Citing insurer sensitivity to certain words, Insure.com recently advised policyholders to avoid using five particular words when discussing a claim with an agent or a claim adjuster. The goal of the piece, according to Kat Zeman, the article's author, was not to promote fraud or lying, but rather to avoid a battle “that could slow down or scuttle an otherwise legitimate insurance claim.”
Zeman said that these words often conjure up images of a claim that should be denied based strictly on semantics. Which five words were flagged? They were “Flood,” “Experimental,” “In my opinion,” “Sorry,” and “Whiplash.” (Forgive the writer for slipping in a phrase instead of just sticking to words.)
As we all know, however, there are two sides to every story. So what are some of the words and phrases that adjusters should avoid using when interacting with policyholders? I posed the question in two LinkedIn discussion groups to which I belong — P&C Claims Professionals and Insurance Property Claims Executives — and received a flurry of interesting and thoughtful responses. (For those of you who have yet to discover LinkedIn, think of it as a Facebook-type site for careerists.) Here are the five most popular themes and phrases that claim professionals deemed inappropriate when handling losses.
Fraud. Several respondents noted that even suggesting fraud — let alone using the actual word — was fraught with perils. “Better prove it” before you use it was the advice of one respondent who works for an independent risk management firm.
You don't understand. This phrase implies condescension, especially to someone who is in the midst of dealing with a loss. “By saying, 'you don't understand,' you're attacking the insured's intelligence or ability to understand the situation,” said an owner of a third-party claim services provider. “It's not unusual to disagree on something or have an insured not understand a policy condition.”
Junk. Using this word to describe a policyholder's possessions insinuates that it has little value, said one claim consultant. Beyond that, observations and notes in a claim file can have repercussions down the road for both the adjuster and the insurer. “I agree with the comments [about] what should go in file notes, and I shake my head when I think back to some file notes I have seen throughout my career,” remarked one claim manager. The best rule to follow? Imagine your notes and observations being read aloud in a courtroom, and adjust them accordingly.
I don't believe you. Expressing doubts about the legitimacy of a claim or the value of an item is a big no-no. If the facts and evidence do not support the assertion, then it's best to keep your opinions to yourself — or put more effort into the investigation. “Saying, 'I don't believe you' implies that you are questioning the insured's integrity or lack thereof,” said an owner of a third-party claim services provider. “Not a good move, and it puts you in an adversarial position.”
Penalty. “My pet peeve has been the word 'penalty,' as used in the phrase 'coinsurance penalty,' which refers to an amount not recoverable on a claim due to the application of a coinsurance provision,” said the president of an advisory services firm. “The policy, including all of its endorsements, does not contain the word 'penalty,' but when cited by an adjuster, it seems to provoke a hostile response from the insured.”
What's the solution? He taught his employees to reference the “response to recovery when applying the coinsurance provision.” It eliminated a negative word that fed the perception that the adjuster was harming the insured. It is also a healthy, proactive step in bad-faith states.
As in all matters of life, it's best to choose your words with care. Respect the insured as well as the process, and the rock-hewn road becomes smooth as glass. At least for a moment.
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