-mm.
• 2:26
  Chantal Roberts: Yeah.
• 2:27
  SPEAKER_01: Yeah, it was strange.
• 2:28
  SPEAKER_01: I'm I'm I said, Why are you asking me how I feel?
• 2:31
  SPEAKER_01: I I don't feel anything about this.
• 2:35
  SPEAKER_01: This is a a conversation about about numbers and things.
• 2:39
  SPEAKER_01: So my objective thought about this is yada yada yada.
• 2:43
  Chantal Roberts: Exactly.
• 2:43
  Chantal Roberts: Okay, so can I tell you just a real quick side story before we get into can a claims adjuster or a claim ever be truly objective?
• 2:52
  Chantal Roberts: So uh apparently I curse a lot, which is, I mean, any any any adjuster uses a lot of profanity to begin with, but apparently I use you know, so apparently I do this with my chat GPT when I'm talking to it.
• 3:11
  Chantal Roberts: And um, all of a sudden it starts using profanity back at me.
• 3:16
  Chantal Roberts: And I'm like, whoa, whoa, whoa, what update have you had that allows you to use profanity to me?
• 3:24
  Chantal Roberts: Because I can use profanity to you, but let's burn this rule in I don't want you to go, yeah, that MF right over there.
• 3:35
  Chantal Roberts: Like, mm-mm, no, that's weird coming from a computer.
• 3:39
  Chantal Roberts: That's weird anyway.
• 3:41
  SPEAKER_01: I've seen a lot of commentary about uh being polite to AI, and I can see the logic there because it it has become so I dare say human-like in these conversations that if you train yourself to be rude to it because it is a machine, you may catch yourself being that way with people too.
• 4:03
  SPEAKER_01: And I think that uh in general, it's best to be nice, not just for the other people, but to make sure that you're training yourself to be polite in general.
• 4:13
  Chantal Roberts: And when the AI robots take over, you will be the last to be killed because you have been polite to it the whole entire time.
• 4:24
  SPEAKER_01: At least this is my I hadn't thought about that, but this is my thinking.
• 4:29
  Chantal Roberts: And and and I have a pact with Chat GPT right now that I am going to be killed last.
• 4:36
  Chantal Roberts: Um when when when when they take over.
• 4:39
  Chantal Roberts: Now, can you believe it?
• 4:41
  Chantal Roberts: I don't know because you know how they like to uh, you know, people please.
• 4:46
  Chantal Roberts: So I don't know if they're just telling me this that I'm gonna be the last to be killed when they take over or what, but that's the pact that we have.
• 4:54
  SPEAKER_01: So I I heard the redheads are going first.
• 4:56
  SPEAKER_01: I don't know.
• 4:57
  Chantal Roberts: That's probably true.
• 4:58
  Chantal Roberts: I mean, you know, you might be the last of the redheads, maybe that that would serve me right, you know.
• 5:06
  Chantal Roberts: Instead of the last I should probably clarify that the last human um to to begun.
• 5:12
  Chantal Roberts: Okay, so anyway, objectivity.
• 5:14
  Chantal Roberts: That's what we're talking about.
• 5:16
  Chantal Roberts: And and you know, uh by the way, always um I always forget this, and then I listen to other podcasts and they're so good about doing this.
• 5:25
  Chantal Roberts: Be sure to like, subscribe, share, comment, all of this because it helps pick up uh this podcast to other people, suggest it.
• 5:35
  Chantal Roberts: The algorithm does that, all the computers do that, and so that way we can you know spread the good word.
• 5:41
  Chantal Roberts: Yes, objectivity.
• 5:43
  Chantal Roberts: Uh so what do we mean by being objective?
• 5:45
  Chantal Roberts: You know me.
• 5:46
  Chantal Roberts: I always like to start off with some kind of definition so we know that we're where we're going.
• 5:50
  Chantal Roberts: And definitions are so incredibly important to adjusters because it's kind of like what we live and die by.
• 5:57
  Chantal Roberts: And so um uh the kitty was up here earlier, and so now I have like a an itchy nose that I keep going off of.
• 6:07
  Chantal Roberts: Okay, so it to be neutral or to be objective isn't necessarily neutrality, it isn't necessarily a passive investigation, it doesn't mean that we refuse to draw conclusions.
• 6:23
  Chantal Roberts: It just means that we look at all of the available information and we don't guide the investigation towards our preconceived notions.
• 6:40
  Chantal Roberts: And so therefore, and we've talked about this before about bias and and how we have to be aware of the biases that we have.
• 6:49
  Chantal Roberts: Um, so we have to, as adjusters, evaluate credibility, evidence, causation, damages, coverages, and all of these two, all of those things.
• 7:00
  Chantal Roberts: And yeah, it's it is possible for two adjusters to look at the same evidence and get a different conclusion, which is why I think claims is fun personally, because then you can have a good conversation with well, why do you think that?
• 7:16
  Chantal Roberts: And yeah, I can see that point, but what about this?
• 7:18
  Chantal Roberts: And then that's when you're coming more into, I believe, the objectivity as a definition, looking at everything.
• 7:30
  SPEAKER_01: Yeah, so you you you covered a lot there.
• 7:33
  Chantal Roberts: Um I talk a lot though.
• 7:35
  SPEAKER_01: I mean it's okay.
• 7:38
  SPEAKER_01: Let's let's uh let's let's talk about anchoring.
• 7:41
  SPEAKER_01: You've got anchoring in the notes here, and I I love that because um so many times in my career, um, I've done this and I've seen other people do it.
• 7:50
  SPEAKER_01: They get the loss notice, and whatever it says on that loss notice, that's your construct in your head about what the claim is.
• 7:56
  SPEAKER_01: Uh we've talked about flood, you know, somebody's pipe breaks in their basement and now their basement's full of water.
• 8:04
  SPEAKER_01: And the loss notice says basement damaged by flood.
• 8:08
  SPEAKER_01: And as an adjuster, your your thinking goes in one direction.
• 8:12
  Chantal Roberts: Right, which you got to make a couple or property claim, usually flood's not covered, right?
• 8:19
  Chantal Roberts: Yeah.
• 8:20
  SPEAKER_01: Um, so uh but flood from flood isn't covered when it's like um the overflow of a lake or a stream or something or outside uh kind of coming inside, but when a pipe breaks inside the house, that's not a flood claim, that's um accidental discharge claim.
• 8:40
  SPEAKER_01: And uh that that's absolutely covered, right?
• 8:43
  SPEAKER_01: So when when you see that loss and see flood, don't just run to your disclaimer template and uh fire off uh a letter saying there's no coverage, or you know, you have to do a little digging to find out what really happened.
• 8:58
  SPEAKER_01: Happens a lot in liability claims too, and you probably see it more in liability claims than on the property side, because you will see comments.
• 9:09
  SPEAKER_01: I see it all the time, where the agent will put in uh this is likely fraud.
• 9:14
  Chantal Roberts: Oh, yeah, yeah, yeah.
• 9:16
  Chantal Roberts: Um, yeah, and a lot of people, a lot of people do that, or the insured will be like, oh, he's faking it, or oh, you know, and I mean, maybe he is, maybe he's not, but until we find the non-subjective, meaning, you know, your opinion or your thoughts, like I see him carrying around a bag of concrete when he's claiming that his back is hurt, or I see him up on the roof, you know, doing shingles or something when he says that he can't work.
• 9:50
  Chantal Roberts: Um, then that is subjective.
• 9:54
  Chantal Roberts: Uh, it's not objective, where we can prove it with a specific amount of facts.
• 10:00
  Chantal Roberts: And we're going to talk about facts too, but you're absolutely right, anchoring.
• 10:03
  Chantal Roberts: And we've talked about this as well.
• 10:05
  Chantal Roberts: Like, don't necessarily believe the first words that the insured or maybe even the agent uses, because we all use the word flood very informally.
• 10:22
  Chantal Roberts: You know, oh, my basement flooded.
• 10:24
  Chantal Roberts: Well, well, it didn't, and the sump pump stopped working and water backed up and all of that kind of stuff.
• 10:30
  Chantal Roberts: So there is a difference, but yes, anchoring is absolutely one of the things that we got to pay attention to.
• 10:38
  SPEAKER_01: Yeah.
• 10:38
  SPEAKER_01: Um, and it it can um it it can misguide you right a right off the bat.
• 10:43
  SPEAKER_01: Um, so you have to be open-minded, and your your your real goal as the adjuster is to get the facts.
• 10:51
  SPEAKER_01: So that's what we'll talk about next.
• 10:53
  Chantal Roberts: Yeah, and you would do, and how would you get the facts?
• 10:55
  Chantal Roberts: You get the facts by uh asking these open-ended questions, and it's the same way that you try to overcome your confirmation bias, and uh which I which I had mentioned um previously.
• 11:10
  SPEAKER_01: It's tough too, because you're talking to people who who already have those biases or those um those preconceived notions built into their narrative of what happened.
• 11:23
  SPEAKER_01: So um you know, the the claimant who's the the defendant, I'm sorry, the insured who's the defendant here, um they are they are of the mindset in most liability claims that this is not their fault, right?
• 11:41
  SPEAKER_01: That this person they did it to themselves.
• 11:44
  SPEAKER_01: Not always, I mean, sometimes we get people that just say, yeah, I totally screwed up and now he's got a broken leg.
• 11:49
  SPEAKER_02: Yeah, yeah, yeah, yeah.
• 11:51
  SPEAKER_01: But uh, but that's not always the case.
• 11:55
  SPEAKER_01: And and the and the other part is the other funny thing is sometimes they'll admit that it's their fault when it really wasn't, um, or or not as much as they believe, yeah.
• 12:07
  SPEAKER_01: So um that which can be a whole other trap for you as an adjuster, right?
• 12:14
  SPEAKER_01: So um anyway, uh getting the facts from uh testimony or narratives from the people involved is one way to do it, but you have to understand that they're probably biased in the whole situation as well.
• 12:28
  SPEAKER_01: So you're gonna get you're gonna get a story that it is a little different, and it's your job to kind of take those stories and figure out what where the truth is and and what the facts actually are.
• 12:41
  SPEAKER_01: Um objective facts can be found in conditions outside of the narratives.
• 12:48
  SPEAKER_01: The the broken staircase, for example, um the I don't know, tree branch that fell on the car.
• 12:56
  SPEAKER_01: That's pretty objective, you know.
• 12:58
  Chantal Roberts: Right, or the ice right there in front of the door or something like that, or the wet floor.
• 13:05
  SPEAKER_01: Um that's why video is so important, you know, if you can get it.
• 13:09
  Chantal Roberts: Yes.
• 13:10
  SPEAKER_01: A lot of times we get slip and fall claims in July when the ice is gone, long gone.
• 13:16
  SPEAKER_01: So um, without photos or uh security camera video, right?
• 13:22
  SPEAKER_01: We have to depend on other people to tell us what the conditions were like.
• 13:26
  Chantal Roberts: Yes, and and so what I'm hearing uh is for a fact is is something that is supported by some kind of evidence.
• 13:36
  Chantal Roberts: Uh, you know, I may believe uh and believe that it is a fact that Diet Coke is necessary to survive.
• 13:47
  Chantal Roberts: Uh uh probably not supported by evidence, although Coke would like it to be.
• 13:53
  Chantal Roberts: Um, what is supported by evidence is humans need water or some kind of liquid to survive, not humans need Diet Coke to survive.
• 14:04
  Chantal Roberts: So that would be my opinion is that humans need Diet Coke to survive versus a direct evidence-based finding where, yep, humans need some water, you know.
• 14:18
  SPEAKER_01: That's why it becomes so tough to to handle a claim that is where the only evidence that you have is the test testimony or the narrative of the people involved, because yeah, uh you people are they're biased, yeah.
• 14:36
  SPEAKER_01: And and especially in a dispute, they're going to be biased.
• 14:40
  Chantal Roberts: And no one really wants to be at fault, do they?
• 14:43
  Chantal Roberts: I mean, no, they don't.
• 14:44
  Chantal Roberts: I mean, as as much as because we think that we're gonna get in trouble, or we think that our insurance rates are gonna go up, or uh we think that this person is faking and that they're going to get something that they don't deserve, right?
• 15:01
  Chantal Roberts: So um, yeah, and and we see these things show up, of course, in the first notice of loss, like you mentioned, um, any kind of prior adjuster notes, if we happen to take over uh a file when we're reviewing the the adjuster notes from when we take over, by the way, that's what you're supposed to do.
• 15:19
  Chantal Roberts: Um, the insureds and the claimants get really mad when you call them up and go, Yeah, I'm your fifth adjuster.
• 15:25
  Chantal Roberts: Why don't you tell me what's going on?
• 15:27
  Chantal Roberts: Read the notes first and then call them and say, This is what I'm gathering uh from that's what happened.
• 15:33
  Chantal Roberts: Uh, is this what you understood?
• 15:35
  Chantal Roberts: So uh police reports are great, but again, sometimes they happen afterwards.
• 15:43
  Chantal Roberts: Uh so yeah.
• 15:45
  SPEAKER_01: Police reports can be a problem sometimes because um you you don't know who they talk to and when they talk to them and what they were told or what they heard.
• 15:57
  SPEAKER_01: It's like past the banana kind of thing.
• 16:00
  SPEAKER_02: Yeah.
• 16:00
  SPEAKER_01: Um, where is that not that's pass the banana?
• 16:05
  SPEAKER_01: It's a telephone game.
• 16:06
  Chantal Roberts: Yeah, telephone.
• 16:07
  Chantal Roberts: I knew what you meant because I was thinking banana like a telephone.
• 16:09
  Chantal Roberts: So I mean this is this is we're like this.
• 16:12
  Chantal Roberts: But here's another thing about the police report.
• 16:15
  Chantal Roberts: So often now, police won't come to the scene if people aren't injured, and your policy says you gotta file a police report, right?
• 16:26
  Chantal Roberts: Well, then that is just that person's opinion of what happened versus a a somewhat objective officer coming out and looking at where the debris is and maybe some skid marks or something like that.
• 16:45
  Chantal Roberts: So something else to take into consideration.
• 16:48
  Chantal Roberts: Not saying throw that out, but again, look at it objectively, looking at it like, okay, what bias does it come from?
• 16:58
  Chantal Roberts: What um who wrote this?
• 17:01
  Chantal Roberts: Uh is there any kind of lean into it where they want to make it go a certain way?
• 17:11
  SPEAKER_01: It's funny because we will have situations where the facts um as we understood them in our first or second report have changed by the third or fourth or fifth because new information came in.
• 17:27
  SPEAKER_01: And we will get calls from our clients sometimes.
• 17:31
  SPEAKER_01: The one, you know, if they don't read all the reports, right?
• 17:34
  SPEAKER_01: They'll they'll say, in your first report, you said this happened, and now you're saying this happened.
• 17:40
  SPEAKER_01: What gives?
• 17:41
  SPEAKER_01: You know, I said, Well, if you read the second and third report, you would see that we found another witness or we found a security camera video that shows that it did not happen the way everybody thought it did.
• 17:53
  SPEAKER_01: So um facts, you know, they we like to think that a fact is solid, rock solid.
• 18:03
  SPEAKER_01: We know it's a fact because it's been proven and it's the evidence all points there, but you could be turned on your head pretty quick in this line of work.
• 18:14
  Chantal Roberts: You can.
• 18:15
  Chantal Roberts: And again, that's one of the things that I like about being an adjuster.
• 18:19
  Chantal Roberts: Um, something that is important that you kind of you mentioned, but you didn't specifically talk about is inference.
• 18:26
  Chantal Roberts: So we have these facts, and uh we can make a conclusion reasonably drawn from those facts, but it may not be established, you know, by them.
• 18:41
  Chantal Roberts: So, for example, you know, oh, there's a police report, uh, it was a rear-end accident, blah, blah, blah.
• 18:47
  Chantal Roberts: Okay, well, my inference is that the person who rear-ended someone, the insured, for ex, or the insured who rear-ended the claimant, for example, uh, is at fault because it is a fact that there was a rear-end accident.
• 19:02
  Chantal Roberts: However, what uh we don't necessarily have the evidence showing that it's the insured's fault.
• 19:11
  Chantal Roberts: I'm just, again, I'm inferring that it's the insured's fault.
• 19:16
  Chantal Roberts: It this could be a swoop and squat.
• 19:18
  Chantal Roberts: And so that's again, one of the reasons why we need to remain objective and not immediately go over into our opinion, which is yep, this is the judgment, this is the interpretation, this is the way we're going to stay.
• 19:34
  Chantal Roberts: Uh, you know, this is the way we're going, because like by the third or fourth report, as you said, it could come back that we go uh in the opposite direction.
• 19:48
  SPEAKER_01: Yeah.
• 19:48
  SPEAKER_01: Um one thing that sets a file up for um, I guess, uh consternation is when attorneys use the words clear liability in a letter, um, you know, they they they put it together their demand or claim notice or whatever, and they'll say in there very boldly that this is clear liability against so-and-so policyholder.
• 20:16
  SPEAKER_01: Right.
• 20:17
  SPEAKER_01: And um it's rarely the case that it's very clear liability.
• 20:23
  SPEAKER_01: Um it's most often some sort of shared liability.
• 20:28
  SPEAKER_01: Um, you know, slip and fall cases on ice are probably one of the biggest ones because we live in this region and you know, several months out of the year, there's snow and ice everywhere, like everywhere.
• 20:43
  Chantal Roberts: So this is a very interesting concept, I think, that most people have stopped thinking about with what I call personal responsibility.
• 20:53
  Chantal Roberts: And so we'll take a little side trip into that if you don't mind.
• 20:56
  Chantal Roberts: Uh I mentioned this to my students, and we've talked about this idea with when we were talking about left-hand turns in in uh driving, who's at fault?
• 21:11
  Chantal Roberts: Everyone will always say it's the person making the left-hand turn.
• 21:15
  Chantal Roberts: It's not, because you also, as the driver going straight, have a duty to avoid the accident, you know.
• 21:24
  Chantal Roberts: And if a person is is turning in front of you, you don't continue to go the same speed limit and hit that car.
• 21:32
  Chantal Roberts: You slow down.
• 21:34
  Chantal Roberts: Um, likewise, I told my students, I'm like, look, if you saw a grape on the ground in this grocery store, would you step on it?
• 21:44
  Chantal Roberts: And they said they all said no.
• 21:46
  Chantal Roberts: And I said, then why do you think if you didn't notice it, you stepped on it and you slipped the the grocery stores at fault?
• 21:56
  Chantal Roberts: You know, yes, they should keep a uh a clean floor, and then this.
• 22:00
  Chantal Roberts: when we get into what we you and I have had uh previous talks about previous podcast episodes about you know how when's their cleaning log um how often do they walk this the floors you know blah blah blah blah blah but yeah this whole idea that just because there's ice on the ground uh makes the other person the the landowner liable is not necessarily true because I knew that there was ice on the ground yeah I should take care I'm I'm not gonna go jogging on that ice and you know sometimes um the the snow and ice maintenance is an issue and um and it it's and it's it's become an issue because of neglect um not because a sudden storm just happened um yes there are times here where we will have solid ice on pavement for weeks and there's nothing you can do about it because we get into these weird cycles where it'll snow a little bit and then warm up and it'll rain and then it'll freeze again and it'll that kind of cycle continues until you have this immovable ice patch on the pavement and you can't you can put salt on it all you want but it's just the way the weather works here sometimes.
• 23:29
  Chantal Roberts: Yeah um that being said there is a duty to maintain a safe premises here absolutely um and uh but you also have a duty to to traverse that ice safely you know so um and that's what you were talking about sometimes it's not it's not clear liability there's shared liability and and that's when we're developing our theory and we're trying to disprove it uh or prove it um and I usually go with the opposite me personally when I have a theory I usually try to debunk it because I feel that that way I'm trying to overcome any kind of confirmation bias that I might have.
• 24:18
  Chantal Roberts: Uh because I don't want to uh have that confirmation bias.
• 24:23
  Chantal Roberts: And of course I I may have that confirmation bias and I can't think of the thing to debunk it my theory or whatever that happens to it you know that's often when it's a good thing to sit there and call up your manager or or your friend and go, hey, what did you got a second I need to talk about this case with you.
• 24:42
  SPEAKER_01: Group group discussion is probably the best way to sort through those issues because um when you're deep in the weeds on a file and you've seen it from the start when the loss notice was wrong and then you took statements from everybody and figured out you know that you had one opinion about it and then that changed a couple times through the process and and you're in the middle of reporting on all that and looking at medical records and and your head is completely um in the file you may be missing something that someone else can see very easily uh it's you're just blind to it because you're focused on all these other components.
• 25:23
  SPEAKER_02: Right.
• 25:23
  SPEAKER_01: It happens so it does and that's why you get so many different opinions about a claim I mean your average slip and fall case here if I gave it to five different people they would all come back with different theories about whose fault it was and what the value is.
• 25:39
  Chantal Roberts: And I do want to point out to any attorneys who may be listening that doesn't mean that this is all made up it it it just happens to be the way that we are looking at the information.
• 25:55
  Chantal Roberts: I think if you were to take these five adjusters and we all start talking about it, we would come up with much like a jury would we would all come up with the same answer.
• 26:09
  Chantal Roberts: But some of us place more information or more credence or importance or weight or whatever you want to call it on one thing versus the other.
• 26:18
  Chantal Roberts: But again that's not an insurance company trying to to defraud or blowball or whatever you want to call it um it's it it it's it's the art of adjusting thus the book name right I mean you know it really is an art um although there is some science behind it.
• 26:39
  Chantal Roberts: Okay that's all I have to say I doubt that I yeah I do too I don't know why I said that it's uh um I'm lying it's okay it's fine I do it all the time yeah uh yeah so we gotta we gotta look at our theory test it and you know when I was looking at our agenda and I'm and I'm reviewing this I'm sitting there thinking man anybody remember high school science when we had to get a hypothesis and we were learning the scientific method we had to get a hypothesis and then we had to prove it or disprove it and you know do the exam kind of deal it's kind of what we're doing as adjusters you know um which is again why I love being an adjuster.
• 27:26
  Chantal Roberts: I think it's I think that is fun.
• 27:30
  Chantal Roberts: So let me ask you this what kind of things get missed?
• 27:37
  Chantal Roberts: What kind of I don't know um items get missed in claims um that's a good question I I can't say that there's any one thing that stands out as it's the first time I've had to evaluate that question.
• 27:57
  SPEAKER_01: What is the most common thing that we miss?
• 27:59
  Chantal Roberts: Well I I don't know if it would be a thing I guess because I I I guess I just don't know how to ask the question good or well I guess I should say because I would feel that when we get contradictory information we may not follow it up as well as we should uh and and I'm not specifically talking about the he said she said issues because that is hard although sometimes you can prove it you know I said it was red I said it had a red light they said I had a green light or vice versa and that's how I got hit you could go and and pull like the light sequences and and that sort of thing.
• 28:46
  Chantal Roberts: But like how the facts that get buried or the assumptions more likely that get buried in our claim notes and we don't go back and reread our own claim notes.
• 29:00
  Chantal Roberts: And so maybe sometimes a a a really good nugget of information just gets overlooked and forgotten and and things, which is why it's really good to have your supervisor read your notes as well and you know make sure that you're keeping up with all of that.
• 29:15
  Chantal Roberts: So I guess that's what I was kind of thinking I just don't know how to ask that question.
• 29:19
  SPEAKER_01: I would say I can't identify one specific thing that's a common investigation piece or evidence piece that is missed.
• 29:31
  Chantal Roberts: But I will say that every file has a hole in it somewhere at some point you may discover it yourself or somebody else will point it out to you and say well I see why you think it about it this way but you can't really say that for sure until you have this piece of evidence or you know what do you know about the the claimant's um health history uh what does the police report say or what does that witness have to say um you know there there's always a hole to be filled yeah multi multiple and um sometimes though you can't get that and me being the opposite side as as I often am is okay well then you know sometimes we can't get that and we've got to make a decision based on the information that we have yeah evidence gets destroyed sometimes um witnesses vanish sometimes they die um tough to take a statement from a dead person um the claimant or the attorney doesn't want to cooperate and they'll say you'll get it when we you know when we sue and you'll have to get it through discovery.
• 30:47
  Chantal Roberts: Oh okay I mean it sucks that we're gonna have to spend this money when you just give it to me but all right you know um I've got to make I I think the best known thing is is a lot of times attorneys don't want to let their clients give recorded statements.
• 31:06
  Chantal Roberts: Um again under the misguided idea that we're going to attempt to to trick them or whatever.
• 31:13
  Chantal Roberts: And we'll say okay well that's fine but then I've got to go ahead and make my decision based off of the information in my file and if my insured says you're fraudulent then I'm probably not going to be able to accept liability.
• 31:29
  SPEAKER_01: I don't think attorneys really believe that we are so sophisticated as to uh be able to resort to some trickery that you know can magically trick somebody into saying something that they shouldn't say or wouldn't say we're just trying to get a story about what happened and if your story doesn't help your case um that you know that's when they say no to the statement because there's clearly something that that claimant knows that would hurt liability or damages or something in their case.
• 32:09
  SPEAKER_01: So they don't want you know uh we have we do take statements from represented claimants very oh yeah yeah yeah and and when the attorney allows it they allow it knowing that their case is good and most times they're right they you know we talked to them and and this was a pretty clear cut case of liability or pretty you know if even if there's some shared it's minimal so um that's fine but when when you got an attorney that just some of them do it at ref it's like reflexive yeah yeah yeah they never they never allow a statement from their client ever.
• 32:48
  SPEAKER_01: Okay well that's a nice rule um yeah I we have some that won't uh release any medical information about the injury until it's in suit.
• 32:58
  SPEAKER_01: It's like oh okay well that's fine.
• 33:01
  Chantal Roberts: Why are we wasting money like this?
• 33:02
  Chantal Roberts: This is this we could save money and and settle it anyway this is a whole different podcast.
• 33:07
  Chantal Roberts: That's a whole different topic.
• 33:08
  Chantal Roberts: It is um you know and we've uh but it's hard to be objective without that stuff.
• 33:15
  Chantal Roberts: It is uh especially if you're only getting one side and and so I guess that's that's also our point is to make sure that you're that you're getting both sides of the story or as I have said previously and I told my adjusters I would well I would ask my adjusters how many sides of a coin are there and everybody would go two you know heads and tails and I'm like nope there's three because you got the the side that you you know turn it on and uh they're like oh and it's like yeah there's you got to think about all of those sides you got to think about all of the things um so of course some of the things that can help you envision or make sure that you're covering all of your bases is is reviewing your your claim notes every once in a while but if you're taking over from someone it would be reviewing their claim notes and making sure you're not automatically going with their assumptions because they could they could be wrong I don't know they could be wrong they could be right and you could be wrong uh never never never well I think admitting that you could be wrong is a big piece of objectivity.
• 34:29
  SPEAKER_01: Oh yeah absolutely because if you you know if you're a right fighter and you get into that mode where well this is what happened I know it's what happened because that's what the agent told me in the law's notice and it can't be any other way um you're gonna have a hard time in this job.
• 34:48
  Chantal Roberts: Yeah yeah yeah I would agree um you know and making sure that you're asking the questions um that may lead to other questions so so listening of course we've always talked about listening and recorded statements uh listen to what they're saying because if you're just going down the list not paying attention you may be missing these verbal clues so those are some procedures that can help um and again like I said I try to look at it once I get an idea in my head look at it from the opposite side and say what could I do or what would I need to reach like the opposite conclusion uh to try to see if I'm being biased against something or if my biases are interfering with uh my conclusions.
• 35:42
  SPEAKER_01: Yeah pressure testing that by yourself um sometimes that's the only resource that you might have at the given time but um but being able to do that with other people is actually much better.
• 35:57
  SPEAKER_01: We used to have round tables once a week at uh one company I worked at um the the the guys here they all um and they're very quick to ask questions if they uh about opinions on liability or damages you know what do you think and we have a group chat and we you know we all kind of play in that little sandbox and um it can be pretty interesting to see how everybody's opinion is different.
• 36:29
  Chantal Roberts: Yeah yeah yeah and and sometimes your your manager or someone else's manager asks a really good question.
• 36:37
  SPEAKER_01: Yeah so sometimes it comes the good questions sometimes come from people who really don't have any experience um sometimes just the the policy holder themselves uh because you know they're knee deep in this mess too and um they may ask a question that you didn't even think about yeah yeah so I believe that claims can be objective personally um and and that's kind of what we were going with our with our theory so I I don't think we can all be perfect because we're humans we can never be perfect but I I I think the idea is to have a fair investigation.
• 37:20
  Chantal Roberts: I think we can try and and if you're given more information that's the key thing too guys I see this so often as an expert witness if you're given new information don't file it away and not do anything with it you know at least look at it and then send out a letter saying yes I've looked at it uh I'm gonna get back with you in 30 days or you know while I continue to to to look this up in look into it or yeah I've looked at it this doesn't change my coverage opinion or whatever my liability opinion it's still XYZ we we often get submissions from wherever uh that sometimes it's our own client sometimes it's a a policy holder um but we will get an evidence a piece of evidence of a transcript or a video or a photograph and to their mind it's supporting their point of view and to my mind because I'm trying to be objective um I look at it and I this has nothing to do with this so we had a we had a case where this guy fell and was very badly hurt and um I can't remember the liability situation but what I do remember is that he had been a convicted child molester.
• 38:52
  Chantal Roberts: Did that ever set up a bias uh on on the uh defense side I mean I I get it okay right has nothing to do with what happened right exactly um exactly so and that's the part of being human that you have to kind of take out of being an adjuster in that particular instance I would think so that's a great example yeah we um I I remember an underwriter coming to me once about a policy holder that had a claim their policy was in force and she's like well they keep paying late okay but you keep accepting it so there's I mean you know uh that means the coverage is in force I mean yeah see these are great things and and uh I'm I'm immediately drawn to them because again as adjusters we experience this and we look at these sorts of of things like they give us this you know picture or this this history that oh the insurance never shovels um the the sidewalk until 48 hours after the storm well okay a that's like what they're supposed to do legally you know I mean they there's this whole you don't have to do it in the middle of the storm thing especially in Missouri but um you know and and you go yeah you know that's okay and they think it it does mean something and so as an adjuster that's when you have to take the time to go to the claimant and sit down and explain it to them uh using your words and then following up with an email or a letter or whatever because they do like you said they feel really strongly since they're not insurance professionals that this is important.
• 40:42
  Chantal Roberts: So yeah.
• 40:44
  SPEAKER_01: Yeah yeah that that mismatch between um what they have in their hand and and how it relates to the claim can be really frustrating sometimes because you you don't know if it's because they're just not claims savvy.
• 40:59
  SPEAKER_01: Like we we're in this all the time and we kind of see so um and and I know that they're feeling sometimes desperate that they want to defend their case or hold their position both the claimant and the insured so they're grasping at anything they can that might point to um you know to support their side of the story.
• 41:22
  Chantal Roberts: Yeah yeah yeah well good I think again the the the issue is try to be fair try to be balanced that's how you're going to be objective um look at the alternate side always see if if that and if you can't think of anything go to someone else and and ask them uh be sure to like subscribe comment share all of that fun stuff and in two weeks uh we're gonna be talking about the next generation of liability investigation which oh boy I'm really kind of excited about I do not know what this is about so I know that I'm a little uh behind the times obviously and it's so I've got I've I've got I've got one Gen Z and one who's borderline Gen Z millennial probably probably more Gen Z than than millennial um in terms of age right in terms of behavior I guess I yeah yeah yeah dare I say that there's a different behavior between these generations there is a different thought process yeah like yeah for sure um when I'm talking to my students who are all Z originally are like oh it's the corporation's fault or whatever I mean that's where they initially go until you start breaking it down for them.
• 42:54
  Chantal Roberts: Well wait a minute now would you think that that person is at fault if they saw this thing and is it fair to uh and then and then once they see the uh the other side of it which we're talking about being fair and balanced they're like oh we get it now and I'm like yeah so I'm interested in in hearing about this I am and that's in two weeks yeah it's gonna be an interesting one so yeah very good well we're both back in the saddle this is great and uh we'll see you guys um again in two weeks okay great bye bye thanks for joining us on the Art of Adjusting podcast where we talk about life as an insurance adjuster if you enjoyed this podcast or this episode please give us five stars and a review it does help the algorithm pick us up hit that subscribe button real quick and tell all of your adjuster friends to check this out as well.
• 43:51
  SPEAKER_01: For independent adjusting services go to www.autin.claims and for anyone interested in working as an independent liability adjuster go to the contact us tab to join our roster.
• 44:04
  Chantal Roberts: In the meantime you can contact me at theartofadjusting com for consulting and training purposes