Active listening in claims investigations

The first statement regarding a new loss is critical, no matter how it is assigned. It may be the only time you speak with those involved, particularly if the claimant secures an attorney. For that reason, it is imperative to extract as much information as possible early in the process.

This first interview should include active listening, which involves a higher level of interaction. It can make the difference in a sound investigation of the case. Comprehending the statement details and asking appropriate follow-up questions are obvious, but let’s look at what often happens in the typical case where an insurance rep reads from a general script instead of processing the answer and changing course as needed.

The basic loss report indicates that the claimant vehicle “came out of nowhere.” This leaves much to be discovered. Here is a snippet of the conversation:

Adjuster: Were you using your cell phone or distracted at the time of loss?

Insured: No, I was not using a phone or distracted.

Adjuster: Were you under the influence of alcohol or any medication at the time?

Insured: No. {pause} I had not been drinking. 

Adjuster: OK, and do you wear any prescription glasses or corrective lenses? 

Insured: Yes.

Adjuster: And did you have them on at the time?

Insured: Yes.

(There was an opportunity to stop and clarify if the insured was taking any medication, but the adjuster just continued on with the script. It may not have mattered in the end, but there was a chance to stop, review and expand.)

As the conversation continues… 

Adjuster: Where were you headed at the time of loss?

Insured: I was going to the airport.

Adjuster: And how were the weather conditions at the time?

Insured: They were fine, it was clear and there was no precipitation.

(Here the opportunity exists for more detail. This is a real-life claim example where asking where the insured was headed was beneficial as per below.)

Insured: I was going to the airport.

Adjuster: OK, you were heading to the airport. {Pauses and reviews} And, what was the purpose of your trip – was this for business or pleasure? 

Insured: Neither, I was not traveling myself. I was just dropping some people off at the time for a flight.

(In this scenario, just a little more questioning revealed that the insured had been using a personal vehicle as a side business to transport passengers to the local airport. They had even started a website advertising their services in their local town. They had no qualms about divulging this, which led to a coverage issue being reviewed on a personal auto policy. However, this revelation led to the insured understanding the policy and being referred to an agent to discuss securing the appropriate coverage.) 

Active listening in the claims world

Actively listening to the claimant can:

• Allow the claim representative to delve deeper for much stronger statements.
• Also save time and money for the carrier. Less follow-up is needed by other adjusters and more accurate coverage and liability decisions can be made to pay what is owed based on the facts unique to the loss.
• Also help identify emotions involved. Anger may be apparent on the part of the claimant and lead to a greater likelihood of attorney involvement. Really absorbing the information and offering empathy (and even an apology) may do wonders in lessening hard feelings.

Taking superior initial statements

• Pause, let the interviewee speak. When asking open-ended questions, let the person continue. Sometimes allowing for an extra pause may let them continue with additional information about the case. Don’t interrupt. If you feel there is more that they wanted to say, revisit the question. 
• Ask for clarity. If you don’t understand them, ask again to restate their answers. If there is a bad connection, ask for the number that is best to call in case you get disconnected. Don’t be afraid to ask multiple times to get the facts correct. If an interpreter is needed, there are always options to use a language line service. 
• Don’t finish their sentences. When giving a statement, avoid the tendency to answer questions for them. Even a simple liability case such as a rear-end accident may have some other extenuating circumstances.
• Use a recorded statement when possible. This will help later on when going back to reestablish facts of the case. The statements change as the months and years go by, so it is good to have this saved in your file. Always obtain their permission in advance.
• Ask if there is anything they want to add to the statement. Often there is nothing, but there may be more information they need to share and they should be allowed to do so. Usually, it will be reiterating a key point they feel strongly about. This also helps gauge their emotions regarding the accident.  
• Sensing emotions and diffusing anger. Claimants may be upset and take it personally that your insured struck their vehicle. They may offer less information as they feel you are the adversary. Set the tone upfront that you empathize with the situation and this is merely the next step in the process so that everyone can move forward towards a resolution. A cool demeanor is crucial to establish trust.
• And finally, don’t take a statement if they are driving or distracted. Ask them to pull over or speak at a better time. The last thing anyone needs is a second accident while distracted. 

Ask yourself if you are truly listening and comprehending the statements that you are taking. An active ear can go a long way in uncovering that additional information that would otherwise escape someone who simply reads off a sample statement guide. 

Take your time, process the information and dig deeper. You’ll notice a big difference in the quality of your statements and their overall effect on the case. 

Chris Casaleggio (ccasaleggio@h2m.com ) is a former liability claims adjuster and currently serves as department manager of Forensics/Insurance for H2M architects + engineers.

Related:

Scoping Loss – A Lost Art?