Claims representatives must be competent because there are various stakeholders to satisfy. Moreover, the adjuster must answer to employer, state regulators, the insured, and the claimant. The claims adjuster has a good-faith obligation to conduct a fair and adequate investigation to determine the legitimacy of a loss and whether coverage exists. Additionally, there is the ever-present obligation to fairly evaluate and resolve claims after liability and coverage have been assessed.

In some cases, a claims representative must become involved in the negotiation and litigation of a claim. If a claim cannot be resolved through negotiation, then litigation will ensue. When this happens, it is necessary that the claims pro be aware of litigation management techniques and how to employ them efficiently. It should be noted that litigation management is an ongoing process intended to control legal expenses while retaining high-quality counsel and legal services.

Claims representatives can enhance their skills and knowledge in job-related competencies through education. When pursuing further learning, claims representatives should consider the proficiencies their job requires and attempt to align their education accordingly. The Institutes can assist claims representatives and other insurance professionals by providing new application-based learning methods to offer knowledgeable solutions specific to job competencies. This type of learning is achieved by providing content that is immediately usable on the job. The Institutes' application-based courses are designed to convey useful and appropriate knowledge, skills, and attitudes to professionals, who can thereby apply the techniques learned to real-life scenarios. In some cases, the application of the knowledge will also require analysis and evaluation. With large amounts of insurance-related information freely available on the Internet, The Institutes strive to differentiate themselves by designing content in a way that helps learners translate knowledge and enhance on-the-job performance. 

Application-Based Models

There are two types of application-based activities that are an essential part of the learning experience and will help claims representatives enhance their ability to harness new-found knowledge on the job. The first, “Apply Your Knowledge Activities,” are short, scenario-based activities that enable learners to apply knowledge from a single learning objective.

For example, Joe purchases a personal auto policy in which he is the named insured. On the way to work in Joe's car, his wife Jane is involved in an accident in which she is liable for thousands in damages. Jane does not have a policy of her own. Based on the policy definitions, are Jane's damages eligible for coverage under Joe's policy? 

The correct answer is “yes.” Joe's wife is covered under the personal auto policy. On the declarations page, the words “you” and “your” include an unnamed spouse of the named insured—provided that the spouse is a resident of the same household. In fact, even when an unnamed spouse of the named insured moves out of the household, but remains married to the insured, the spouse is considered “you” for another 90 days or until the policy expires—whichever comes first. Coverage ceases if the spouse is named on another policy.

The second group of activities, “Knowledge to Action Activities,” are extensive case-based exercises that enable learners to apply knowledge from multiple learning objectives. As part of the course work, learners will be required to review the relevant sections of the policy and answer questions pertaining to the facts of the case.

A New Test-Drive

Previously, The Institutes' case studies illustrated the application of knowledge, skills, and attitudes. Now, however, rather than telling the claims professional what to do, they are encouraging the learners to do it. Instead of providing the answers, the case studies provide a set of facts and resources, prompting the learners to resolve the issue.

The new Associate in Claims (AIC) Personal Auto Track is the first track The Institutes created following application-based learning methods. This track was designed to help auto liability adjusters learn how to efficiently and effectively navigate through the ever-changing landscape of auto liability claims and the entire loss adjustment process. This track is designed to improve employee effectiveness, enhance adeptness at handling coverage disputes, help mitigate costly lawsuits, and reduce the time and costs associated with dealing with personal auto claims.

The AIC Personal Auto Track illustrates the basics of auto liability and physical damage claims handling, including discussion of the coverage provided in auto policies. Additionally, a portion of the course material will help learners in evaluating bodily injury claims.

According to The Institutes, completion of the AIC Personal Auto Track will benefit the public, the insurer, and the claims representative. This education will help steer claims representatives toward more effective and efficient claim resolution. Better claim handling not only improves customer satisfaction and retention, but also the insurer's bottom line. This track is the first of a long line of claims-specific job competency education to be provided by The Institutes. For more information, refer to the sidebar above.