In today’s tough economic times it is entirely possible for you, the insured, to know more about what your policy means than the claims handler who is actually managing the claim from the other end. DCS spends a great deal of time reminding claims handlers what disability policies mean. Although I used to say, “It’s not our job to teach claims handlers their jobs, it is often necessary today to do just that.
So many times people call me to say their claims specialist doesn’t seem to know anything. I agree. Questions asked often receive silence on the other end of the line followed by a quick, “I have to ask my manager”, or “let me transfer you to my manger. Sometimes I wonder if there’s anyone in the company who really knows what’s going on. Today, the process is so diversified that there is literally no one person in the insurance claims area who knows ALL of the aspects of claims management – they only know their own little piece.
It has been our experience claims handlers in general exhibit the following:
- Poor attitudes toward insureds with a presumption the person is filing a false claim for secondary gain or the claim is fraudulent.
- Ignorance concerning what policy contract provisions actually say, and/or deliberate misinterpretation of policy contracts in accordance with some internally communicated strategy or agenda.
- Are deliberately kept ignorant of the more complex issues related to disability claims such as financial reserves, liability approval rates etc.
- Attempt to enforce internal actions and administrative strategies where no policy provision exists.
- Lack of autonomy in making claims decisions. Claims handlers must obtain the approval of their manager or consultant before making a claim decision. Although the claims handler is “out front” on the claim, he/she does not actually make the liability decision.
- Lack of communication and “caring” skills.
- Lack of customer service orientation. Unum, for example, no longer has the “Mind of a Customer”, and their service to insureds in non-existent.
- Unknowledgeable. I am very hard pressed to find a claims handler anywhere who can put two sentences together. Unum still has that same problem from time to time.
- Quick internal promotions place claims handlers in the position of having to know things when they really don’t and have little experience to rely upon.
- No management leadership to guide and train claims handlers to do a better job.
- Lack of accountability and oversight. Leadership is a real problem.
All of the above is not necessarily a bad thing for claimants and insureds. I have spent nearly 14 years trying to educate and inform insureds with knowledge at least equal to that of the insurance company. Today, the knowledge of the average insured is likely to be greater than that of the claims hander.
Although its not our job to “educate and train” an unknowledgeable claims handler, it is our job to make sure all of the insured’s rights under the terms of the policy contract are enforced. It does seem though that claims handlers’ experience and know-how has been eliminated from the process as an important cost of doing business. Too bad, but certainly to our advantage.
