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Claim adjusting

 
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tonyb



Joined: 04 Jan 2004
Posts: 17
Location: Montgomery, PA

PostPosted: Thu Jan 15, 2004 2:03 pm    Post subject: Claim adjusting Reply with quote

Adjust

by Antone P. Braga

Knowledge is leverage. The more you know, the more you have adjusting power. The real trick in adjusting is to get a good result as quickly as possible, with as little trouble as possible. It is the continued fate of unknowing, unprepared policyholders to deal ineffectively. Their lack of ability, I am sure, is due in part to attitude. However, lack of information and understanding are the real culprits. It is difficult to imagine doing something in an area of which you know little or nothing, no matter how simple the task. This scenario has repeated itself down through the ages.
So long as a man imagines that he cannot do this or that, so long is he determined not to do it; and consequently so long is it impossible to him that he should do it. BENEDICT SPINOZA

To adjust is to negotiate. An adjuster is a negotiator. Think about that for a moment. This simple fact seems the most difficult for policyholders to realize. There is no secret definition. The dictionary defines the word adjust: To settle or bring to a satisfactory state, so parties are agreed in the result: to adjust our differences; to bring to agreement, to determine the amount to be paid, as in settling an insurance claim.

Many 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 US 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.

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 removed 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.

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!

Deciding to switch your options in mid-stream can be a trying and counter-productive experience. It would be best to make your decision early in the claim process and see it through to settlement. If your claim is a straightforward matter, there is no reason why you cannot calculate, prepare and adjust your claim on your own behalf. If you are the type of person who prepares and files your own income tax forms and would enjoy horse trading, you need not fear adjusting. In some respects it may not be as easy, nor as difficult as you might imagine; probably no more difficult than calculating and filing your taxes, or perhaps selling real estate by-owner.

There are pitfalls of course, but most can be avoided by adherence to honesty. Exaggeration and fraud are the two biggest mistakes you can make. Many people resort to these tactics as a means to compensate for their lack of adjusting knowledge. Those thoughtless acts provide good arguments, bargaining chips and a feather in the cap of the company adjuster. Although the misrepresentation may be minor in scope it can result in denial of the entire claim. At the very least, a drastic compromise can be expected. The wording in your insurance policy gives you ample authority to adjust with the company adjuster on an even footing. You do not need unfair advantage on your side. It is far greater jeopardy than it is worth and against the law.

Remember, values are matters of opinion. Your informed opinion is very important. You are truly an equal in the transaction--equal in weight of opinion and equal in authority to determine and adjust your claim. If all else fails you have authority to formally file your claim, which in effect is your demand for payment. The insurance company has specific time limits in which to respond. You are an adjuster!

We are all adjusters, in all our dealings. You are an adjuster in your own right when you have bargaining power and are prepared to deal from a position of knowledge and strength. This mental image is important for all your negotiations. The winning combination in adjusting is having an organized, methodical, self-confident approach and at the same time an awareness that compromise often plays an important role. Actually, winning in adjusting is not the act of one party driving the other party to defeat, as some believe. The perfect adjustment occurs when the enlightened needs of both sides are met to the satisfaction of both sides.

In order to arrive at an adjusted settlement, each side has its own needs to satisfy. The less you know, the more you are apt to meet the needs of the person with whom you are adjusting. This is one important reason to understand your needs. If you don't know what to expect and how to get it, you may become satisfied too easily.

No one knows the outcome of an adjustment beforehand. Therefore, it is impossible to anticipate to what extent either party will give in to the needs of the other. Bargaining power becomes the main ingredient in adjusting. It usually comes about naturally as facts come to the surface. The more you know, the more you know to what extent you must adjust your needs. Likewise, it is easier to satisfy needs that are not completely known to the person with whom you are adjusting.

Adjusting is a matter of give and take, and unless you are dealing from a position of strength, you will probably give too much.

A company adjuster facing a knowledgeable policyholder usually realizes that the claim adjustment will be a collaborative effort. Also, this mutual respect may more likely lead to mutual agreement.

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.

Probably the most difficult aspect of acting as one's own adjuster, is in having to enter the realm of the unknown at a time following a disaster. Psychologically, most people are not up to the task under the circumstances. It is very common to see people in a state of shock, confusion and helplessness. Those who are objective, informed and prepared, are more inclined to be emotionally level and competent.

The time of a personal disaster is not the time to be thinking about all of this for the first time. Think about it now and take comfort in the knowledge you adjusted if the unthinkable happens to you.

© 1977-2015 APB

For everything that is given, something is taken.
—RALPH WALDO EMERSON
This content is local to your area in that it affects virtually everyone in your area, indirectly or directly: property insurance policyholders. When the next stories run having to do with a local disaster such as a hurricane, earthquake, flood, tornado, fire, etc., perhaps think of those disaster survivors and to what extent you may have helped in their preparedness and recovery. The simple truth is still the most powerful to articulate and pass-on, especially in this day of social media. Thank you for any help you may give.

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