California SB-1159: On 9/17/2020 California enacted SB-1159 which imposes certain reporting requirements on California employers. Effective immediately, California employers are required to report positive COVID-19 tests to their workers compensation claim administrator, whether there is an allegation the COVID-19 exposure is related to work or not. Additional information on California SB-1159 can be found here.
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The Power of Claims Adjuster’s Tone and Transparency in Uncertain Times

Topics: Agent Resources

By Erick Sawyer AVP, Claims Quality, Compliance and Training

In early September, I recall watching the news intensely as one of the most powerful storms passed over the Northern Bahamas where my parents and immediate family resided for decades. As a Bahamian native, tropical weather was no secret; but this historic storm was different and the strength and stalled movement had those out of the path hoping for the best but expecting the worst. We knew Hurricane Dorian would be catastrophic.

The coronavirus (COVID-19) pandemic has “hit” the entire world with the same impact of a category five hurricane. No country has been untouched by some aspect of the virus, from medical care to economic upheaval. The uncertainty, fear and anxiety that victims of a hurricane have as the storm is approaching are the same emotions that everyone is currently having as the coronavirus spreads, the death toll grows and businesses remain temporarily closed.

Insurance Claims Adjuster Training and Processes

As a claims insurance professional, you often get immune to handling events that disrupt the lives of those on the other side of the claim number. You exempt yourself from the feelings and emotions that come with unexpectedly losing all you have or a loved one. You stick to the process, you follow the script, and you settle the claim sometimes in a very stoic way. For years, I have coached claims employees to express empathy, use caring phrases, and be there for the agent, insured, or claimant when they need you the most. This shifted from a coaching conversation to a personal story when I waited days to hear from my parents on a brief, distorted call mutter, “We are okay. Everyone is alive.”

A few days later, as the sun eventually appeared after the storm, I recall the initial call from the claims adjuster. Without hesitation, the adjuster said, “Is your family okay? I want you to know that you are on my list and we will be by your side all the way.” Those simple words meant the world to me during that very difficult week. It was no longer a script or another claim, but the adjuster truly cared about the well-being of my family and was committed to helping us restore life.

Modifying Claims Adjuster’s Tone and Style in a Time of Crisis

In the midst of a global crisis, such as coronavirus (COVID-19) or a weather-related calamity, experienced adjusters around the world may face difficult claim scenarios and conversations. They will be the first to contact the insured, an injured worker, or an agent to discuss a potentially life-altering situation. It will be more than another phone call to make, but an opportunity to deliver on the claims promise for your organization. In these unexpected times, adjusters should do the following:

Be caring. A claim is often prompted by an event that has disrupted the life of the person on the other side. A paycheck has stopped, personal property has been damaged, or an injury or hospitalization has occurred. More than anything in the early stages of the process, the other party wants confirmation that someone cares about their situation and unexpected life circumstances. Phrases like, “I am sorry you are going through this,” may not be enough. Adjusters may have to dig deeper and express true concern and compassion during such tragic times. Express care comes with genuine empathy through the words you say and the tone you use during those early conversations.

Be clear. During the early stages of the claim process, emotions are high and the claims adjuster is providing a lot of information. It is critical for the claims professional to set the process up for success by being clear and concise while resolving the claim. They should ask questions like, “Do you have a way to write down information?” or “Do you feel confident that you know the next steps you need to take?” Step-by-step instructions in easy to understand language will help the claim run smoothly and all parties feel confident they are moving towards a resolution.

Be candid. An insurance policy is words on a page until a claim occurs. As the facts of the loss unfold, it is key that the claims adjuster provides detailed information as to what the policy covers or not. This requires straightforward communication that clearly outlines what the claimant can expect. Too often, claims adjusters use phrases like, “It may be covered,” when they know the policy excludes the loss altogether. Avoiding difficult but necessary conversations never assists in an amicable resolution. Transparent and fact-based discussions set the stage for the claim outcome and assist the insured or claimant in preparing for the likely final decision.

Balancing Skill, Style and Transparency in Claims Processing Today and in the Future

According to a 2019 Workers’ Compensation Benchmarking Study completed by Risk and Insurance, 75% of adjusters need empathy training and 34% of adjusters indicate they need better tools to communicate with injured workers and other claims stakeholders. As the world changes in an unprecedented way, claims professionals will need to better balance the words they use and bringing clarity to the claims process while leveraging psychology and technical skills as the new normal for the field.



This material is for informational purposes only and is not legal or business advice. Neither AmTrust Financial Services, Inc. nor any of its subsidiaries or affiliates represents or warrants that the information contained herein is appropriate or suitable for any specific business or legal purpose. Readers seeking resolution of specific questions should consult their business and/or legal advisors. Coverages may vary by location. Contact your local RSM for more information.
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