The Art of Adjusting: Writing Down the Unwritten Rules of Claims Handling

by Chantal M Roberts

Overview

Every profession has its unwritten rules which practitioners learn through on-the-job training. Being a claims adjuster is no different, except that insurers expect the claims department to shoulder more and more duties with less personnel-- leaving little time for training from seasoned adjusters. This is exacerbated by the "brain drain" of the Baby Boomers leaving and no clear educational process for adjusters.

The Art of Adjusting: Writing Down the Unwritten Rules of Claims Handling will help the adjuster:

• Write better reservation of rights letters
• Handle irate insureds and claimants in a more professional manner
• Understand how to read an estimate and medical records.

Chantal M. Roberts, CPCU, AIC, RPA, is a claims handling, standards, practices, and procedures expert witness with 20-plus years' experience as a multi-lined claims adjuster. In her first book, she attempts to bridge the gap between being a new adjuster and a seasoned hand by offering some of the lessons she learned so that adjusters can get back to doing what they are meant to do: settle claims quickly, proficiently, and economically.

Product Details

ISBN-13:	9781737426806
Publisher:	Tilting at Windmills Press
Publication date:	07/01/2021
Edition description:	Large Print
Pages:	314
Product dimensions:	7.00(w) x 10.00(h) x 0.66(d)

About the Author

Chantal M. Roberts, CPCU, AIC, RPA, is a claims handling, practices, and procedures expert witness with 20-plus years' experience as a multi-lined claims adjuster. She is passionate about good faith claims handling and strongly believes being an adjuster is a noble career choice. She is a self-described insurance nerd and actually enjoys talking about claims handling. She attempts to insert humor into a topic that is about as dry as burnt toast and is available for hire to instruct adjusters on what she believes is the correct way to handle claims based on her experience both as an adjuster, a claims manager, and an expert witness. She is also a published author of several articles in professional journals with topics ranging from active shooters to COVID-19 claim handling to pitfalls in marijuana policies. Chantal lives in Overland Park, KS with her extremely tolerant husband, her loving dog, and a cat who correctly ignores her.

Table of Contents

The Art of Adjusting: Writing Down the Unwritten Rules of Claims Handling

Table of Contents

Author's Notes

Chapter 1-Insurance Concepts

Risk Management

What Insurance Covers

Insurance Regulation

Insurance Contracts

People Involved in Insurance

Wrap Up

Chapter 2- Insurance Policy

Types of Policies

Parts of the Policy

Declarations

Insuring Agreement

Conditions

Exclusions

Endorsements

Covered Causes of Loss

Insurance in Action

Wrap Up

Chapter 3-Words Have Consequences

Real Life War Story

Where the Rubber Meets the Road

Insurance in Action

On the Home Front

Wrap Up

Chapter 4-The Claims Handling Process

Good Faith Claims Handing

First Notice of Loss

Reviewing Coverages

Discussing the Loss with the Insured

Discussing the Loss with Other Parties

Reserves

Assignment of an Appraiser

While the Appraiser's Away

The Next Steps

Closing the File

Other Handling Issues

Wrap Up

Chapter 5-The Next Steps

Suspicious Claims

Insurance in Action (Red Flags)

Reviewing Coverages (Again)

Reviewing the Damage Assessments

Insurance in Action (Reviewing Damage Assessments)

Disagreements with the Damage Assessments

Subrogation

Salvage

Wrap Up

Chapter 6-Introduction to Litigation

Threat of Litigation

Sources of the Law

Introduction to Litigation

Litigation Management

Choosing Defense Counsel

Small Nuggets of Litigation Wisdom

Wrap Up

Chapter 7-Adjuster Ethics

Morals and Ethics

State Departments of Insurance

Organizational Ethics

Insurance in Action

Wrap Up

Chapter 8-Claims Will Always Be Adversarial

But Why Are Claims Adversarial?

Wrap Up

Chapter 9-Claim Notes

File Documentation

Writing File Notes

Getting Personal

Insurance in Action

Wrap Up

Chapter 10-Property Coverage Unwritten Claim Rules Written Down

Actual Cash Value

RCV and Coinsurance

Insurance in Action (Coinsurance)

Another Insurance in Action Example (Coinsurance)

Depreciation of Labor

But Wait! There's More!

Overhead and Profit

Three Trade "Rule"

Making a Profit from Insurance Claims

Insurance in Action (Depreciation)

Making Repairs...Or Not

Line of Sight Repairs

Rolling Totals

Insurance in Action (Total Losses)

Value Policies

Settling Without a Proof of Loss

Contents

Wrap Up

Chapter 11-General Liability Coverage Unwritten Claim Rules Written Down

Coverage v. Liability

50 Shades of Grey

CPT/ICD-10 Codes

If You Ain't First, You're Last

Insurance in Action (Negotiating Settlements)

Disagreeing with the Settlement Offer

Partial Bodily Injury Settlements

Insurance in Action (Partial Settlements)

Chiropractors

Time Demands

Wrap Up

Chapter 12-The Art of Adjusting

You Are a Professional

Under-Promise and Over-Deliver

Over-Communicate

Conference Calls Are Your Friend

Why Am I Paying Premiums?

Always Prepare the File for Litigation

You Will Be Sued

You Will Have a Formal Complaint Lodged Against You

Just Like Grandma

Knowledge Is Power

Could You Lower Your Voice, Please?

Do I Need an Attorney?

Promise Keepers

Appendix