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Claim to bid | Zalma on insurance



Watch the full video at https://rumble.com/v1r3q4q-claims-commandments.html and at https://www.youtube.com/watch?v=UoQ4qKpJnnc

In this fifteenth of fifteen claims bids, we address the need for every insurance professional to work with the first party insured property.

You must work with the first insured

The key to resolving insurance claims amicably is constant and objective communication between the insured and the adjuster. Regular communication about the claim allows the insured and the adjuster to build a relationship.

Building relationships is a fundamental aspect of human communication. Being able to build relationships can be seen as a fundamental part of social intelligence. Professionals should first spend time building rapport and the trust of the interviewee. there are four parts to building rapport.

People who want to build relationships should strive to:

  • building trust, such as showing honesty, trustworthiness and fairness,
  • understand another person’s views, such as making statements that the professional understands how the other person feels,
  • show respect, that is, be polite and express gratitude, and
  • be the kind of person others would like by expressing a willingness to be empathetic and altruistic.

A claim situation where the adjuster fails to establish contact with the insured is doomed to fail. Rapport is a relationship characterized by harmony, agreement, conformity, or affinity.

Rapport can be established by the professional complimenting the office decor, if possible, to make it honest. However, if the insured is relegated to a dreary closet, a relationship can be established by the professional who is concerned about the difficulty of working in less comfortable surroundings. The adjuster can contact the insured can also explain that his employer also forces the adjuster to work in a similar situation.

The adjuster, in order to establish a rapport, should delay questioning by trying to find mutual interests and concerns with the person to be interviewed. The task of creating a report can take minutes or hours. It is imperative that in order to complete a successful fit, sufficient time must be spent establishing rapport before the serious and detailed part of the interview begins. Regardless of the skill of the adjuster, if rapport is not established, the goal of the adjustment will not be achieved.

Once a report has been established, it is important that the adjuster maintains a relationship with the insured by creating an ability to regularly communicate with the insured. The insured should be provided with the adjuster’s office phone number, the adjuster’s cell phone number, and an email address where the insured can reach the adjuster to resolve any questions that may arise.

The adjuster, even if he has not asked a question of the insured after the report is made, should write a diary to communicate with the insured at least once every thirty days even if the communication is nothing more than a phone call asking how the insured feel. doing. If possible, the adjuster should also fill the insured in on how the claim investigation is progressing and any events.

Personal contact is preferred but the caseload for most modern insurers does not permit continuous personal contact. If such a contact is not available, contact must be made by telephone, post or e-mail.

For example, if the insured has been sued by a third party, the adjuster should explain what is happening and what will happen in the lawsuit, including the appointment of counsel to defend the insured. When the defense attorney files an answer to the claim, the adjuster must provide a copy of the answer to the insured, explaining the meaning of the language in the answer and what the defense attorney expects to do next to protect the insured’s interests. Each communication should be noted in the file. At least every 30 days, certain communications must pass between the adjuster and the insured and be noted in the adjuster’s file if the communication is material or merely an attempt to maintain the relationship between the insured and the adjuster.

For example, if the claim relates to a fire in the insured’s home, the adjuster, after preparing a report, should present to the insured a schedule of the time needed to determine the extent of the damage, establish a time to meet with the insured, an independent contractor, and the insured’s contractor. The meeting should happen quickly with everyone ready to work.

The adjuster, the experts and the insured should then agree on the extent of the damage and the adjuster should explain how long it will take the contractors to make an estimate of the repair. When the estimates are received, the adjuster should compare the estimates and meet with the insured to determine the differences between the two or more contractors.

The insured and the adjuster should then agree on the contractor whose estimate covers the entire loss and a contract should be entered into to repair the house. As the repair continues, the adjuster should inspect the work and regularly update the insured on the progress of the repair until the repair is complete.

The Fair Damages Rules set minimum, not maximum, standards. Adjusters should, and are expected to, exceed the minimum standards set by the regulations. Insurers are now finding—in bad faith litigation—that trial attorneys will cite violations of the minimum standards set forth in the regulations as evidence of bad faith sufficient to allow an expert to assess damages against the insurer. Because the regulations are stated to be minimum claims handling standards, failure to comply will allow a judge or jury to hold that the failure to comply is evidence of tortious conduct sufficient to support a claim that the insurer committed bad faith.

The adjuster must be familiar with the Fair Claims Settlement Practices laws and regulations in his or her state regarding communications to the insured and work to exceed the requirements.

The adjuster who establishes and maintains a relationship with the insured will settle more claims quickly and without difficulty and will never face the wrath of a government regulator or auditor for not meeting the minimum handling standards, but will always exceed the minimum requirements.

The adjuster who fails to communicate regularly and substantively with the insured will have difficulty reaching an agreement with the insured and will find himself or herself accused of violating the requirements of the fair claims settlement statutes or the rules created to enforce the statutes. This failure can also lead to litigation between the insured and the insurer.

(c) 2022 Barry Zalma & ClaimSchool, Inc.

Barry Zalma, Esq., CFE, now limits his practice to serving as an insurance consultant specializing in insurance coverage, insurance claims management, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims attorney and more than 54 years in the insurance industry. He can be reached at http://www.zalma.com and zalma@zalma.com. Subscribe and receive videos limited to Excellence in Claims Handling subscribers at locals.com

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Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published on https://zalma.substack.com. Go to the Zalma On Insurance podcast at https://anchor.fm/barry-zalma; Follow Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos on Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to Insurance Claims Library – https://zalma.com/blog/insurance-claims-library




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