Latest / The Art of Adjusting® Podcast / Episode #96: The Bad Faith Warning Signs

Transcript

Episode #96: The Bad Faith Warning Signs · The Art of Adjusting® Podcast

• 0:06
  William Auten: Hello, I'm Bill Aughton of Autin Claims Management.
• 0:09
  Chantal Roberts: I'm Chantel Roberts of CMR Consulting, and welcome to the Art of Adjusting Podcast.
• 0:14
  William Auten: Today we're going to talk about life as an insurance adjuster from the perspective of property, auto, liability, or workers' compensation adjusters.
• 0:22
  William Auten: 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.
• 0:33
  William Auten: Good morning.
• 0:33
  William Auten: Hey Chantel, how are you?
• 0:35
  Chantal Roberts: Oh, I'm doing well.
• 0:36
  Chantal Roberts: Thank you.
• 0:36
  Chantal Roberts: How are you?
• 0:37
  William Auten: I'm good.
• 0:38
  William Auten: I'm good.
• 0:39
  William Auten: Doing well.
• 0:39
  William Auten: We're keeping busy and the weather's finally tuned up.
• 0:42
  William Auten: We've got some 75 degree days and some 80 degree days, so it's been nice.
• 0:47
  Chantal Roberts: Very good.
• 0:48
  Chantal Roberts: Very good.
• 0:49
  Chantal Roberts: Yeah, we are having a storm here today, so you may hear some thunder in the background or something to that effect.
• 0:56
  William Auten: Usually those fronts that hit you eventually make their way east, and uh we'll see some rain in about a week or so.
• 1:02
  Chantal Roberts: Yeah, absolutely.
• 1:04
  Chantal Roberts: Absolutely.
• 1:05
  Chantal Roberts: So today we are going to be talking about, you know, the the ways a file can go sideways and and um how bad faith doesn't really it do it it doesn't always start with the file, but it can.
• 1:23
  Chantal Roberts: And uh I uh when we were talking originally, you and I uh I said, hey, you know, I'd like to talk about bad faith from kind of an expert witness point of view, because I know that we always do at the beginning of the year, we always talk about the Unfair Trade Practices Act, the Unfair Claim Settlement Act, so that it puts me out of business, essentially.
• 1:48
  Chantal Roberts: And and so I thought I would specifically point out some of the things that I've been seeing that adjusters are doing.
• 1:56
  Chantal Roberts: And uh I had mentioned to you how I had published a white paper.
• 2:02
  Chantal Roberts: Yeah.
• 2:02
  Chantal Roberts: And you said, let's talk about that too.
• 2:06
  Chantal Roberts: And I'm like, it actually would do really well because the white paper kind of combines what I've been talking about.
• 2:13
  Chantal Roberts: The white paper is called the ROI of claims staffing and education.
• 2:18
  Chantal Roberts: And what it talks about, it's specifically for the C-suites of insurance companies, and it talks about how the boards, the governing boards, don't know what the product is that they're selling.
• 2:35
  Chantal Roberts: And the product that they are selling is that a covered claim will be paid.
• 2:40
  Chantal Roberts: And the only people who can determine that is the claims adjusters in the claims department.
• 2:44
  Chantal Roberts: It's not this piece of paper.
• 2:46
  Chantal Roberts: So by deliberately shortchanging the claims department by understaffing it or not educating it, because so many, so many insurers don't send people out to CE anymore, don't send people out to seminars or webinars or anything like that anymore.
• 3:08
  Chantal Roberts: And the adjuster is meant to educate themselves, which hopefully this podcast does.
• 3:14
  William Auten: So hopefully it does.
• 3:16
  William Auten: It does for me and you, I think.
• 3:18
  Chantal Roberts: So I think so.
• 3:19
  Chantal Roberts: Yeah, and be sure to share with your friends so more people will know, you know, click like, subscribe, blah, blah, blah.
• 3:24
  Chantal Roberts: But that's what the white paper is for.
• 3:27
  Chantal Roberts: And it's so it this conversation would not be about how adjusters are evil, I because I don't really think that at all.
• 3:36
  Chantal Roberts: But it's more about recognizing some of these warning signs before a claim escalates into a bad faith situation or lawsuit, and we get that really big verdict that nobody wants to talk about.
• 3:53
  Chantal Roberts: Or we have a lot of hostility and all that.
• 3:56
  William Auten: When it comes to adjusters being evil, okay, there's always going to be bad apples.
• 4:01
  William Auten: Let's put that disclaimer out there that that uh you'll have some some jerks in this line of work.
• 4:06
  William Auten: Um but what you have to understand about insurance companies too, they're not evil either.
• 4:15
  William Auten: Um they might uh be per portrayed that way, but mostly that is due to their um operation in being selective about how they choose risks and how they pay claims.
• 4:31
  William Auten: And it's all against a set of rules uh that are usually outlined in a policy.
• 4:37
  William Auten: And you know, how many times a day does an adjuster give bad news to somebody that that the rules say that this isn't covered?
• 4:46
  William Auten: And I know I would love to help this situation, but I can't because this is a contract and there's an agreement, there's rules and structure.
• 4:57
  William Auten: And this is not just um, you know, we're not just writing checks to make people happy necessarily.
• 5:04
  William Auten: We're trying to function within a business model.
• 5:07
  William Auten: Right.
• 5:08
  William Auten: And there are some people that will argue that that a business model like that is evil.
• 5:14
  William Auten: I heard one guy ranting the other day that insurance companies are um what did he say?
• 5:20
  William Auten: Um he said they're evil basically.
• 5:24
  William Auten: And um I I don't I don't agree with that.
• 5:29
  William Auten: First of all, they're they're not good or evil, they're just a giant machine.
• 5:35
  William Auten: And uh when you recognize that it is kind of a system and there's disconnects within that system that sometimes lead to bad outcomes.
• 5:45
  William Auten: You know, the the bean counters are looking at a certain thing or a certain policy uh form and not understanding the nuance of the language or not understanding that that form functions with some other in some other context, and they don't understand why they're paying a certain type of claim.
• 6:02
  William Auten: Um and the claims department folks have a different interpretation.
• 6:08
  William Auten: Um when you have that dynamic to the outside looking in, it looks like there's there's some sort of bad faith thing going on when really it's a systematic maybe flaw, perhaps, right, and should be corrected, and that's fine, but it doesn't mean they're evil.
• 6:25
  Chantal Roberts: No, and and I think too, and it goes back, and this is not what the topic of the conversation is today, although it would be a great topic, is it goes back to our education as an industry to our consumer who are the policyholders.
• 6:44
  Chantal Roberts: Uh, you know, because we're busy saying, you know, save 15% or more by just signing up online, or we've seen a thing or two, and we can go with the flow and we're in good hands because we're good neighbors or whatever.
• 6:58
  Chantal Roberts: And that doesn't tell you anything about the policy that you are buying as a as a consumer.
• 7:06
  Chantal Roberts: So that's a like I said, whole different podcast, but you're absolutely right.
• 7:12
  Chantal Roberts: Whereas the accountants and the underwriters and the marketing people may go, yeah, that's totally covered.
• 7:20
  Chantal Roberts: The claims people will say, Is it though?
• 7:24
  Chantal Roberts: And which is one of the reasons why I tell my students, I think that we're teaching insurance backwards.
• 7:29
  Chantal Roberts: We need to start with claims and go, what do you want covered?
• 7:32
  Chantal Roberts: You want that covered?
• 7:33
  Chantal Roberts: Okay, we need to back it up and go boom, boom, boom, you know, and and and then work back towards selling it and then underwriting it, and then how much is it going to cost?
• 7:44
  Chantal Roberts: But that's that, like I said, whole nother thing.
• 7:47
  Chantal Roberts: But part of this, again, the thing that you're talking about, people seeing insurance companies as evil or adjusters as as quote unquote evil, is when adjusters are overworked and excuse me, they're just doing triage claims handling, uh, and they're putting out fires left and right.
• 8:08
  Chantal Roberts: And so they have inadequate supervision, they have communications that are compressed, and there's lack of time for some kind of thoughtful investigation.
• 8:20
  Chantal Roberts: And that is how we we kind of get to this point of there may be bad faith.
• 8:27
  Chantal Roberts: And so I wanted to alert the adjusters of hey, if you start seeing some of these warning signs that I see, take a minute and pause and do some investigation, either on yourself, on the file, or whatever, so that we can avoid this escalation of the file to litigation, because it just costs everybody a little bit more.
• 8:56
  Chantal Roberts: And if we owe the claim, we pay the claim.
• 8:59
  Chantal Roberts: If we don't owe the claim, then we need to explain it a little bit better.
• 9:04
  Chantal Roberts: So that is what we will be talking about today and why, as the white paper is being tied in, the claims department is not considered to be an expense center, even though it's on the expense part of the ledger for insurance companies.
• 9:23
  Chantal Roberts: Uh, it is really an operational risk control system because everything that the adjuster touches impacts the entire organization.
• 9:32
  Chantal Roberts: You know, our loss adjustment expenses, and if you get a lawsuit, uh if you're investigating things three or four times, you know, sending out appraisers or field injusters, estimators.
• 9:46
  Chantal Roberts: So anyway, that's that's kind of what I was thinking.
• 9:50
  Chantal Roberts: That's a long introduction.
• 9:52
  William Auten: Yeah.
• 9:53
  William Auten: So um so the um the root cause of bad faith, um, a lot of people will probably think on its face that it's the behavior of a of an adjuster when in the process of handling a claim.
• 10:09
  William Auten: Um, but really there could be some underlying structural things that lead to it.
• 10:14
  William Auten: Take vacation schedules, for example.
• 10:17
  Chantal Roberts: I've seen that.
• 10:18
  William Auten: If you're not managing your vacation schedules properly in your claims department, you're gonna wind up short-handed.
• 10:24
  William Auten: And if you if you allow, you know, a lot of people to take time off in a season where you know it gets busy and you you drop the ball on a bunch of claims because you're understaffed, um that's kind of a potential bad faith situation because you've not, you know, as the manager of that department or that company, you are are not um you know, stewarding it properly.
• 10:52
  Chantal Roberts: Um absolutely.
• 10:53
  Chantal Roberts: Yeah.
• 10:54
  Chantal Roberts: And and I see it when you don't have enough, and again, this is this is globally, this is not anything that an adjuster themselves can do, but more as a C-suite thing.
• 11:07
  Chantal Roberts: And this is something that we kind of talked about in the white paper, is if if you have so few adjusters that they can't that they're already operating at one and a half desk, two desk, like they're they're handling the file load for two adjusters instead of just their stuff because you don't want to hire them because it's an expense or whatever, that does um aggravate the system.
• 11:34
  Chantal Roberts: And it it causes these emotions to boil over, that leads to bad faith lawsuits.
• 11:44
  Chantal Roberts: Okay.
• 11:45
  Chantal Roberts: So if we don't have enough people to even answer the phone or answer questions or handle a claim when an adjuster is on vacation, then yeah, that this is when again we we antagonize our client who is the policy holder, and we start seeing like shifts in tone in their communications and everything, because the the insured, and I'm just gonna say insured, but it it could be the first party claimant or a third-party claimant, regardless, even though there's not really bad faith, quote unquote, for uh um a third party, although there are the states like I think California is one, Louisiana is one where you can do the long arm statute, not gonna talk about that.
• 12:32
  Chantal Roberts: But anyway, just know that that's what I'm talking about.
• 12:35
  Chantal Roberts: Um, because you can see the the switch in tone and communication with a third-party claimant as well.
• 12:43
  Chantal Roberts: So when you see this, when it goes, nobody answers my phone.
• 12:49
  Chantal Roberts: You know, nobody answers the phone.
• 12:51
  Chantal Roberts: I can't get an answer out of anybody.
• 12:53
  Chantal Roberts: So-and-so said this, but so-and-so is saying this, and now so-and-so is on vacation.
• 12:58
  Chantal Roberts: Um, you know, that switch from here are the facts to either anger or fear, which anger is very close to fear, uh is is one of those warning signs.
• 13:14
  Chantal Roberts: And one of the ones that I saw in a in a case was the fact that the adjuster's father had died.
• 13:23
  Chantal Roberts: And the the insured blesser was so frustrated by this point.
• 13:28
  Chantal Roberts: The insured was wrote, I don't care.
• 13:32
  Chantal Roberts: I they wrote it in an email.
• 13:33
  Chantal Roberts: I don't care that your dad died.
• 13:34
  Chantal Roberts: I'm like, wow.
• 13:37
  Chantal Roberts: Whoa.
• 13:40
  Chantal Roberts: I mean, let's pay attention, insurance company.
• 13:44
  Chantal Roberts: And and that's not the adjuster's fault.
• 13:48
  Chantal Roberts: That is the governing board's fault.
• 13:50
  Chantal Roberts: And so that's how the white paper ties into this.
• 13:53
  Chantal Roberts: But but what the actionable item that our adjusters can do, and that's what I want to talk to everybody about, is you need to acknowledge that communication.
• 14:08
  Chantal Roberts: Hopefully, the person who is filling in for the adjusters whose parent has died.
• 14:14
  Chantal Roberts: Um, say, hey, I I recognize I got your email.
• 14:18
  Chantal Roberts: I understand you're that you're frustrated.
• 14:21
  Chantal Roberts: I recognize this, and I want to acknowledge it.
• 14:25
  Chantal Roberts: And let me see what I can research into this, and I will get back with you by the end of X date, and then put it on your calendar and do it so that you don't become another liar that this person has been dealing with, right?
• 14:42
  Chantal Roberts: I would also pick up the phone and use my voice when you're before you send that email.
• 14:48
  Chantal Roberts: Um, you know, and uh then you can confirm that in an email.
• 14:56
  Chantal Roberts: And so that is the difference between kind of like working a file rather than just like kicking the can down the street, uh, such as, well, your adjuster is off for three days, they'll be back on Monday.
• 15:12
  Chantal Roberts: Call back then.
• 15:15
  Chantal Roberts: That's gonna make the injury, and then it's that's like a little paper cut.
• 15:22
  Chantal Roberts: Yeah.
• 15:22
  Chantal Roberts: And those things are annoying, you know.
• 15:24
  Chantal Roberts: It's like a salt in a wound, and and now the insured or the claimant is just gonna keep thinking about the these little bitty things, these little niggly things that are making them mat.
• 15:37
  William Auten: They're gonna make a list in their head, yeah, and they're gonna recite it to everybody that asks them how the claim is going, and uh it's not gonna be good.
• 15:46
  William Auten: Um, another, you know, we talked about vacation schedules.
• 15:49
  William Auten: Uh, what about authority levels?
• 15:51
  William Auten: Because, you know, I've seen a lot of places where there are um it has to go to one person for authority, and then if it's over a certain dollar amount, it's got to go to the next desk, and then if it's over that amount, it's got to go to the large lost person.
• 16:04
  William Auten: And it's just this unending chain of and the people that are setting that system up are probably not thinking, well, this is gonna slow things down, and it could it could mean that someone's gonna get mad or they may not care.
• 16:24
  William Auten: Um, but what but what they're really trying to do, I get what they're trying to do.
• 16:28
  William Auten: They're trying to make sure that that that something doesn't get paid that shouldn't by accident.
• 16:33
  William Auten: Right.
• 16:34
  William Auten: Um and you know, I don't know if having 15 people look at the file is necessarily the answer for that.
• 16:41
  William Auten: Maybe just educate the people and give them some autonomy and and authority to do things uh might be a better way to go.
• 16:49
  Chantal Roberts: Yes.
• 16:50
  William Auten: But um but it it's also tough.
• 16:53
  William Auten: The job market, you know, you don't have a lot of people flooding into these jobs.
• 16:58
  Chantal Roberts: Um that's another thing that the white paper talks about.
• 17:01
  Chantal Roberts: Uh but you're absolutely right.
• 17:03
  Chantal Roberts: Let's talk about the the authority level because I have seen it where the insured and maybe even their attorney, maybe they're already represented by an attorney, they just want to get paid because it's already been two years since they've gotten the last check.
• 17:20
  Chantal Roberts: And now they've got a, I don't know,$98,000 check.
• 17:24
  Chantal Roberts: And the adjuster's authority is$25,000, but the manager's is$50,000.
• 17:30
  Chantal Roberts: And then that manager, like the grand manager, is 75.
• 17:34
  Chantal Roberts: And then you got to go up to the scene senior or the junior VP of claims to get up to$100,000 or whatever.
• 17:42
  Chantal Roberts: You know, that makes people mad.
• 17:46
  Chantal Roberts: Absolutely makes people mad.
• 17:47
  Chantal Roberts: And I do get it, you're absolutely right.
• 17:50
  Chantal Roberts: The reason why we have these levels is so that we as an insurance company can get eyeballs on this claim and have some kind of review on it, which is great because that's what we're supposed to be doing anyway.
• 18:06
  Chantal Roberts: However, and I'm not saying increase everybody's authority.
• 18:09
  Chantal Roberts: However, what we may want to do is shoot it directly to the senior VP instead of it going or maybe give it to our manager who shoots it up and then CC everybody on it, but it it moves it a little quicker.
• 18:25
  Chantal Roberts: And then on this again, what we have to do is call our claimant, which would, in this case, have been the attorney because they were represented, and say, hey, listen, I've got to go through three people to get authority.
• 18:41
  Chantal Roberts: And they they also have things to do.
• 18:44
  Chantal Roberts: I have outlined why this is urgent, but I don't control their schedule.
• 18:52
  Chantal Roberts: So I just want to let you know I've I've already sent it to them, and you know, boom, but I can't control how fast it's gonna go.
• 19:03
  Chantal Roberts: I would guess based on the past, it's gonna take me five days to get authority.
• 19:09
  Chantal Roberts: And I I know that's not what you want to hear, doesn't make you happy.
• 19:13
  Chantal Roberts: I I have told them it's an emergency.
• 19:16
  William Auten: So what what that person hears is you have to wait.
• 19:21
  William Auten: What they don't hear is there are 500 documents in your file, and 15 of them uh uh are scanned and faxed and blurry, and somebody's physically got to read them, and um uh another uh set of them are not labeled properly, so we have to, you know, and that has to go through all these people.
• 19:46
  William Auten: As organ we have it as organized as we can get it, but it's not like reading a newspaper, it's like reading a novel written by a four-year-old, and it's uh uh you know, things are out of order and things are messy, and and um uh on top of that, there may be coverage issues.
• 20:05
  William Auten: It may be what happened to you uh or your house or whatever, uh, may have been really weird and doesn't fit into the category of an accidental fire or a hail storm or something that's clearly obviously covered.
• 20:20
  William Auten: Right.
• 20:21
  William Auten: So there's things that have to be reviewed in order to determine whether or not anything gets paid at all.
• 20:27
  William Auten: And that's a complex process.
• 20:30
  William Auten: Exactly.
• 20:30
  William Auten: All that stuff and more needs to be explained to that person to explain that five-day delay, right?
• 20:38
  William Auten: But and if you don't, all they hear is I have to wait.
• 20:42
  Chantal Roberts: Right.
• 20:43
  Chantal Roberts: And and you are absolutely right.
• 20:45
  Chantal Roberts: And so when you don't even say you have to wait.
• 20:53
  Chantal Roberts: You know, if you just say, I I put in the request, so I'll let you know when it happens, that you've you've met the bar.
• 21:05
  Chantal Roberts: I mean, you've communicated that.
• 21:07
  Chantal Roberts: Um, but again, we're talking about how we can avoid these kinds of escalations.
• 21:13
  Chantal Roberts: And so then what you want to do is kind of go beyond what is absolutely positively necessary and go, look, there's you know, it's got to go up to my manager, their manager, and the the senior VP.
• 21:25
  Chantal Roberts: And based on what comes back, usually it's five days.
• 21:28
  Chantal Roberts: Now I've told them it was an emergency.
• 21:31
  Chantal Roberts: Hopefully they'll get to it, but I I don't want to misrepresent here.
• 21:35
  Chantal Roberts: Um, also, this is kind of a complex claim.
• 21:38
  Chantal Roberts: And if you just stop at five days, but I've done this, this is a little bit more information, and they're not going to be happy, but at least they understand.
• 21:46
  Chantal Roberts: If you go even further than that and say, this is why it's gonna take like five days, because they're reviewing everything behind me, making sure I'm doing my job correctly.
• 22:01
  Chantal Roberts: They then understand you've been transparent with them, adjusters.
• 22:07
  Chantal Roberts: So once you've done that, there's they could still be mad, but there's really nothing they can do about it, right?
• 22:13
  Chantal Roberts: And then you can, again, you confirm it in an email like, hey, uh told you I've sent it based on history.
• 22:20
  Chantal Roberts: I'm gonna say five days.
• 22:22
  Chantal Roberts: I don't know, I can't promise anything.
• 22:24
  Chantal Roberts: Yada, yada, yada.
• 22:26
  Chantal Roberts: Uh, and and again, you have been forthcoming.
• 22:31
  Chantal Roberts: For the C-suite, how the white paper ties in is that adjusters nowadays don't have time to make these phone calls.
• 22:41
  Chantal Roberts: We don't, because we're putting out fires, right?
• 22:44
  Chantal Roberts: We we don't have this staff because no sooner do we like hang up the phone than the phone rings again.
• 22:51
  Chantal Roberts: And and for us to get through all the KPI, the key performance indicators that we have to do, closing files, you know, closing 10 files a month or whatever they have us do, means that we have to take shortcuts.
• 23:06
  Chantal Roberts: So, what we need are more adjusters, and that's how the white paper kind of ties into this this whole thing, is so that we can be better.
• 23:17
  William Auten: Yeah.
• 23:18
  Chantal Roberts: And and that means that we need more adjusters.
• 23:21
  William Auten: And when you say we can be better, I think what you mean is the insurance industry as a whole, not Joe adjuster sitting in the desk.
• 23:29
  William Auten: Although there's plenty of opportunities for Joe to to improve.
• 23:33
  William Auten: And I made that up.
• 23:35
  William Auten: If your name is Joe, I'm not picking up.
• 23:36
  Chantal Roberts: Sorry, we don't mean, yeah.
• 23:38
  Chantal Roberts: Wouldn't it be awkward if there was an honest person named Joe Adjuster?
• 23:43
  Chantal Roberts: That would be awkward.
• 23:44
  Chantal Roberts: That would be weird.
• 23:45
  Chantal Roberts: So awkward.
• 23:46
  Chantal Roberts: Um yeah, so what we're talking about is is pretty much like the triage mode, which is what adjusters are doing.
• 23:55
  Chantal Roberts: And another sign, another warning sign that a file is going to be blowing up is just because we're just focusing in on that one thing rather than actually working the file.
• 24:08
  Chantal Roberts: You know, like I said, we're just kicking the can down the path a little bit.
• 24:14
  Chantal Roberts: And you see this by having a lot of repeated start and stop movements in the file.
• 24:23
  Chantal Roberts: So within, I don't know, three days, you'll have a whole bunch of work done on the file.
• 24:29
  Chantal Roberts: And then it just goes silent for, I don't know, 28, 30 days or something until someone pops back up and says, what's going on?
• 24:38
  Chantal Roberts: Where's my check?
• 24:39
  Chantal Roberts: And then you have maybe, you know, one whole day of activity and where you reviewed the estimate and you sent out a check and it goes silent again for 15 weeks or days until the insurer goes, this isn't enough.
• 24:54
  Chantal Roberts: And you know, boom.
• 24:56
  Chantal Roberts: So what we're doing is we as adjusters, as file handlers for ourselves, need to know why the file stopped.
• 25:08
  Chantal Roberts: You know, we need to stop at that point if if we just see this continuously, or if we're supervisors, we need to look and go, okay, think like a chest master.
• 25:20
  Chantal Roberts: What's the next step?
• 25:21
  Chantal Roberts: What are the next two steps?
• 25:23
  Chantal Roberts: How can I get this file moving?
• 25:25
  Chantal Roberts: Because really, the only happy file is a closed file.
• 25:30
  Chantal Roberts: And I do want to say to the C-suite as well, just because we've paid, we've made initial payments, doesn't mean we get to close the file.
• 25:38
  Chantal Roberts: Almost always there's going to be supplements.
• 25:40
  William Auten: So like on property anyway.
• 25:42
  Chantal Roberts: Yeah, yeah, on property anyway.
• 25:44
  Chantal Roberts: On property anyway.
• 25:45
  Chantal Roberts: Uh and and so I see these metrics where they're so proud of themselves because they they worked a cat file, they're they worked a cat event and they closed 90% of their claims within 30 days.
• 25:58
  Chantal Roberts: And my question to them is, yeah, but how many did you reopen?
• 26:04
  Chantal Roberts: I mean, how many did you reopen?
• 26:06
  William Auten: That makes me think of two separate scenarios.
• 26:09
  William Auten: Uh, one one scenario you have um you have a group of seasoned adjusters with authority of say$150,000 a piece.
• 26:20
  William Auten: Um there's very few claims that come across their desk that they can't just wrap up.
• 26:27
  William Auten: And they know what they're doing, so they're able to get those claims closed.
• 26:31
  William Auten: Another company had that set up, but they they were worried that there was some leakage, meaning that there was claims being paid that shouldn't or they were being overpaid just because adjusters were being lazy or expedient or whatever.
• 26:45
  William Auten: Right.
• 26:46
  William Auten: So they put levels of author different levels of authority in um to make sure that those claims were being seen by more eyeballs.
• 26:56
  William Auten: So when you compare the two, you might find that uh the second company pays less on claims than that first company.
• 27:05
  William Auten: But the risk of um, well, like you said, the supplements are probably going to happen in that second scenario to balance things out.
• 27:17
  William Auten: Um but what you risk by doing that also is a bad faith scenario because now you've got all these delays built in um unintentionally, but you've got these delays built in where other trip-ups can happen.
• 27:31
  William Auten: And let's say you've got three levels of authority and that middle level went on vacation.
• 27:38
  William Auten: What happens now?
• 27:39
  William Auten: And no one knows what to do, and the claim sits for 30 days or 40, 50, whatever.
• 27:45
  Chantal Roberts: Yeah.
• 27:45
  William Auten: So in those two scenarios, I I feel like the first one is the cleaner way to do it.
• 27:53
  William Auten: And if if it costs the company uh technically, you know, more in claim payments by 15% or 20%, um, does that mean that that you've actually overpaid by that much?
• 28:08
  William Auten: Or are you hiding some monsters in the other system that are gonna blow the whole thing up at some point?
• 28:15
  Chantal Roberts: And you've mentioned some great things that the white paper talks about, the ROI of claim staffing and education, which is okay, C-suites, you know, you've you've got a choice because the money's gonna come out one way or the other.
• 28:34
  Chantal Roberts: Either we're slightly overpaying, which we hope we are not, we because we're only supposed to be paying what's owed, right?
• 28:41
  Chantal Roberts: But we may be overpaying, but we got the file closed and it doesn't come back, or we stick to this really strict kind of no, we're gonna only look at this thing and then excuse me, we're gonna look at that thing, and then we're gonna look at this thing, and we then aggravate the insured so much that now it's in lawsuit.
• 29:11
  Chantal Roberts: So instead of slightly overpaying, let's say by 15%, now we're going to be paying additional loss adjustment expenses because now we've got all of these other inspections that we've had to do, and maybe we had to pay someone to do that, and we have attorney fees.
• 29:29
  Chantal Roberts: And we know that we're gonna have to tack on like another 20% to settle the claim or whatever.
• 29:34
  Chantal Roberts: So which one do you want?
• 29:36
  Chantal Roberts: It it it's you're always going to pay, but which way do you want to pay?
• 29:41
  Chantal Roberts: And I would agree personally that the first method that you were talking about is the correct and the and the best, I guess I shouldn't say correct, but maybe the best method better, better than the second option.
• 29:54
  Chantal Roberts: Yeah, because I have also seen as an expert, again, these are adjusters are in triage mode.
• 30:02
  Chantal Roberts: That's why I say that the adjusters aren't evil, they're not bad or anything like that, but they're in triage mode.
• 30:08
  Chantal Roberts: So the insured will go, Hey, uh, this isn't enough.
• 30:12
  Chantal Roberts: I need you to send someone else out and write another estimate because my contractor says it's gonna be$15,000 and you've paid me$7,000 or whatever.
• 30:24
  Chantal Roberts: And the adjuster makes the notes but never reopens the file.
• 30:30
  Chantal Roberts: And so then a diary isn't set and it falls off that adjuster's radar until like two months later.
• 30:37
  Chantal Roberts: Hey, when are you going to the insurance pops back up?
• 30:39
  Chantal Roberts: When are you going to give me my uh it's like send someone out again?
• 30:43
  Chantal Roberts: And again, that's what I'm talking about.
• 30:45
  Chantal Roberts: This is this is a warning sign.
• 30:48
  William Auten: So yeah.
• 30:51
  William Auten: Um, so I want to talk about the the attitude among um claims departments, um, managerial, I guess, more than anything, that um when they're faced with irate policyholders, because there's time delays built in for review, or there are internal uh procedures that um govern the way they pay certain claims, like um for a roof claim, if they you know have um an internal policy that says it's not in the insurance policy, but it's their policy that they only repair after so many hail hits or you know, they only replace after so many hail hits or whatever.
• 31:36
  William Auten: You you know what I'm talking about.
• 31:38
  William Auten: Yeah, yeah, yeah.
• 31:39
  William Auten: I've seen those.
• 31:39
  William Auten: Those arcane little you know, weird things about drip edge and the the silly arguments that some adjusters are are forced to to get into.
• 31:50
  William Auten: Um and when when those are addressed with the smart people in charge, um and the reply is um you know, I don't care.
• 32:03
  William Auten: This is the way we do things, uh that's problematic.
• 32:07
  William Auten: And I've seen that kind of attitude in claims departments before during my career.
• 32:15
  William Auten: Certainly none of the clients that I work for today uh do that.
• 32:19
  William Auten: And I'm I I do mean that.
• 32:21
  William Auten: Um we we work for uh kind of a strange subset of of the insurance industry, they're small regional carriers.
• 32:30
  William Auten: Um but I I you know I I think that if that attitude prevails in your claims department, it only takes one person to to have that kind of attitude.
• 32:44
  William Auten: And it and especially if that person is overseeing many young people, yeah, um, it sets the the wrong tone.
• 32:52
  Chantal Roberts: It yeah.
• 32:53
  Chantal Roberts: Yeah, I shouldn't care.
• 32:56
  Chantal Roberts: Well, yeah, and but it's also it it is a systemic thing, and um it does come from the top down, I believe.
• 33:07
  Chantal Roberts: And a lot of these, again, the C-suites, uh and that's what the the paper was about.
• 33:14
  Chantal Roberts: It it's written to those MBAs who think that they can squeeze this penny, or I guess it's a nickel now, uh, and and get more profit out of the claims department.
• 33:32
  Chantal Roberts: And again, the claims department is not a cost center.
• 33:36
  Chantal Roberts: We've got to change that thinking.
• 33:39
  Chantal Roberts: And and I have been asked though, before I respond back, is yeah, here's the deal.
• 33:48
  Chantal Roberts: As an average adjuster, I totally agree that let's just use a roof, for example.
• 33:53
  Chantal Roberts: Like uh a residential roof may need overhead and profit put on it, you know, on that.
• 34:02
  Chantal Roberts: If that's the only thing that is done.
• 34:05
  Chantal Roberts: But my company here has these guidelines that say absolutely no overhead and profit are on roofs at all, on residential roofs, period.
• 34:18
  Chantal Roberts: And so I disagree with that.
• 34:21
  Chantal Roberts: So what do I do, Chantel?
• 34:23
  Chantal Roberts: And and what I would say to the adjuster is again, we need to write very clear notes, but we can't sell, we can't throw our boss and the company that we work for underneath the bus, so to speak.
• 34:40
  Chantal Roberts: And so that's when you say, hey, according to the rules or this guidelines or whatever, I have not considered overhead and profit on the roof.
• 34:52
  Chantal Roberts: And so boom, it's right there for the expert to know about when we're reviewing your file.
• 35:01
  Chantal Roberts: Do you need to tell the insured about it?
• 35:03
  Chantal Roberts: No, not really.
• 35:05
  Chantal Roberts: You could tell them when when they're asked, when you're asked or whatever.
• 35:09
  Chantal Roberts: But yeah, they're um make sure that you're kind of CYAing, I guess, is is is what I'm saying.
• 35:16
  William Auten: That is an important aspect of it, is definitely you know, put in there that you are paying uh according to your company's policy regarding overhead and profit.
• 35:26
  William Auten: A better approach is to understand why that policy is in place and be able to explain that to whoever you're talking to.
• 35:34
  Chantal Roberts: Exactly.
• 35:35
  William Auten: Because that means that you understand it, you've internalized it whether you agree with it or not is another issue.
• 35:43
  William Auten: But um in most cases, those discussions about overhead and profit with a single contractor make sense in the realm of Exactimate or any of the other estimating systems because it's got those components built into labor rates and uh and material costs.
• 36:02
  Chantal Roberts: So right.
• 36:04
  Chantal Roberts: And to go if if I can interrupt, I'm sorry.
• 36:08
  Chantal Roberts: To answer your other point about, you know, let's say that there's a supervisor who may be mistraining people or their his or her adjusters based off of his or her opinion.
• 36:20
  Chantal Roberts: This is again why it's so important that adjusters get training and education.
• 36:25
  Chantal Roberts: And I don't necessarily mean just the CE for your license every two years or whatever.
• 36:32
  Chantal Roberts: It means going to seminars somewhere else and listening to other points of views, talking to other adjusters at your local claims association and that sort of thing to make sure that we are putting actually the customer first.
• 36:54
  Chantal Roberts: Because again, the promise is that we are going to pay a covered claim.
• 36:59
  Chantal Roberts: And that's what we've got to do.
• 37:03
  William Auten: And I I think 90% of uh bad faith issues can be um reduced or eliminated by educated adjusters who are able to um verbalize what is happening, where they're at in the file, uh what they've done in the file, what they need to do on the file, and how they came up with a number to settle the claim.
• 37:31
  William Auten: Because if they can rationalize that and they can and they can state that, um it shows that you're making an effort to do the right thing.
• 37:41
  William Auten: And when presented with an alternative opinion, um if that's communicated to you properly, you may internalize that and say, you know what, you're right.
• 37:51
  William Auten: And we do owe for whatever.
• 37:54
  William Auten: And uh, I'm gonna do a supplement uh to include that.
• 37:57
  Chantal Roberts: Exactly.
• 37:58
  Chantal Roberts: Absolutely.
• 37:59
  Chantal Roberts: And and I think that is part of the key aspect is an educated adjuster is is better able to communicate.
• 38:10
  Chantal Roberts: And and you and I talk about communication all the time.
• 38:14
  Chantal Roberts: And I again, I know that adjusters are like, this is great, I would love to communicate more, but I'm really busy.
• 38:21
  Chantal Roberts: And again, you don't have any control over your insurance company hiring more adjusters, except maybe uh anonymously slipping your boss the the white paper or something.
• 38:35
  Chantal Roberts: It's a long read, it's 37 pages.
• 38:37
  Chantal Roberts: But the the point is if we had more adjusters, you it would be better.
• 38:44
  Chantal Roberts: And I mentioned pipeline because you you were talking, we were talking about vacation and and we don't have enough adjusters to to to cover that and everything.
• 38:55
  Chantal Roberts: I mentioned this in in the white paper, and I said, listen, we gotta look, we as again again in the industry have to look at ourselves when we're only looking for college graduates who have experience for two years.
• 39:12
  Chantal Roberts: What you nope for an entry job, you can't do that.
• 39:17
  Chantal Roberts: Maybe, maybe what we want to do is hire someone right out of high school who's not ready to go to college, but wants to begin a great career.
• 39:26
  William Auten: And have a have a have an internal education program that's a good idea.
• 39:31
  William Auten: Absolutely.
• 39:32
  William Auten: You know, like send them to education is is huge.
• 39:35
  William Auten: Yes.
• 39:36
  William Auten: Um there are other barriers.
• 39:39
  William Auten: I mean, not everybody can articulate their thoughts very well.
• 39:43
  Chantal Roberts: No.
• 39:44
  William Auten: Um, and that's a really important skill to have in this job, is you've got to be able to talk about the things that you're doing, the things that you need, and the things that are going to happen in the process of the claim.
• 39:56
  William Auten: And um, and you have to be comfortable today with technology.
• 40:00
  William Auten: Yes.
• 40:01
  William Auten: Now I've seen some adjusters who are great at articulating their thoughts.
• 40:07
  William Auten: But when it comes to tech, what's you know, what's Word?
• 40:11
  William Auten: I don't know what Word document is.
• 40:14
  William Auten: A word is yeah.
• 40:16
  William Auten: Um, so you know, there's a lot of different barriers, but I mean, some of them you can't overcome, but education is is gonna be the key.
• 40:28
  William Auten: And an educated adjuster is important, but an educated policy holder or claimant is also important.
• 40:34
  William Auten: It's not, you know, don't gatekeep the information from them because the more they understand about what you're doing, uh, the less irate they're going to get when they have to wait that five days.
• 40:46
  Chantal Roberts: Absolutely.
• 40:46
  Chantal Roberts: And it and it also goes back to again, adjusters, and the C-suite and the marketing people, I get so upset when I teach this particular portion of the risk management book.
• 41:02
  Chantal Roberts: Is oh, did you know that claims only has four steps?
• 41:06
  Chantal Roberts: And one of them is the first notice of loss, and the fourth one is pay the claim.
• 41:13
  Chantal Roberts: No, guys, if you're teaching that to the underwriter and to the agent and to the actuarial people, they're gonna look at the adjuster and go, what's taking so long?
• 41:26
  Chantal Roberts: Because there's only four steps.
• 41:28
  Chantal Roberts: No, there's not four steps.
• 41:30
  Chantal Roberts: And guess what?
• 41:30
  Chantal Roberts: The fourth step is not pay the claim.
• 41:34
  Chantal Roberts: It's consider the claim or resolve the claim because guess what?
• 41:41
  Chantal Roberts: A denial may be the the resolution of the claim.
• 41:45
  Chantal Roberts: We don't pay everything that walks in the door.
• 41:48
  Chantal Roberts: Anyway, I'll get off my soapbox.
• 41:50
  Chantal Roberts: Um, but again, you're absolutely right.
• 41:54
  Chantal Roberts: Knowing how to communicate this stuff is really important.
• 41:57
  Chantal Roberts: And and that also bleeds down to our claim notes.
• 42:03
  Chantal Roberts: And I've been talking, I or I've been mentioning, hey, be sure you write down, uh, I have made this uh figure or I've estimated this amount based off of our company guidelines.
• 42:19
  Chantal Roberts: And then you need to go, here's the total or the total amount of damage is let's say$17,000, less the depreciation for the ACV, less the deductible for the total amount, because I will see notes in a file as an expert witness that just says wrote the uh payment letter and cut the check.
• 42:48
  Chantal Roberts: Okay, but there's 15 payment letters and there's 15 checks.
• 42:53
  Chantal Roberts: And yes, I have to go back and and do this, but that's a vague diary note.
• 43:01
  Chantal Roberts: And one of the things that an adjuster needs to understand is that the DOI, the Department of Insurance, often has administrative rules that state your notes need to be in such detail that if you were hit by a bus, I could walk in and pick up handling your file.
• 43:24
  Chantal Roberts: Because I know the inner workings of your mind.
• 43:28
  Chantal Roberts: Now we don't need to know everything that you were thinking about the insured or the claimant, if you know what I mean.
• 43:34
  Chantal Roberts: But you need to document why you made these decisions.
• 43:38
  Chantal Roberts: Uh, what remains to be done.
• 43:42
  Chantal Roberts: And I know that a lot of insurers are now using AI to summarize the notes every time.
• 43:47
  Chantal Roberts: So, like when someone else picks up the file, that's great and everything, but you should be doing it too.
• 43:52
  Chantal Roberts: Because I don't necessarily know if AI is picking up the right things.
• 43:56
  Chantal Roberts: I I love AI, I trust it.
• 44:00
  Chantal Roberts: But I verify it.
• 44:03
  William Auten: Yeah, you you um yeah, I mean we could have a whole other thing about AI.
• 44:08
  William Auten: Um I I'm starting to see clients um build AI policies into their um their agreements and contracts and we have an AI policy here.
• 44:22
  William Auten: It's tough.
• 44:24
  William Auten: Um it it's not it's not good enough to take over the job of a claims person, for sure.
• 44:33
  William Auten: It's certainly not good enough to make decisions on claims um or recommend decisions.
• 44:40
  William Auten: It's pretty good as an editor, uh an organizer, um but I uh I think it's got a long way to go.
• 44:50
  William Auten: And I think there's some privacy things that it is always going to be I I don't know enough about it, but it seems like it's next to impossible to keep private information private when you're working with an AI system.
• 45:06
  Chantal Roberts: Absolutely.
• 45:08
  Chantal Roberts: Uh I always say that look, I I don't I try to keep my stuff private, but I know I'm already on the black web or whatever, like all of that's already been breached and sold or whatever.
• 45:21
  Chantal Roberts: But going back to vague notes, how this specifically impacts like the specific adjuster, the one adjuster, is when the insurer, the fi the carrier, your place of business is sued by the insured for bad faith, it makes it hard to defend you by the defense attorney because it's been what, three years, four years, five years?
• 45:52
  Chantal Roberts: You've handled hundreds of thousands of claims since then to remember what you were thinking and how you came up with that number.
• 46:01
  Chantal Roberts: You know, because sometimes I look at it and I go, I don't, I do not know how they came up with that number.
• 46:08
  Chantal Roberts: And you got to document that.
• 46:12
  Chantal Roberts: So, and again, for the white paper, the C-suites and everything, you know, look, more staffing is needed for that one specific adjuster to have the time to do that.
• 46:23
  Chantal Roberts: I don't, there's not much more I can say about that.
• 46:27
  Chantal Roberts: We just need more people.
• 46:28
  William Auten: I agree.
• 46:30
  William Auten: You know, more people to the party.
• 46:32
  Chantal Roberts: Yeah, besides the fact we'll have a lot more fun.
• 46:34
  William Auten: Um it's a good party to join.
• 46:36
  William Auten: I mean, it's a fun place to be.
• 46:38
  Chantal Roberts: It is.
• 46:39
  Chantal Roberts: I mean, I love being a claims adjuster.
• 46:41
  Chantal Roberts: It's it's difficult, it's hard, but that's part of the the reason why I like it.
• 46:47
  Chantal Roberts: Uh, but I also like the fact that I get to help people.
• 46:50
  Chantal Roberts: And and there you go.
• 46:52
  Chantal Roberts: Okay.
• 46:53
  Chantal Roberts: So I would say the last warning sign that I see as an expert adjuster is again, and this is because adjusters are triaging or putting out fires and not really working the file to conclusion.
• 47:14
  Chantal Roberts: They're kicking the can down the road, are these template letters that are sent.
• 47:21
  Chantal Roberts: And the adjuster doesn't remove the language that doesn't apply to the claim.
• 47:31
  Chantal Roberts: So, for example, let's just say it's a homeowner's claim or whatever.
• 47:36
  Chantal Roberts: Uh, a lot of these domestic carriers will have really long template letters, like 30-day letters.
• 47:44
  Chantal Roberts: I'm still investigating your file.
• 47:46
  Chantal Roberts: This is what I need to conclude the claim, and those kind of letters.
• 47:51
  Chantal Roberts: And it will have that, and I I know because I've seen it when I was working the domestic carriers, you basically just get a box, right?
• 48:05
  Chantal Roberts: And you type in the box, like you pick out, I want to do a 30-day letter, and it pulls it up, and you get a box, and you type in the box, and you hit print, and the letter is put in front of you.
• 48:19
  Chantal Roberts: And then that's when you can, as an adjuster, edit that letter.
• 48:26
  Chantal Roberts: Uh let's say, again, as an example, we've got a homeowner's claim.
• 48:34
  Chantal Roberts: I don't know, a partial kitchen fire.
• 48:37
  Chantal Roberts: So they can still live in their home and everything, right?
• 48:42
  Chantal Roberts: And we don't have to have any additional living expense because I don't know, the stove is still good.
• 48:54
  Chantal Roberts: Uh let's make it a living room fire.
• 48:58
  Chantal Roberts: Okay, so living room fires because so we've got we've got kitchen, we've got bathroom, we got bedrooms.
• 49:04
  Chantal Roberts: You can still live in that home, right?
• 49:07
  Chantal Roberts: You just don't have a living room.
• 49:10
  Chantal Roberts: So take out, and and the insured goes, yeah, I don't, I don't, I'm still living here, I don't need additional living expense.
• 49:18
  Chantal Roberts: Take that portion of the letter out because what I have seen as an expert witness is when the insurer is sued for bad faith, the policyholder attorney points to that letter and says, see, they even knew that they had that coverage and they didn't give it to us.
• 49:44
  Chantal Roberts: And and what the insured is doing is they're making a claim for additional living expenses all the way back to the beginning of the file, even though they've told you, and it's in your file notes, that you or that the insured doesn't need additional living expense.
• 50:01
  Chantal Roberts: So what I'm saying is update the letter.
• 50:05
  Chantal Roberts: It could confuse people with in applicable language or something like that.
• 50:13
  Chantal Roberts: And for goodness sakes, if you can't, because I have seen it where all of these letters are printed out of the home office, and so you never get to see the letter or anything like that, I would make that in file note.
• 50:25
  Chantal Roberts: I couldn't change the letter.
• 50:28
  Chantal Roberts: Again, you're not selling your in or you're not, you know, throwing your insurer, your employer in front of the bus or anything, but you know, that's more of a systems issue, and you don't have any control over that.
• 50:42
  Chantal Roberts: I would just say, I can't change any of the wording.
• 50:44
  Chantal Roberts: I send it out as it is.
• 50:46
  William Auten: There are a lot of things that can be automated in this business.
• 50:49
  William Auten: Um, but you're right.
• 50:52
  William Auten: If the automation is um dysfunctional in a way that it continually tells the insured it's 30 days, we're still waiting for the following information, and then it gives a laundry list of things, and you're not updating that because they gave you all those things, and three of the things on the list you don't really need from them anyway, right?
• 51:16
  William Auten: Uh, because it's not pertinent to the claim.
• 51:18
  William Auten: What you're doing is you're telling that insured that this person is just spitting out these letters to check a box that they did it, not to really handle my claim.
• 51:28
  unknown: Right.
• 51:29
  William Auten: And I think that's the point of what you're getting at is that um, and and if and if you are unable to customize those letters in a way that fits the claim that you're working on, you need to talk to your supervisor.
• 51:43
  William Auten: Uh, and if nothing else, you need to document the file.
• 51:47
  William Auten: The this letter keeps going out asking for the police report, and there was no police report involved, so it's frustrating the policy holder.
• 51:56
  Chantal Roberts: And right.
• 51:57
  Chantal Roberts: Um and you know, all of these things that we're talking about is just a paper cut and it's a paper cut and it's a paper cut, and it's almost like it's a death by a thousand paper cuts.
• 52:06
  Chantal Roberts: And when I was doing research for the ROI of claims staffing and education white paper, one of the things that I learned was there was a market conduct examination by the by the Pennsylvania Department of Insurance.
• 52:22
  Chantal Roberts: And this was a health insurer case, but it's still kind of relevant if you think about it.
• 52:28
  Chantal Roberts: The health insurer was sending out these letters saying, hey, we're looking at your file, we're researching your claim or whatever.
• 52:37
  Chantal Roberts: But the insurer, the the Department of Insurance found that the insurer, their form letters, wasn't adequately informing the insured of the status.
• 52:49
  Chantal Roberts: So they got fined, a pretty hefty fine.
• 52:52
  Chantal Roberts: I think it was like 14 million.
• 52:53
  Chantal Roberts: Don't quote me on that.
• 52:54
  Chantal Roberts: Read the paper.
• 52:55
  Chantal Roberts: I don't I don't remember exactly, but that's what I'm talking about.
• 52:59
  Chantal Roberts: So if you continually state that you need the information for the loss adjustment expense and the hotel bills, the grocery bills, all that kind of stuff, and they don't have it, but you can't take it off, you need to mention this.
• 53:15
  Chantal Roberts: But yeah, absolutely.
• 53:18
  Chantal Roberts: So anyway, yes, that's exactly what I was talking about.
• 53:21
  Chantal Roberts: There, of course, there's gonna be gray areas and nuances and and all of that, but it all comes down to having enough staff and being communicative, I think.
• 53:33
  Chantal Roberts: But when you see these warning signs, this is this is a warning sign, this is gonna explode on you.
• 53:38
  Chantal Roberts: It's like the ticking time bomb.
• 53:41
  Chantal Roberts: It's it's gonna go.
• 53:43
  William Auten: Yeah, so adjusters, uh, you need to be um you need to be polite and you need to be um uh what's the word I'm looking for?
• 53:52
  William Auten: Informative?
• 53:53
  William Auten: Informative, but you need to demonstrate that you care about the the process of the claim.
• 53:59
  Chantal Roberts: Empathetic.
• 54:00
  William Auten: You need to do that individually, but the carrier as a whole um needs to focus on making sure that their operations also send that message that they're um that they care about their policy holder and they they care about doing things correctly and properly.
• 54:17
  William Auten: And yes, that might mean making sure you don't pay claims you shouldn't, but it also means making sure you expediently pay the claims that you should.
• 54:27
  Chantal Roberts: I want to mention one more thing.
• 54:28
  Chantal Roberts: Uh we were talking about when the insured gets upset and maybe like the tone of their communication changes, like their written communication changes.
• 54:41
  Chantal Roberts: And of course, we're supposed to acknowledge and respond to communications, uh and the DOI says it's something like that reasonably leads one to believe that it that a response is necessary, right?
• 54:59
  Chantal Roberts: And if the if the insured is saying, or the claimant is just going on like, you never do anything, you don't return my phone calls, you don't do this, and you don't do that, do we does that need a response?
• 55:15
  Chantal Roberts: Technically, no, they're not asking for anything, but here's the deal they are crying out to the in the void for you to respond.
• 55:26
  Chantal Roberts: And if you're silent about this, then that's a response.
• 55:33
  Chantal Roberts: And and I don't want it to be a response because then the the silence is my adjuster doesn't care.
• 55:42
  Chantal Roberts: The my insurance company doesn't care because they're not even responding to me.
• 55:47
  Chantal Roberts: So you go, okay, Chantel, what do I say?
• 55:50
  Chantal Roberts: This is when you respond with empathy, like you were saying, you you say, I hear that you I hear your frustration.
• 55:58
  Chantal Roberts: I'm sorry I haven't been able to return your phone call.
• 56:01
  Chantal Roberts: I have been in a meeting all day, or I've been in, you know, a court with a litigated file or whatever.
• 56:08
  Chantal Roberts: Um, I was on vacation.
• 56:10
  Chantal Roberts: I apologize for not responding, or or something that acknowledges their pain or their issue.
• 56:20
  Chantal Roberts: And it goes a long way because if silence becomes its own communication and and it's not a good thing when someone is silent.
• 56:32
  Chantal Roberts: Speak up, yeah, be heard, be heard, speak up for yourself.
• 56:37
  Chantal Roberts: Yeah, so yeah, it's um that's kind of it.
• 56:40
  Chantal Roberts: If you want to uh read the all 37 pages, there's graphs though, so don't worry, there's some pictures there.
• 56:50
  Chantal Roberts: Uh you can go to cmrconsulting.net slash appearances and then slash ROI claim staffing.
• 56:59
  Chantal Roberts: We'll put a link in the show notes.
• 57:02
  Chantal Roberts: And yeah, so that's that's it.
• 57:05
  Chantal Roberts: Um, I think next time, Bill, I thought because we'd mentioned this a couple of episodes ago where we were talking about uh Medicare and Medicaid and the automatic liens that they have on files and what adjusters need to be doing.
• 57:23
  William Auten: Yeah.
• 57:23
  Chantal Roberts: I thought we should um talk about that.
• 57:28
  William Auten: Okay.
• 57:29
  William Auten: Um that is a little bit of a rat's nest, but I can I can speak operationally to what needs to happen kind of on the front lines.
• 57:38
  William Auten: Yes.
• 57:38
  Chantal Roberts: Um, yeah, that's what I'm talking about.
• 57:40
  William Auten: All the carriers seem to have a different way to communicate the uh uh to the appropriate entities what they need to do.
• 57:47
  William Auten: Yeah, but um nonetheless we can we can hit the high spots on that for sure.
• 57:52
  Chantal Roberts: Absolutely.
• 57:52
  Chantal Roberts: So that's gonna be on Thursday, June 18th.
• 57:57
  Chantal Roberts: And so thank you for listening.
• 57:59
  Chantal Roberts: Yep, be sure to share, like, subscribe, comment, because it helps the algorithm pick us up.
• 58:06
  William Auten: Yeah.
• 58:07
  William Auten: Yeah.
• 58:08
  William Auten: All right, okay.
• 58:09
  William Auten: So well, we'll we'll talk again soon.
• 58:12
  William Auten: And uh thanks for listening.
• 58:14
  Chantal Roberts: Yeah, see you later.
• 58:15
  Chantal Roberts: Bye.
• 58:15
  William Auten: All right, take care.
• 58:16
  William Auten: Thanks for joining us on the Art of Adjusting Podcast, where we talk about life as an insurance adjuster.
• 58:22
  William Auten: Hit that subscribe button real quick and tell all of your adjuster friends to check this out as well.
• 58:26
  William Auten: For independent adjusting services, go to www.autin.claims.
• 58:31
  William Auten: And for anyone interested in working as an independent liability adjuster, go to the contact us tab to join our roster.
• 58:39
  Chantal Roberts: So this wraps up another Art of Adjusting podcast.
• 58:43
  Chantal Roberts: If you enjoyed this podcast or this episode, please give us five stars and a review.
• 58:48
  Chantal Roberts: It does help the algorithm pick us up.
• 58:51
  Chantal Roberts: In the meantime, you can contact me at theartofadjusting.com for consulting and training purposes.