Latest / The Art of Adjusting® Podcast / Episode 107: Negotiation Lessons From 10,000 Insurance Claims
Transcript
- 0:06William Auten: Hello, I'm Bill Auten of Auten Claims Management.
- 0:09Chantal Roberts: I'm Chantal Roberts of CMR Consulting, and welcome to the Art of Adjusting Podcast.
- 0:14William Auten: Today we're going to talk about life as an insurance adjuster from the perspective of property, auto, liability, or workers' compensation adjusters.
- 0:22William 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.
- 0:31William Auten: Hi, Chantal.
- 0:32William Auten: Hi, how are you?
- 0:34William Auten: Good.
- 0:35William Auten: Good.
- 0:35William Auten: I see you got some curly hair today.
- 0:37William Auten: I love it.
- 0:38Chantal Roberts: I do.
- 0:38Chantal Roberts: Thank you.
- 0:38Chantal Roberts: Thank you very much.
- 0:39William Auten: Yeah, we uh You know, I was thinking about doing that with my hair too, but I just I can't.
- 0:43William Auten: I don't I don't think it would frame your face.
- 0:46Chantal Roberts: Yeah, no, I don't think it would frame your face well, you know, because I mean some people can carry it off.
- 0:50Chantal Roberts: This is I I'm actually a naturally curly person, so it's you know, um, so it it it it looks good on me, but I'm not I mean I love you, but I I'm only telling you this because I love you, right?
- 1:01Chantal Roberts: You know, it's um you gotta make sure you're not looking bad.
- 1:07William Auten: Don't hurt my feelings.
- 1:08Chantal Roberts: Yeah.
- 1:09William Auten: I I got I'm pretty sensitive guy.
- 1:11Chantal Roberts: I know you are, yeah.
- 1:12Chantal Roberts: I know you are.
- 1:13Chantal Roberts: Yeah, Amy and I talk about it all the time.
- 1:15Chantal Roberts: Um, so you know, today uh what we're gonna be talking about is these negotiation lessons uh from that we've learned over our lifetime as as claims adjusters.
- 1:29William Auten: Um you know, and and these don't tiptoe around the title here.
- 1:34William Auten: It's negotiations from 10,000 claims.
- 1:37Chantal Roberts: Absolutely.
- 1:38William Auten: How did I come up with 10,000 claims?
- 1:40William Auten: How did you come up with 10,000 claims, Bill?
- 1:42William Auten: I don't know.
- 1:43William Auten: I I'm I'm sure I've handled that many in my career.
- 1:46William Auten: I I have to have.
- 1:48William Auten: So, but anyway, uh that that's the that's the title.
- 1:53William Auten: And whether or not we have actually handled 10,000, I bet you between the two of us.
- 1:58Chantal Roberts: I was gonna say between the two of us, but if you think about it, um even hurricane claims, uh if we got a thousand claims a year over 10 years, wouldn't that be 10,000?
- 2:12William Auten: Uh-huh.
- 2:12William Auten: Mass checks out.
- 2:14Chantal Roberts: Yeah.
- 2:14William Auten: And I've been doing it for 30.
- 2:16Chantal Roberts: So yeah, and I've been doing it for like 25.
- 2:18William Auten: I mean, I think I think we're there.
- 2:20Chantal Roberts: Yeah.
- 2:20Chantal Roberts: But we're not going to be talking about like these gimmicks or the pressure tactics or uh whatever.
- 2:27Chantal Roberts: We're talking about a strong investigation, which we've always been talking about.
- 2:31unknown: Yeah.
- 2:31Chantal Roberts: And how this will lead you to having a real strong negotiating position.
- 2:39William Auten: Yep.
- 2:39William Auten: Yep.
- 2:40William Auten: Um, what's the song?
- 2:42William Auten: Uh, kind of know when to hold them, know when to fold them.
- 2:45William Auten: Yes.
- 2:45William Auten: And what's the third thing?
- 2:47Chantal Roberts: Know when to walk away and know when to run.
- 2:52William Auten: These four things.
- 2:53Chantal Roberts: But you never count your money when you're sitting at the table.
- 2:58Chantal Roberts: Okay.
- 2:59William Auten: Oh, you're gonna sing for us.
- 3:00William Auten: I don't think you ever sing for us.
- 3:03Chantal Roberts: Yes.
- 3:04William Auten: I can see the numbers climbing climbing right now, yeah.
- 3:09Chantal Roberts: Or it would be declining.
- 3:10Chantal Roberts: I don't know which.
- 3:12Chantal Roberts: Um, yeah.
- 3:15William Auten: So monitor snapping off exactly like exactly.
- 3:19Chantal Roberts: Yeah, everybody turns off their their sound.
- 3:21Chantal Roberts: Are are they talking now and she's not singing anymore?
- 3:24Chantal Roberts: Okay, I'll turn back in.
- 3:26Chantal Roberts: Okay, so after so many claims, uh, what have you learned about negotiating that like I guess a textbook can't really teach?
- 3:38Chantal Roberts: This is something from your own background.
- 3:40William Auten: Yeah, and I I brought up the song because that's kind of the way it works.
- 3:45William Auten: You have to know when it's time to actually have those t discussions with somebody, um, when it's not necessarily appropriate to have those discussions and um when to to hold the line.
- 4:00William Auten: You know, when you're at a certain number and and you're very confident that that your number's the the number that should settle the claim.
- 4:09William Auten: And um, you know, there's a lot of uh posturing and puff puffing up that uh people do on both sides, uh I've noticed.
- 4:20William Auten: And you have to kind of uh sip through that and um you have to be a little bit of a stoic sometimes.
- 4:30William Auten: Um but it yeah, and it's hard to articulate that into a textbook kind of um diatribe.
- 4:39William Auten: I I would say that knowing when to engage and knowing when to stay put can't be boiled down to just a simple um set of rules, I would say.
- 4:52William Auten: But you do kind of know.
- 4:55William Auten: And one of the things that we are engaging in here uh is educating adjusters who don't have as much experience as I do.
- 5:05William Auten: And we have some that have many years, but in different uh different uh aspects of insurance claims.
- 5:14William Auten: So when it comes time to begin negotiations, the question is, well, what's this what's this injury worth?
- 5:22William Auten: You know, what's that type of injury worth?
- 5:26William Auten: Well, we settled one for X amount of dollars, but we had a same the same injury last year that settled for twice that.
- 5:34Chantal Roberts: Right.
- 5:35William Auten: It it it's tough because there's no science.
- 5:38William Auten: I always tell people there's no book that we can open up and just go down to say, oh, this injury is worth this much in that jurisdiction.
- 5:45Chantal Roberts: I do want to point out though, this isn't necessarily about bodily injury.
- 5:50Chantal Roberts: I know that that's where you focus on a lot because you do a lot of liability and I do a lot of property, and that's one of the reasons why we balance out so well.
- 5:58Chantal Roberts: Because a lot of times we do have to negotiate on a roof or on the total settlement of a house or negotiation of the remediation or something to that effect.
- 6:13William Auten: And look at depreciation alone.
- 6:15William Auten: I mean, you could spend hours negotiating just how much you're gonna depreciate something.
- 6:21Chantal Roberts: Yeah, absolutely.
- 6:22Chantal Roberts: Absolutely.
- 6:22Chantal Roberts: I would say that there are some a couple of hard rules, in my personal opinion, on that, but that's a whole different podcast.
- 6:31Chantal Roberts: Um, you know, so yeah, I think you're right.
- 6:35Chantal Roberts: Sometimes it's really hard because uh as the name of the podcast in the book says, it's really kind of an art, yet it is also there's some science behind it.
- 6:46Chantal Roberts: Um when we're talking about bodily injury.
- 6:50Chantal Roberts: I know that I used to use, and I don't know if you use uh if you use it or even if it's still around, um, I'm gonna try to remember the name, uh, jury verdict research, I think is what the the product was called.
- 7:03Chantal Roberts: And you would type in your like zip code or your your jurisdiction, and you would say, okay, I've got a sprained ankle, woman 35, whatever, you know, and they would spit out some of the most current jury verdicts for something like that.
- 7:19Chantal Roberts: And that was a good way to look at what that particular injury was going for in that area.
- 7:29Chantal Roberts: Uh, but there you go.
- 7:32Chantal Roberts: That's part of the preparation, I would think, of getting ready to do the evaluation and the negotiation is your preparation and your investigation.
- 7:45Chantal Roberts: I think that's that's your leverage, isn't it?
- 7:48William Auten: Yeah.
- 7:49William Auten: Um yeah, because knowing the value of a claim uh uh so we always look at how do I start this?
- 7:58William Auten: We look at first of all, we look at general damages and special damages.
- 8:03Chantal Roberts: Right.
- 8:04William Auten: And the the special damages are pretty easy because that's a mathematical function that's just adding up all the um hard costs, uh out of pockets and medical bills and whatever expenses that that can be documented.
- 8:19William Auten: Um the general damages are those wishy-washy ones like pain and suffering, that loss of consortium.
- 8:26William Auten: What's that worth?
- 8:28William Auten: Um and we don't use uh we don't use any websites or databases or um for for court verdicts and things like that for a couple reasons.
- 8:38William Auten: Um most of those that you find are within big metropolitan areas that we don't always play in.
- 8:46William Auten: Right.
- 8:46William Auten: And um, you know, in a in rural upstate New York, a case can settle for a very different number than it might in Queens, you know.
- 8:57Chantal Roberts: Jurisdiction does matter.
- 8:58Chantal Roberts: And and adjusters do need to be aware of the jurisdiction.
- 9:02Chantal Roberts: And and if you don't know what a jurisdiction is, that's just where your court happens to be.
- 9:08William Auten: Yeah.
- 9:08William Auten: We have a really good database though of just of the claims that we've settled.
- 9:13William Auten: And that database is getting bigger and bigger every year, uh, because we do settle a lot of claims.
- 9:19William Auten: And um we there are some attorneys that don't like to negotiate with us for whatever reason.
- 9:27William Auten: Um, but most in most cases we can get something settled.
- 9:31William Auten: And um we are off, you know, we are always governed by our our clients' authority.
- 9:37William Auten: And if uh if we just don't get enough authority, there's not much we can do.
- 9:41William Auten: But you know, if if everybody's being reasonable, uh we get signed releases uh almost every day we get a release in here of some sort, whether it's property, injury, um, you know, you name it.
- 9:56William Auten: So uh just because of that, we do have uh uh we have a good database of of information that can help guide us when we're negotiating.
- 10:06William Auten: Because if the attorney says, look, I know this claim is worth X amount of dollars, I can say, well, you know, we just settled four of those in the past year, uh, and we know how much that is actually worth.
- 10:18Chantal Roberts: Right.
- 10:19William Auten: And one thing I am not gonna do today is talk about specific types of injuries or specific values uh that we have settled claims for because a lot of reasons.
- 10:30William Auten: Um one of the most important things, I think it's just it's proprietary information for for us, uh for one thing.
- 10:37William Auten: And um I also don't want to give a false sense uh to somebody listening who might be in a different jurisdiction.
- 10:45William Auten: Well, my claim, if Bill says he settled for this particular injury for this amount of money, then I must deserve that much too.
- 10:53William Auten: Or exactly or maybe they could get more than what we settled it for because we happen to be in a different rural area or something like that.
- 11:02Chantal Roberts: And it and it does matter.
- 11:03Chantal Roberts: And uh one of the things that of course I always want to come back to is the investigation and the documentation and talking about our claim file when when either property damage or bodily injury, when you're getting ready to negotiate, what you what you as the adjuster need to do in your file is state why you are settling for this amount of money.
- 11:31Chantal Roberts: You it would be uh general or excuse me, specific damages, $1,000, you know, because that's all of the medical bills.
- 11:40Chantal Roberts: General damages, X amount of dollars for total settlement range of X to Y or whatever.
- 11:49Chantal Roberts: And the reason is because of XYZ.
- 11:53Chantal Roberts: Um, and then that you know, they treated for four weeks.
- 11:57Chantal Roberts: It was a sprained strain, it was a low impact claim, it um it is a roof that we can repair rather than replace.
- 12:06Chantal Roberts: You we can remediate rather than tearing out all the carpet or or something to that effect.
- 12:12Chantal Roberts: Um, you need to list your reasons why, because a, it will help you if you do get into a lawsuit later.
- 12:20Chantal Roberts: But B, when you're trying to negotiate with someone, you can list the reasons why, because I I'm sure you'll go ahead and talk about this, Bill.
- 12:30Chantal Roberts: Again, a lot of people, when you're negotiating with them, are very close to the incident, you know, the claimants, and I mean first party and third party.
- 12:43Chantal Roberts: And so they automatically think, no, my pain and suffering was a lot more than what you're giving me credit for.
- 12:50Chantal Roberts: And so I want $50 billion or whatever.
- 12:53William Auten: But if you can say, I understand that, but you only treated for four weeks and you had a sprained ankle, you you know without the uh without the factual information that you get during the investigation, your premise for whatever uh stake you put in the ground is simply that because I say so.
- 13:15Chantal Roberts: Exactly, exactly.
- 13:16William Auten: And that's not really a position.
- 13:18Chantal Roberts: No, and and that is that is fantastic.
- 13:21Chantal Roberts: Thank you.
- 13:21Chantal Roberts: That's a great summary for what I was rambling on about, is you definitely want to have those facts behind you.
- 13:30Chantal Roberts: And when you are negotiating with that claimant, either the first party or the third party or their attorney or their public adjuster or whomever, you give those facts.
- 13:41Chantal Roberts: This is the reason why I'm doing it.
- 13:43Chantal Roberts: And of course, those facts are also in your claim notes.
- 13:47William Auten: And it's not just this is the reason, it's going to be these are the reasons that I am holding this position.
- 13:54Chantal Roberts: Yes.
- 13:54William Auten: Um because there are multiple factors.
- 13:57William Auten: These claims are are not, you know, it's it's not just a matter of the severity of the injury or necessarily whose fault the claim was.
- 14:08William Auten: Um it's almost never 100% somebody's fault.
- 14:15William Auten: Right.
- 14:16William Auten: Sometimes it is.
- 14:17William Auten: You know, we do have cases where somebody just really screwed up and um, you know, somebody got got hurt because of it.
- 14:26William Auten: Uh, but in I would say most of the cases that we have, there's some shared liability.
- 14:31Chantal Roberts: You know, uh I would say that there uh a thorough investigation would always uh uh facilitate your your negotiation, but I don't think it ever becomes unnecessary.
- 14:43Chantal Roberts: Uh what do you think about that?
- 14:46William Auten: Uh that an investigation becomes unnecessary?
- 14:50Chantal Roberts: No, no, no.
- 14:51Chantal Roberts: That a thorough that that a thorough investigation would make negotiation unnecessary.
- 14:57William Auten: I'm sorry.
- 14:58William Auten: I guess I get cut off.
- 15:00Chantal Roberts: I oh I'm sorry.
- 15:01Chantal Roberts: Um my question was can a thorough investigation uh ever make negotiation unnecessary?
- 15:07Chantal Roberts: I guess is the best way to answer that question.
- 15:11William Auten: Oh, I see what you mean now.
- 15:12William Auten: Um I was trying to be witty.
- 15:17William Auten: It certainly can yeah, it well, it certainly can um it can uh speed up the negotiation process because I you know I've so many times I've I've beg begun negotiations and stated my reasons for our position, and the other side just was not aware of that.
- 15:38William Auten: They're like, oh, I I didn't know that.
- 15:40William Auten: And uh, you know, shame on them.
- 15:43William Auten: Um, you know, they should be digging into the claim as much as we are to find out the facts.
- 15:49William Auten: Um there are other times where the same thing happens to us where they have information that we would never be able to know unless we talk to the directly to the claimant, which is why we always ask for an opportunity to do that.
- 16:03William Auten: But when they deny us that, they are holding information that would probably grease the wheels to a settlement if they would just open up and let us talk.
- 16:14William Auten: But a lot of times they don't because reasons.
- 16:17Chantal Roberts: To be fair though, we're asking the other side, and I can hear all the attorneys screaming at us right now who are listening.
- 16:26Chantal Roberts: We're asking the other side to also investigate the loss, but we don't let them speak to the insured, you know.
- 16:32Chantal Roberts: So there is there is a little bit of of not being fair in in this scenario.
- 16:40Chantal Roberts: Um, so for us to go, oh well, did you know XYZ and them going uh no?
- 16:46Chantal Roberts: But uh the burden of I see really is is really on the claimant, yeah.
- 16:54Chantal Roberts: Yeah, absolutely.
- 16:56William Auten: So I and I do I do think that that's significant.
- 17:00Chantal Roberts: Oh, absolutely.
- 17:01William Auten: If you are if you are making a claim holding your hand out to pay me money, um, you should be in a position to tell us why, all of the reasons globally why.
- 17:11William Auten: Right.
- 17:12William Auten: Um other than I said so.
- 17:14William Auten: Other than I said so, right.
- 17:16Chantal Roberts: Because then you're getting into someone uh like me as the the adjuster going, well, I'm not gonna pay you that because I said so.
- 17:23Chantal Roberts: And then the claimant saying, Well, you need to pay me that because I said so.
- 17:26Chantal Roberts: And this is how we end up in court.
- 17:28Chantal Roberts: When really we could be having an actual discussion, and that's why it's called negotiation.
- 17:34Chantal Roberts: We give them and take a little bit, uh, because our demands are not positions, you know, they're not conclusions or the the the demands are positions, but they're not conclusions, I guess I should say.
- 17:45Chantal Roberts: And uh it is, I think there's been a change in in the way insurers handle claims.
- 17:55Chantal Roberts: And I don't know if I'd necessarily agree with it, but this is maybe my old schoolness coming back to haunt me, is that we sit around and wait for the claimant or the plaintiff attorney or the insured, you know, to make a demand before we will respond.
- 18:15Chantal Roberts: And if um, you know, it's a non-represented claimant or it's a property damage claim, even though it is the claimant's first and third party job to put forth their claim, if I've got all the information I need to settle this claim, I'm gonna go ahead and pull that trigger and call the claimant up and say, you got about 15 minutes.
- 18:42Chantal Roberts: I also need you to have a piece of paper and a pencil.
- 18:45Chantal Roberts: We're gonna go over some things.
- 18:47Chantal Roberts: And and I start the negotiations right there by making an offer.
- 18:55Chantal Roberts: And I think nowadays it's kind of twisted where the carriers want to wait until the claimant makes a demand.
- 19:03Chantal Roberts: And if they're represented fine, they know to do that because the attorneys do that all the time.
- 19:10Chantal Roberts: But I don't think an unrepresented claimant knows to do that.
- 19:15William Auten: Well, I would say with unrepresented claimants, we are always we are often uh the ones to make the first move on that.
- 19:24William Auten: And the reason behind that is uh we we know more about these claims than they likely do.
- 19:31William Auten: And uh most often um we'll we'll get to a settlement with an unrepresented person.
- 19:43William Auten: We may not have the same idea at the outset of what the value is, um, but we're never so far apart that we can't, you know, reason and and come.
- 19:54William Auten: I I wouldn't say never, because there are cases where the demand is just ridiculous.
- 19:59William Auten: And uh we would prefer that they go get an attorney that can explain to them.
- 20:04Chantal Roberts: I was just gonna say, can we just take a little side trip over to the fact where I have literally told claimants, please go get an attorney when they threaten it.
- 20:14Chantal Roberts: Yeah, I'm gonna go get an attorney.
- 20:16Chantal Roberts: Oh, I think you should.
- 20:17Chantal Roberts: Okay.
- 20:18Chantal Roberts: I think you should.
- 20:19Chantal Roberts: Um, yeah, I think that would be a good idea.
- 20:22Chantal Roberts: Um, you can never tell a claimant not to get an attorney.
- 20:26Chantal Roberts: You can never do that, never do that.
- 20:28Chantal Roberts: But I have literally told a claimant, multiple claimants.
- 20:33Chantal Roberts: Yeah, I I I think that would be a good idea.
- 20:36Chantal Roberts: I I think you should talk to someone about this.
- 20:39William Auten: I've had I've had at least two cases in my career where they threatened to get an attorney, and I said, that'd be fine, just let me know.
- 20:48William Auten: And I don't encourage them, I don't say, Oh, yeah, please please do that right now.
- 20:51Chantal Roberts: When I hang up here, let me let me give you some people to call.
- 20:56William Auten: But what I do is um that that is fine.
- 21:00William Auten: Um, I won't be able to discuss this directly with you anymore, but please uh if you know who they are now, I'll take their name and number.
- 21:07William Auten: If you don't know yet, um please give them my information.
- 21:11William Auten: I will be sitting here waiting for their call.
- 21:13William Auten: But I've had cases where I've done that.
- 21:16William Auten: They went to the attorney, the attorney called me and said, This person's crazy.
- 21:21William Auten: Um I'm not sure if I can represent them.
- 21:27Chantal Roberts: Yeah.
- 21:28William Auten: And then eventually they drop the case and we go back to handling directly with the claimant.
- 21:33William Auten: And um, and then it gets settled for you know a fraction of the amount that they were asking for.
- 21:41Chantal Roberts: Yeah, and thank you for the attorneys who are being honest with with the claimants, too, by by saying, Yeah, the this is not off, you know, you're you're not gonna get you know five million dollars for this sprained ankle or whatever.
- 21:56Chantal Roberts: Um, you thank you for for giving them the a A realistic frame line.
- 22:02Chantal Roberts: And I think one of the things that I would like to talk about when we're talking about demands or offers being positions.
- 22:13Chantal Roberts: And I I would like to say this.
- 22:15Chantal Roberts: I've always been taught that the insurance company offers a settlement and the claimant always demands a settlement, just so that we have that terminology correct.
- 22:29Chantal Roberts: But I sim I tend to talk about a demand, you know, back and forth like globally, but regardless.
- 22:36Chantal Roberts: That's not that we're lowballing.
- 22:53Chantal Roberts: Um, and I've always thought of it as being like a speed limit kind of deal.
- 23:00Chantal Roberts: Every once in a while you'll see those speed limits that say minimum speed 45 and maximum speed 60 or whatever.
- 23:07Chantal Roberts: Do you know what I'm talking about?
- 23:08Chantal Roberts: Yeah.
- 23:09Chantal Roberts: That's kind of the way that I think about it, is that there's a range right there.
- 23:13Chantal Roberts: And just because I'm going 45 miles per hour doesn't mean I'm going so although I'm going slow.
- 23:20Chantal Roberts: Um, and just because I'm going 85 in a 65 doesn't mean I'm speeding, although I'm speeding.
- 23:27Chantal Roberts: Please don't arrest me or write me tickets, officers.
- 23:31William Auten: Um well, I I would say that uh the thing that bugs me about, and here's the only time I'm gonna talk about numbers as um from from an example standpoint.
- 23:42William Auten: When an attorney makes a demand of a million dollars and the company's first offer on that same claim is $20,000.
- 23:50William Auten: Um that does not automatically mean that that is a lowball situation.
- 23:56William Auten: Right.
- 23:56William Auten: And the and the insurance company their first offer is always scrutinized under that lowball kind of moniker.
- 24:05William Auten: The ridiculous high million dollar demand doesn't have a a comparable term.
- 24:12Chantal Roberts: Exactly.
- 24:12Chantal Roberts: Yeah.
- 24:13William Auten: Um it's just, you know, there's no criticism when they demand something that is clearly absurd.
- 24:22William Auten: Um but there should be.
- 24:24William Auten: And I don't think highball is the the proper term.
- 24:29Chantal Roberts: No, because that's a drink, isn't it?
- 24:31William Auten: It is, it is.
- 24:32Chantal Roberts: Yeah, so maybe we want that.
- 24:34Chantal Roberts: I don't know.
- 24:35William Auten: I'm just I'm just gonna say but I think that the uh that that there should be some recognition that um that there are ridiculous demands made that tend to muck up the process rather than grease the wheels.
- 24:54William Auten: Um I think there's a probably a faster way to get things done.
- 24:58William Auten: We're always accused of delaying things, but you know what?
- 25:02William Auten: When someone's demanding uh a million dollars against a $20,000 offer, things aren't gonna go really quick.
- 25:10William Auten: You know, there's obviously some some problems there.
- 25:13Chantal Roberts: And let's also talk about real quick, if a demand comes in for a million dollars, and let's say the policy limit is $50,000, for example.
- 25:25Chantal Roberts: You as an adjuster, of course, need to call the insured and let them know that there has been a demand over policy limits.
- 25:35Chantal Roberts: And if they have some kind of umbrella or excess policy, they need to be putting those people on notice.
- 25:41Chantal Roberts: And then you need to notate your file that you've called the insured and told them this, and you need to send a letter.
- 25:47Chantal Roberts: And I'm talking about a letter, you can send it in email form, but actual letter attached to an email, not just an email, because we tend to we tend to ignore those emails sometimes.
- 25:59Chantal Roberts: And and I would even snail mail it, quite frankly, just to make sure that everybody's on the same thing.
- 26:08Chantal Roberts: When we're also talking about demands and offers, some states, such as Texas, for example, require you as the adjuster to let the insured know of every offer and demand.
- 26:22Chantal Roberts: So every time the insured or the claimant, third-party claimant comes back and says, I want a million dollars, or I want $25,000, or I want one dollar, whatever, you would say the claimant has asked for X amount.
- 26:38Chantal Roberts: I have offered Y amount.
- 26:40Chantal Roberts: I am waiting for, you know, them them to accept it, or I'm doing additional research into this, blah, blah, blah, blah, blah.
- 26:48Chantal Roberts: I'll keep you informed.
- 26:49Chantal Roberts: FYI, know your state rules.
- 26:52William Auten: Yeah.
- 26:53Chantal Roberts: I think it's a good idea to do it anyway, regardless of state rules.
- 26:56William Auten: But um, so I can make arguments for and against it.
- 27:01William Auten: And my argument against it is that um when when you've got the noise of a policy holder and their potentially their agent or their broker, yeah, um, confusing things, the risk that you wind up with a policy holder or an agent or broker contacting the other side to try and, you know, could you imagine um the the chaos that would ensue if you're trying to negotiate with an attorney who's making a ridiculous demand and your insured calls them up and say, what are you doing?
- 27:39Chantal Roberts: You know, I that okay, a uh insureds, you're not allowed to do that.
- 27:45Chantal Roberts: Um, you know, because it's against policy.
- 27:48Chantal Roberts: It says that you're not allowed to settle the claim with without you know uh our permission.
- 27:53Chantal Roberts: So don't do that.
- 27:54Chantal Roberts: Don't, don't, don't, don't, do not do that.
- 27:56Chantal Roberts: But I have seen it where it you're, I mean, you're absolutely right, it does create some problems because I have seen where the insured or the agent, especially if the claimant happens to be a best friend, a neighbor, a cousin, or something like that, where they go, I want you to settle this.
- 28:16Chantal Roberts: And now you've got the insured saying, I want you to settle this for X amount of money, whatever they're asking for.
- 28:22Chantal Roberts: And you're like, that's not the way it goes.
- 28:25Chantal Roberts: And so now you've got it in your file.
- 28:28Chantal Roberts: So there is some, you know, back and forth uh pros and cons.
- 28:33Chantal Roberts: I think the pros outweigh the cons, but that's just me.
- 28:37Chantal Roberts: But I know in, for example, in Texas, you gotta do it.
- 28:41Chantal Roberts: So there you go.
- 28:43William Auten: There's a lot of emotions involved in insurance claims, uh, both from the claimant side and the policy holder side.
- 28:50William Auten: Uh, for the adjuster, we have no emotions, so we're fine.
- 28:53Chantal Roberts: But yeah, we're heartless.
- 28:55Chantal Roberts: We've been sucked dry.
- 28:57William Auten: But the uh um uh a case that well, I've had several cases like this over my career where somebody gets hurt on the property, let's say insured um claims you look, this is fraud.
- 29:11William Auten: I know this guy's lying.
- 29:12William Auten: I know it didn't happen this way.
- 29:14William Auten: Don't pay this guy a dime.
- 29:15William Auten: It's ridiculous.
- 29:17William Auten: Then uh they get an attorney or they have an attorney.
- 29:21William Auten: The attorney makes a demand for policy limits, and all of a sudden the insured is like, whoa, good, and they get their excess letter, you know.
- 29:30William Auten: And uh are you what are you doing?
- 29:32William Auten: Are you gonna settle this claim or what?
- 29:34William Auten: You know, um, well, you sir, you told me that this was fraud and that we shouldn't pay a dime.
- 29:40William Auten: Uh, but now you want us to pay our your policy limits.
- 29:42William Auten: So which is it?
- 29:44Chantal Roberts: Which is it?
- 29:45Chantal Roberts: Yeah.
- 29:46William Auten: And uh But that's because the emotions are there, you know, exactly.
- 29:49William Auten: And and um, you know, attorneys know that that there is a uh a non-emotional buffer in the adjuster uh between there, but they they you know it's their job to maximize things.
- 30:04Chantal Roberts: Their clients, yeah.
- 30:05Chantal Roberts: That that is that is something to to to be thinking about.
- 30:09Chantal Roberts: And I have been thinking about just FYI having like a defense counsel on.
- 30:14Chantal Roberts: We've already had a plaintiff counsel on talking about what it's like to be a plaintiff counsel.
- 30:19Chantal Roberts: And I think it would be good to have another plaintiff counsel on as well.
- 30:22Chantal Roberts: But uh thinking about next year maybe having a defense counsel on and talking about what defense counsel needs from us.
- 30:29Chantal Roberts: Regardless, let's continue on.
- 30:31Chantal Roberts: Like when do we when do we know when to negotiate and and when not to?
- 30:36Chantal Roberts: And I I think you'd said it, you know, pretty well.
- 30:39Chantal Roberts: You you you kind of learned this.
- 30:42Chantal Roberts: And my theory is as soon as I've got enough information, like I call the claimant, if we're talking bodily injury, I call the claimant up or their counsel and they say, yes, you know, they finished treating.
- 30:56Chantal Roberts: If I have a uh a med auth, I've started already collecting their medical records uh and their lost wage records and that sort of thing.
- 31:07Chantal Roberts: Um if it's a council, you know, represented kind of deal, I usually let the plaintiff counsel gather all of that up and then I'll wait for the demand package.
- 31:20William Auten: Yeah, so that is all claim process stuff that um I mean the the there's a kind of a scheduled life of the claim that we go through, but but there are signals that tell you when they're actually ready to negotiate with you.
- 31:40William Auten: And it's not just the demand letter, the demand letter uh may be um their position, like you said, uh that's it's just them throwing out their number to kick things off.
- 31:53William Auten: Um and that probably is a pretty good signal that it's time to start negotiating.
- 31:58William Auten: But um, but if that demand and your your valuation of the claim are very, very far apart, then you may have a conversation about that distance.
- 32:08William Auten: And um you will know then if they want to continue negotiating because you're gonna get calls.
- 32:15William Auten: They will continue to call you and get a all right, let's let's see if we can do something here.
- 32:21William Auten: And um, if they go silent, they're probably building their war chest and uh to prepare for a lawsuit.
- 32:28William Auten: So um and and when I say go silent, um I don't mean they they have quieted down because they're waiting for meds, you know.
- 32:39William Auten: They'll we have those discussions.
- 32:41William Auten: I'll call them for a status, they'll say, hey, we we they're still treating, so it's gonna be a while.
- 32:46William Auten: They've got surgery in two months and recovery after that.
- 32:50William Auten: So you're probably not gonna talk a lot for a few months or several months.
- 32:55William Auten: Um but if that demand letter comes in and you've made a you've made an offer against that demand that they don't particularly like, and then they just go quiet and they don't return your phone calls, that's probably a pretty good sign that's into litigation.
- 33:13William Auten: But if they are keeping that dialogue alive, then it's important to make sure that you have your your strategy uh outlined about uh how you're going to approach the negotiation and how you're going to explain your position with all of those reasons why your number is what it is.
- 33:32Chantal Roberts: Exactly.
- 33:32Chantal Roberts: So let's talk real quick about what it looks like on the property side, because we see a lot of this with public adjusters, for example, um, or contractors, for example.
- 33:46Chantal Roberts: So again, usually what I want to do is have my independent appraiser or adjuster, my field adjuster to go out at the same time as the contractor or the public adjuster, because I want both of them to walk through the, let's just say roof, let's just call it a roof together and figure out what the damage is, the scope of damage is so that we're not quibbling about it later.
- 34:12Chantal Roberts: If it doesn't work out that way, where my guy goes out first, we get an estimate in, I send it off to the insured, and the insured's like, I don't think I can get this repaired for this.
- 34:24Chantal Roberts: They get a contractor, and the contractor comes back with a vastly larger number.
- 34:30Chantal Roberts: Think of that in terms of an offer of us sending out our estimate and the demand coming back with the contractor's or the PA's estimate.
- 34:41Chantal Roberts: And so you still have to respond to that, adjusters.
- 34:44Chantal Roberts: You still need to take that seriously.
- 34:47Chantal Roberts: Uh, hopefully they've got an exactimate and you can go line by line looking at what the differences are.
- 34:53Chantal Roberts: For example, um, maybe you have your price list wrong.
- 34:57Chantal Roberts: That could be it.
- 34:58Chantal Roberts: I mean, maybe they have their price list wrong.
- 35:00Chantal Roberts: I don't know.
- 35:01Chantal Roberts: But there has to be a reason why they're getting more or larger number, other than they're adding it to the roof or something like that.
- 35:10Chantal Roberts: Um, so that's when, again, you start that negotiation aspect of it.
- 35:18William Auten: Estimating is um a skill that takes, I think, a long time to develop.
- 35:23William Auten: And um you could look at a contractor's estimate that will have three line items in it for a $100,000 loss.
- 35:33William Auten: That's so the three, you know, fixed kitchen, fixed roof, fixed house.
- 35:38William Auten: Yeah, yeah, yeah.
- 35:39William Auten: Well, the exact domate estimate's gonna have six hundred lines, you know, and and you may be w way far apart.
- 35:48William Auten: Chances are um I wanna I don't want to say chances are, but that there's there's a possibility that your exact domain estimate has six hundred lines, but it actually needs eight or nine hundred lines.
- 36:01William Auten: You missed some you missed a lot of procedures that have to happen in order to get all this stuff done.
- 36:07William Auten: Um I mean, just think about on commercial losses of one that gets very expensive very quickly is scaffolding and sidewalk protection on a storefront.
- 36:19William Auten: Um you may be required by the municipality to construct this thing in front of the store so repairs can be made behind the scenes that protects the pedestrians below.
- 36:33William Auten: Have you ever seen those?
- 36:35William Auten: They're expensive.
- 36:35William Auten: They're this the they're big complex, you know, um aluminum steel structures.
- 36:41William Auten: So exactly uh and they they're they're not cheap.
- 36:45William Auten: And that can account for a very, very big discrepancy between two estimates.
- 36:50Chantal Roberts: One of the things as one example, yes, and and one of the things that I see that contractors and public adjusters do, uh, which is great, and I don't see it so much with the insurance uh estimates, and I think it's because of our different interpretation of the word quote incurred end quote, is the idea of um code upgrades and uh debris removal and you know all of these fees and things that these additional coverages that are available to the insured, but not until it is incurred.
- 37:34Chantal Roberts: And I wish more carriers would put it on a line and the estimate that just says TBD to be determined, so that the insured doesn't think that we've forgotten it.
- 37:47Chantal Roberts: And I think that's one of those that's that that could be a reason why some of our estimates are not matching because the public adjuster or the contractor have it in their estimate and they're counting it now.
- 38:01William Auten: What I'd like to see with Xactimate is to keep that as a separate coverage line.
- 38:07Chantal Roberts: Yeah.
- 38:07William Auten: And then all the items that would fall under there get put under that coverage line.
- 38:11William Auten: So it's a separate, you know, breakout at the end of the estimate.
- 38:15William Auten: Um and I think totality does that as well.
- 38:21William Auten: Oh, cool.
- 38:22William Auten: They may have a box that you check.
- 38:24William Auten: I I forget now.
- 38:26Chantal Roberts: Um but anyway the the point being is that as as property adjusters, when you see this, this is the same thing as bodily injury, as getting a demand letter from the plaintiff attorney as bodily injury or whatever.
- 38:41Chantal Roberts: They've got a different viewpoint, and so now we need to investigate that viewpoint.
- 38:46William Auten: Um yeah, and and you're you're not only negotiating on damages, but um the the discussion is always also going to surround scope.
- 38:57William Auten: And you know, they may be writing to do work in a a section of the building that wasn't damaged, and you don't owe that.
- 39:06William Auten: And they may say, well, it doesn't make sense to not do it, or you know, whatever.
- 39:12William Auten: Yeah, but having those uh the again it comes back to the reasons.
- 39:16William Auten: Yes, if they've got reasons for their position, you as the property adjuster should have reasons for yours, and it may be a coverage thing, it may be a scope thing, it may be a depreciation thing.
- 39:27William Auten: Like I said before, depreciation is a whole other negotiation kind of a strategy.
- 39:32William Auten: Um especially uh if you come across it, an ACB policy, which they still write out around here, by the way.
- 39:39Chantal Roberts: Yes.
- 39:39Chantal Roberts: Yes.
- 39:40Chantal Roberts: Um, yeah, and and so when you make that offer, like you said, and all of a sudden the claimant or the public adjuster or the plaintiff attorney goes silent, this should be kind of a red flag to to you as a as a uh as an adjuster.
- 40:00William Auten: You can call it a red flag, but it's not like a bad red flag.
- 40:04William Auten: It should just be a so far apart that that you're not gonna, you know, just know that this is probably where it's gonna go.
- 40:12Chantal Roberts: Yeah.
- 40:12William Auten: And you know, and if you're if you're accurate in your position, um then it may be that that litigation works in your favor.
- 40:21William Auten: I mean, we've had policy limit demands where we, you know, valued the claim a lot l for a lot less and we come back with a summary judgment.
- 40:29William Auten: And then they get nothing, you know.
- 40:31William Auten: Um and that's a shame, but uh because in in a case like that, we would have paid something, you know, but instead it went to defense attorney.
- 40:43William Auten: And uh anyway, and the same thing can happen on property, on the property side where um, you know, things do go silent.
- 40:54William Auten: Um I I would say most public adjusters though will give you kind of a signal if they're gonna if this looks like it's gonna be a uh um a litigated matter.
- 41:05Chantal Roberts: I did think of something on on the pub on on the property damage side, it's a little bit different.
- 41:10Chantal Roberts: I do want to um remind our adjusters, our carrier adjusters, or or um even well, I guess carrier adjusters, yeah.
- 41:20Chantal Roberts: Um, that we need to pay what we owe when we know we owe it.
- 41:24Chantal Roberts: So if there is an honest to goodness coverage or scope dispute, and I say that I owe $5 and the public adjuster or the contractor says I owe $100, I need to cut that check for $5 less the deductible or whatever.
- 41:41Chantal Roberts: Uh, instead of holding that money back from the insured, because we're talking about a different kind of coverage.
- 41:50Chantal Roberts: We don't want to be withholding the insured's money in an attempt to force a settlement or whatever.
- 41:59Chantal Roberts: That goes against good uh unfair claim settlement practices, by the way.
- 42:04Chantal Roberts: So FYI.
- 42:06William Auten: And it's it's unfair too, because it is if um if they have a duty to mitigate, but if they're depending on that insurance money to to begin mitigation, they can't do much.
- 42:17William Auten: So it's best to get and you know, issue in advance, folks.
- 42:21William Auten: I mean, if they're serious damage, and you know it's it's you you pretty much have a sense of if it's a fire in a house, you can give them a five thousand dollar advance for most fires, you know, yes, um, or even more, depending on how bad it is.
- 42:39Chantal Roberts: Give them five thousand for the the property remediation, give them, I don't know, a thousand or even five hundred to to buy some underwear if you're gonna have them live in in a hotel for just a little bit, you know, and prepay for a week in the hotel.
- 42:55Chantal Roberts: Um, you can give some advanced payments, absolutely.
- 42:59William Auten: One thing that I've never been a fan of is to have an insurance company assign a contract or through a referral program or something like that.
- 43:08William Auten: But um my mind changes a little bit on the mitigation because you know, if you can get a company in there right away to dry the place out and get rid of the the the nasty stuff so that the repairer can come in and put it all back together.
- 43:26William Auten: Um you know, I think you're you're doing everybody a favor because you're eliminating limiting the amount of damages that can that are going to take place because things stay wet or stay whatever.
- 43:40William Auten: Um so in general, I don't like the idea of assigning a contractor because I think the insurance companies should stay out of the repair business.
- 43:52William Auten: But I do feel like mitigation companies, um, that's a different story.
- 43:58William Auten: But that takes a lot of Management too.
- 44:00William Auten: I think it takes some babysitting and some monitoring and that kind of thing.
- 44:04William Auten: Otherwise, it's kind of like a blank check in some cases.
- 44:08Chantal Roberts: Yeah, absolutely.
- 44:09Chantal Roberts: So what do you think new adjusters should be learning from us at this time?
- 44:20Chantal Roberts: Um, what happens when an adjuster works up a file or transfers from someone senior, like, hey, we started this, now we want you to learn from it, you know, kind of deal.
- 44:32William Auten: So my recommendation for this kind of question would be directed to managers and supervisors.
- 44:39Chantal Roberts: Yeah.
- 44:40William Auten: Um and uh and the the large loss people or the the more advanced people.
- 44:46William Auten: So if an a claim comes in and let's just say it's a a run-of-the-mill slip and fall, and it goes to adjuster A, and it very clearly becomes uh a claim that's valued outside of their general authority, so it goes to someone else.
- 45:03William Auten: And which plaintiff attorneys love that, by the way.
- 45:07William Auten: They love it when you take a file and give it to somebody else because in their mind it immediately doubles the value of the claim.
- 45:15William Auten: So it's to be avoided.
- 45:18William Auten: Uh in my recommendation is is to try and avoid that for two reasons.
- 45:23William Auten: One, the the dynamic I just described, and two is because that adjuster who has lower settlement authority and less experience, needs to get that experience.
- 45:36William Auten: So let them finish that claim out with the help of a mentor along the way, rather than just handing it over to Joe down the hall, who's been here for 35 years.
- 45:49William Auten: Right.
- 45:50William Auten: The other thing I would say is if you have that model set up and that's what you do, make sure Joe down the hall comes down and talks to the new guy and explains to them what the settlement actually was, because otherwise they're working in a vacuum.
- 46:05William Auten: They don't know that this type of claim commanded that kind of money at the end of the day, unless it's communicated throughout your staff.
- 46:14William Auten: Exactly.
- 46:15William Auten: So I think there should be a lot of open discussions about um what happens to claims, uh, not just that gets settled by the adjuster, but which go to the litigation and settle through either um uh mediation or a um a jury trial.
- 46:32Chantal Roberts: Yeah.
- 46:32Chantal Roberts: You know, a lot of these carriers now have like litigation units where once a claim goes into litigation, it goes over to these litigation units and maybe the adjuster uh has taken the bar exam or has gone to law school and knows a little bit about uh the legal system.
- 46:54Chantal Roberts: It's kind of the same thing though.
- 46:57Chantal Roberts: Uh why why do this?
- 47:00Chantal Roberts: You know, these other adjusters who are not handling litigated files need to know what is going on so that we can avoid litigated files.
- 47:11Chantal Roberts: I mean, it's well, maybe avoid litigated files.
- 47:14Chantal Roberts: And I'm not saying avoid them as an like it's a bad thing, but it's expensive to litigate files, even for the insurance company.
- 47:20Chantal Roberts: So let's put me as an expert witness out of business and settle those claims if we can.
- 47:27Chantal Roberts: And if we've got a righteous denial, then we will go all the way, right?
- 47:33Chantal Roberts: But if it's, oh, if I would have only done XYZ, or if I would have given a little here and taken a little here negotiation, then we would have avoided this situation.
- 47:46William Auten: Yeah, uh communication across different uh different areas of a claims department is so important.
- 47:53William Auten: And I think it's also important to have good communication with underwriting too, which is a whole other podcast.
- 47:59William Auten: But um but I would say that if you're the type of adjuster that once a claim gets into litigation and goes to the litigation unit and you you're of the opinion, well, it's not my problem anymore, um maybe maybe try and adjust your thinking and and and keep your head in that that file and maybe talk to that litigation adjuster.
- 48:22William Auten: Um, I I think there should be some s systematic ways for everybody to stay involved because uh otherwise the knowledge gets lost.
- 48:33William Auten: And um, you know, you you what's the what's the phrase?
- 48:38William Auten: Um definition of insanity is keeping it.
- 48:41William Auten: Yeah, it's keeping from the same thing, mistake and and uh I think that's what happens when you've got uh a group of adjusters who are not familiar with what happens down the line.
- 48:51William Auten: Exactly.
- 48:52Chantal Roberts: Um so I totally agree.
- 48:55Chantal Roberts: Yeah, yeah, yeah.
- 48:56Chantal Roberts: Uh anything else that we need to let let people know about?
- 49:02William Auten: I've got one announcement to make.
- 49:05William Auten: We have a new listener.
- 49:07William Auten: Oh yay! Yes, yay, Elvis Dale Wilson contacted me on LinkedIn.
- 49:12William Auten: Hi, Elvis.
- 49:13William Auten: Hi, Elvis.
- 49:14William Auten: He he uh he said that um he founds finds our uh podcast and YouTube channel absolutely interesting.
- 49:23William Auten: And um he said that he was on episode 24 and like two days later he was up to 42.
- 49:31Chantal Roberts: So Elvis, wow, you did are you sleeping or are you just having it on a loop and you are sleeping, like you're putting us like we're putting you to sleep?
- 49:41William Auten: Well, I appreciate the uh the sentiment, uh Elvis, and uh I hope you're listening to this one and and that we're providing some valuable information.
- 49:51Chantal Roberts: So super exciting, yeah.
- 49:52Chantal Roberts: And be sure to get in contact with us via YouTube, Spotify.
- 49:57Chantal Roberts: I'm very bad at responding to YouTube.
- 50:00Chantal Roberts: I don't think they give me a notice, really.
- 50:03Chantal Roberts: And like I'll find out two weeks later.
- 50:05Chantal Roberts: So I'm sorry, but I will I will respond to you.
- 50:08Chantal Roberts: Um, so yeah, let us know.
- 50:10Chantal Roberts: Drop us a note uh via YouTube, Spotify, that that you like it, that you don't like it, what topics you want to hear about, because uh in two weeks, we're going to be talking about for those independent adjusters, building a claims operation that does not depend on one person.
- 50:27Chantal Roberts: So if you're a solo practitioner and you feel like I need some more people, you know that this is going to be the podcast for you.
- 50:37William Auten: I might learn some things.
- 50:39Chantal Roberts: Yes, you might.
- 50:40Chantal Roberts: Who knows?
- 50:40Chantal Roberts: Yeah.
- 50:41Chantal Roberts: So uh we will see you in two weeks.
- 50:44Chantal Roberts: Yes.
- 50:45William Auten: Yes, ma'am.
- 50:46Chantal Roberts: Okay, see you later.
- 50:48William Auten: Bye-bye.
- 50:49Chantal Roberts: Bye.
- 50:49William Auten: Thanks for joining us on the Art of Adjusting Podcast, where we talk about life as an insurance adjuster.
- 50:55William Auten: Hit that subscribe button real quick and tell all of your adjuster friends to check this out as well.
- 51:00William Auten: For independent adjusting services, go to www.autin.claims.
- 51:04William Auten: And for anyone interested in working as an independent liability adjuster, go to the contact us tab to join our roster.
- 51:12Chantal Roberts: So this wraps up another Art of Adjusting podcast.
- 51:16Chantal Roberts: If you enjoyed this podcast or this episode, please give us five stars and a review.
- 51:22Chantal Roberts: It does help the algorithm pick us up.
- 51:24Chantal Roberts: In the meantime, you can contact me at theartofadjusting.com for consulting and training purposes.