Insurance Claims Handling Expert – Guidelines are Strict

At the minimum, most insurance agents are required by their companies to report a Claim promptly and accurately after they are put on notice that a possible Claim may be filed. Some agents are vested with claims handling authority which may be voluntary and limited in scope. The agency agreement should outline the boundaries of this responsibility.

Clients expect their agents to present their claim in a light most favorable for getting the claim paid. Companies expect the agent to present the facts as he knows them and let the claims adjuster determine the degree to which coverage applies.

As long as the agent follows his company guidelines for reporting claims, he has generally met his Standard of Care. Quality agents will prepare their clients for the claim adjusting process by explaining the steps that must be taken before a claim can be paid. Agents can get into trouble by suggesting too much, so they straddle the fence between providing good service and unreasonably building up expectations.

It should be noted that agents are often paid contingency bonuses if their book of business with a company is “profitable” during a prescribed time period. This contingency bonus is threatened by excessive claims activity or severity. The agent must not say or do anything that would give the impression that he considered his contingency bonus when servicing or advising his client.

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