Adjuster Negotiation

Back to: TelaClaims Adjuster II- Customer Service, and Ethics

Introduction

Adjuster Negotiation becomes an everyday activity while handling claims. It is essential to know your limits while negotiating to make sure you can keep your promises. It is vital that you have control of the negotiation to come to a happy middle with the insured, and you as the adjuster have an obligation to catch any attempt at fraud.

Remembering a timeframe in fair claim negotiations

Another concern is the speed at which insurers are required by law through fair claims settlement legislation to reach quick resolutions to outstanding claims. Speeding up the claims process seems to be out of sync with the capacity to spot suspected fraud and settle claims fairly. Public adjusters are sometimes working with company adjusters who are under much pressure to close a file, cope with answering to management, control costs, and handle a never-ending invasion of new claims.

Negotiating In Good Faith

While a claim may technically be little more than a financial transaction under a contract, an insured loss is not taken lightly by those who have suffered the loss. Every adjuster must employ his or her best tools – information and fairness to each loss. The resulting efforts must be directed to the good of all concerned parties and the integrity or wholeness of the loss. No claim can be successfully negotiated unless all parties are in agreement as to the facts. Knowing the facts gives the adjuster the necessary tool to successfully settle the claim. The ethics of adjusting requires the integrity to use that information reasonably and with the legitimate purpose of settling a claim.

Things to remember while Negotiating

• Is the pricing reasonable?

Often, Vendors or Insureds send in over-priced estimates for their repairs and replacements; they are expecting to increase the RCV that you as an adjuster have provided initially. Read over their estimate look over the unit pricing, the amount of material, and overall line items of their estimates to make sure that they are not inflating the price of or adding any extra line items to their estimate.

• What is the scope of variance?

Why is the price different from the original estimate? Where is the price difference and is it inflated? Are there any unusual procedures being done? And is it reasonable?

• Can you justify why you chose this decision?

Do you feel like the decision you came up with is justifiable? Only come to your conclusion when you feel confident in explaining your position to the carrier in case things get escalated. Also, note that it is essential you have documentation describing how you came to that decision.

• Is it covered?

Reading policies is not as easy as it may seem. A lot of insureds don’t understand what is covered in their policy or don’t understand exclusions that apply. Some exclusions are circumstantial like hurricane occurrences, or flooding and insured’s don’t realize that so make sure all your decisions match policy limits and coverages.

• Can an independent expert possibly deny the claim due to discrepancies?

Often when an insured is pushing or negotiating price difference or causation, we can use an independent expert to solve the problem. These independent experts (i.e., engineer, mold expert, etc.) provide reports with profound explanations of causation. We can use this to decrease fraud and to end negotiations reasonably.

• What is the key to negotiating?

The key to these negotiations is to stay within policy boundaries and always to be fair. Making the insured feel like he or she is getting shorted can lead to the insurance carrier losing clients; thus you should always try to help as much as you possibly can by keeping an eye out for fraud.