How Strong is your Peer Support Program?
by Antone P. Braga
While emergency communications are essential in time of crisis, there is little if any focus on the insurance industry’s role and lack of meaningful information available to policyholders as well as to adjusters. Crucial information should reach the insuring public and adjusters alike. The insured public should be provided disaster insurance rights and rules of recovery as a matter of course at the inception of insurance, so that everyone is fully informed from the outset.
I would say consumers make up the largest peer group, and insurance consumers the largest portion of that group. Yet it is this segment that lacks fundamental consumer protection in time of disaster, of all times! How can that be? Where is the critical support? Insurance agents? Insurance adjusters? States’ Departments of Insurance? States’ Governors? First responders? Red Cross? FEMA? Etc.? As a starting point for insurance consumers to answer, “How Strong is your Peer Support Program?,” one needs to first understand government’s and industry’s willingness to participate on behalf of the consumer, or not, and the basic premise and image of the industry in its advertising, compared to law and to what extent we insurance consumers need to help through our own Peer Support Program:
The Cat In Your Hat
President Obama: revealing dialogueMany people think only the person representing the insurance company is considered an adjuster. And historically, the policyholder has been considered for lack of a better word the adjustee, or the one receiving the adjustment. If you can’t imagine yourself as an adjuster, it is probably because of the word itself. When adjusting is foreign to your background, education and experience, it only follows you would have difficulty assuming that role.
Traditionally, an adjuster is a person who makes a determination of the amount of a loss, liability, or claim on behalf of a principal (insurance company or policyholder). A company adjuster or independent adjuster is hired by the insurance company, is paid from the policyholder premiums, and represents the insurance company in determination of the insured loss and liability of the company. A policyholder adjuster or public adjuster is hired by the policyholder, is paid from the policyholder settlement, and represents the policyholder in determination of the insured loss and claim of the policyholder. Each acts as an agent for their respective clients. In most U.S. States where adjusters are licensed at all, they are licensed to act either exclusively for the insurance company or exclusively for the policyholder never both at the same time. They are two separate worlds with separate interests to protect.
As a policyholder you should be aware of your adjusting options:
1) You may act as your own adjuster in dealing with the company adjuster (calculate, prepare and adjust your claims on your behalf).
2) You may hire a policyholder adjuster to deal with the company adjuster (calculate, prepare and adjust your claims on your behalf).
3) You may give up your authority to the company adjuster (calculate, prepare and adjust your claims on behalf of. . .anyone’s guess).
Seriously, one adjuster serving just one interest in any one transaction is plenty!
It is a blatant conflict of interest for the payer to represent the payee in a payment transaction, notwithstanding how usual insurance claim business is conducted between companies and policyholders. However, awareness is in the process to change that conflict of interest back to how intended and written in the insurance policy. It is a simple fix to revert to the language in the insurance policy itself, long ignored and all but lost from modern usage in favor of co-mingled interests when companies deal directly with their policyholders. These very words, in legal terms, have stood the test of time. I do believe that eventually our assumed, commingled interests will be once again separated as they were originally intended, surely as any conflict of interest is worthy of separation.
The quickest way to the best settlement for both sides is through cooperative enterprise. If both sides enter on a collaborative basis, there is a strong likelihood that each will strive for common goals. These common goals may have different values to each side, but their existence provides a channel for dialogue. Dialogue is an exchange of opinions or ideas, the free interchange of different points of view. It is through this interchange that each side can recognize its strengths and weaknesses, and accordingly make claim adjustments.
© 2014 APB