If you have a claim pending, we can offer a few tips for working with adjusters to get your insurance claims paid.

Over the past few months since the coronavirus has caused widespread business interruption, hundreds of articles have published from the plaintiff attorney bar and insurers. All are concerned with coverage under business income, property and general liability policies. Will a business insurance policy cover for lost income, decontamination, or third-party claims alleging COVID-related negligence?

Across the US, state departments of insurance (DOI) are beginning to weigh in. From offering grace periods for cancellation to ordering return premiums for auto, workers compensation and other lines of coverage, businessowners and the insurance industry scrambles to stay abreast of coronavirus implications.

We’re not going to discuss insurance coverage because decisions are evolving rapidly. Anything we write today about coronavirus insurance coverage may change with a new DOI announcement or developing court decisions. Instead we’ll review how you can work with your claim adjuster to improve the claims process and get your insurance claims paid.

The Core of Solid Claims Handling is Relationship Building

As a business owner, you know how important it is to build relationships with your customers. Whether your customers are tenants or you’re managing relationships with vendors who service your commercial properties, relationships are vital. Claims handling is no different. Adjusters are critical to a speedy resolution of your claims, so try to see adjusters not as adversaries, but as your advocates. If the hair on an adjuster’s neck stands up when you announce yourself, you might have started off on the wrong foot. It’s never too late to readjust your approach and see adjusters as supporters, rather than opponents.

The best insurance carriers train their adjusters to search the policy for a reason to find coverage, rather than looking for a reason to avoid paying your claim. It may seem like adjusters throw every policy exclusion at you in managing your claim. However, adjusters must, in a reasonable time, cite any exclusion that could affect coverage.

Communication is the key. If you don’t understand something, if your adjuster is using jargon for example, ask that adjuster to explain what he or she is saying in layperson’s terms. Your adjuster may forget this may be your first claim or your first experience with that type of claim. Getting an explanation may be as simple as that pleasant message you leave on an adjuster’s voicemail to get your call returned promptly.

Your Adjuster Will Need Documents – Often, Lots of Them

Your adjuster can do only so much to push your claim toward resolution. To resolve your claim, you must supply documentation supporting your claim. For example, if someone falls on your property, your adjuster may ask for maintenance records. Or in a business income claim, your adjuster will require detailed financial records. Your adjuster cannot access your maintenance or accounting information without you.

One tip – assign someone in your organization who can access all the pertinent records for the claim. Each policy has what the industry calls a “cooperation clause.” This is an agreement that says you will cooperate with the insurer’s adjuster by supplying reasonable documentation to investigate and conclude a claim. Failure to cooperate with the insurer’s adjuster can result in a delay or claim denial.

If you don’t believe the details of your claim entitles that adjuster to certain information, talk to your broker or to that adjuster’s manager. Learn why the insurer requires that information. The information must be relevant to the claim you file, not a fishing expedition.

What Should You Expect from Your Insurance Company After a Claim?

Every insurer has detailed standards that bind their adjusters to certain actions. Here are just a few of the standards you should expect from your adjuster.

  • Twenty-four-hour contact. The adjuster must strive to contact everyone involved, the insured, the claimant if there is one, and the insured worker in workers compensation claims within 24 hours of receiving the claim. Therefore, your prompt notice of a claim is essential to starting the claims process.
  • The adjuster must investigate every claim. Your insurer should consider any claim before denying it, even when the insurer believes that no coverage applies.
  • Plan of action. Every claim should have a plan of action. This means your adjusters should explain the claims process to you and you should know how they plan to resolve the claim. Sometimes it’s as simple as asking the adjuster, “So, what’s the next step?” Adjusters are sometimes so overextended that they forget to keep you in the loop.
  • No pushing of vendors. While your insurance company may have “preferred” repair shops or vendors, you have the right to use your own vendors for repairs. Some insurers “forget” this. Less experienced adjusters may insist you use only certain vendors, such as body shops. Vendors are your choice.
  • A strong follow through on subrogation. Subrogation means that someone else caused the damage and your insurer may be able to collect from them once the adjuster settles the claim. For example, if another party struck your vehicle, you could choose to go through your own collision coverage. Once your insurer collects from the other party, the insurer reimburses your deductible. Adjusters may miss subrogation opportunities, and this hurts your loss history.

A Collegial Claims Process Can Help You Get Insurance Claims Paid

Like every other relationship, your approach to your claim can make a big difference. Your adjuster will appreciate your efforts and great attitude. As the saying goes, “You catch more flies with honey.” A friendly approach can help you get insurance claims paid more quickly and amicably.

Our clients depend on us if they have difficulties during their claims process. Contact us here for more information about the Reshield advantage.