Episode #70 - How Agents, Risk Managers, and Adjusters Can Actually Get Along

In this episode of The Art of Adjusting® Podcast, Chantal is joined by guest co-host Sandy Avina to unpack the messy—but fixable—world of insurance collaboration. What happens when adjusters, agents, and risk managers all think they’re steering the ship? Spoiler: chaos. But it doesn’t have to be that way.

We cover:
 ✔️ The surprising disconnect between “little R” risk managers and actual insurance strategy
 ✔️ Why agents often get trusted more than adjusters (even when adjusters know more)
 ✔️ Why that email chain isn’t helping—pick up the phone
 ✔️ How a recurring med spa laser malfunction became an insurance case study
 ✔️ Ways adjusters can share insights without crossing lines

Whether you're new to claims or you've been in the industry longer than a fax machine, this episode will give you insight (and maybe a laugh) about how we can all work together better.

📞 Communicate clearly. Collaborate smarter. And for the love of insurance—send the denial letter in the mail.

👉 Don’t forget to subscribe, like, and comment—especially if you’ve got your own story of miscommunication madness.

#InsuranceClaims #RiskManagement #AdjusterLife #InsuranceAgents #ClaimsHandling #TheArtOfAdjusting #InsurancePodcast #SandyAvina #ChantalRoberts #InsuranceEducation #CommunicationMatters

For more insights, you might consider a career in liability adjusting or if you're searching for reliable adjusting services, visit Auten Claims Management.

To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting.

Promotions:

• Once Upon a Claim: Explore the magical world of claims adjusting through fairy tales. Get your copy now.
• The Art of Adjusting®: Master the art of claims adjusting with practical insights and expert advice. Purchase here.

For more insights, you might consider a career in liability adjusting or if you're searching for reliable adjusting services, visit Auten Claims Management.

To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting.

Promotions:

• Once Upon a Claim: Explore the magical world of claims adjusting through fairy tales. Get your copy now.
• The Art of Adjusting®: Master the art of claims adjusting with practical insights and expert advice. Purchase here.

Chapters

• 0:00 Welcome to Art of Adjusting
• 3:24 Sandy as Guest Host Introduction
• 8:20 Defining Risk Management Roles
• 19:56 Communication Challenges in Claims
• 27:07 Building Better Partnerships
• 43:40 Setting Expectations with Policyholders
• 54:34 Upcoming Episode and Closing

Transcript

Speaker 1: 0:00

I'm Bill Auten of Auten Claims Management.

Speaker 2: 0:02

I'm Chantel Roberts of CMR Consulting and welcome to the Art of Adjusting podcast.

Speaker 1: 0:07

Today we're gonna talk about life as an insurance adjuster from the perspective of property, auto liability or workers' compensation adjusters. Our goal is to bring interesting topics in the world of claims adjusting to people who are working as an adjuster now and to people who are considering a career as a claims adjuster. Hi.

Speaker 2: 0:24

Sandy Hi Chantel, how are you? I'm doing great Thanks. Guess what? What You're not, bill.

Speaker 1: 0:37

So, I applied for the Bill understudy and I just got approved, so hold on to the role.

Speaker 2: 0:40

Yay. So yeah, I'm actually fun facts guys. Bill is fine. He came on, I think, for a few episodes, but he is doing fine. Actually, he's doing better than fine. His job has just absolutely taken off. His work is absolutely taken off and so good for him, so we give him a lot of props there. So Sandy is going to be my guest host for six episodes, three months. So yeah, I'm super, super excited about that. And, sandy, do you want to introduce yourself real quick to say kind of like what you do, because I'm excited, because we're going to have a different point of view, kind of then, from what Bill and I do, from two adjuster point of views.

Speaker 3: 1:27

Sure, so I am Sandy Avina. If you don't know me, I hope to connect with you on LinkedIn. I am a lifelong insurance nerd and work in the field of claims management and risk management, particularly with public entities. And you start out as an adjuster, as many of us do, and I will always have a place in my heart for that. But excited to talk about our topic today because there are a lot of folks in risk management who are not familiar with claims and don't have that background and can use some help in terms of how to work with their adjusters and understanding a little bit more about what they do.

Speaker 2: 2:09

Yeah, so I think for the next three months it's going to be a lot of fun, because Sandy can be able to give us, as adjusters, a different kind of viewpoint of what we need to do to be better partners, and that's kind of what we're going to be talking about today, and then in a couple of weeks, we're also going to be talking about how to have those tough conversations, and I thought you know also one of the things about having these tough conversations and the thing that we're going to be mentioning again today is being that partner picking up the phone, getting the agent or the risk manager involved in these discussions.

Speaker 2: 2:48

If you haven't, do go to both of our LinkedIn sites and you can see the whole Star Wars episodes that Sandy and I did together, where we're talking about how the agent and the adjuster work together. So fun facts, I mean. There you go. So, anyway, this topic today about how agents, risk managers and adjusters, how we can get along, how we can, we're working. Basically, even if we are with different companies, we're all on the same side. You know, we're on the side of the policyholder, right? And so that's who we need to be helping, in my opinion, right there.

Speaker 3: 3:40

Yeah, 100%. We're supporting the policyholder and I think a lot of times the pain point just comes from the need for better communication between all parties. So I always say your policyholder doesn't know what you know. Times I think we suffer a little bit from this curse of knowledge where we have this expertise and we think like, oh, they should know this or I mentioned this to them once, We've talked about that, but they are. It's going to be really tough to remember everything and even when I was an adjuster I would remember thinking, OK, I just talked to this person for 30 minutes. They're going to remember about four minutes of that conversation and it's just constant, I think repetition and education, and even when you feel like you've talked to them about this a million times, it feels like that to you, but to them it's very new, especially if that knowledge base is starting at zero.

Speaker 2: 4:37

Yeah, absolutely so. Let me ask you, sandy I always like to start with definitions and since this is a podcast for adjusters, of course everybody can listen. I think I do have some risk managers or an agent or two listen. So what would you say that like the definition of a risk manager is?

Speaker 3: 5:00

Oof. So that is a great question. Short answer is everybody's business, is your business? All roads lead through risk management. But I think a more realistic answer is it depends on the structure of the organization. So there's what I like to call big R risk managers and little R risk managers. Your big R risk manager is somebody who that's in their title. Right, they are a risk manager, their risk management analyst, their director of risk management, but they're usually involved in insurance procurement and the claims management, employee safety and any sort of loss prevention measures. So they're seeing both sides of the house, right.

Speaker 3: 5:42

How to prevent it from happening, but also what to do once it happens. Then you have little R risk managers and those are the folks who are gifted the responsibility of risk management and that's not their role. But they are approached and said hey, you're handling, and usually this is how it starts, it sneaks in. Well, you're an HR, so why don't you handle the work comp? Because employee leaves are all the same. And since you're dealing with that, that has to do with insurance and renewals. There's questions I can't answer. You handle that.

Speaker 3: 6:10

Hey, since you're handling that insurance renewal, here's some other insurance renewals, you know HR or finance or maintenance operations, transportation, wherever risk management landed, and those are your little R risk managers. And so that's a really tough position to be in because you are essentially trying to fill two roles and that isn't even really something you may have a background in. So it really does depend on the organization. I think that's what we struggle with is that there is no standardization in terms of what risk management is and what they do. It really just depends. It's a mixed bag.

Speaker 2: 6:50

Yeah, and I can say that the agent, like the retail agent, whether I guess I should say producer, whether that be the broker or the actual agent also fills that role of like a quote unquote risk manager, because that is the person that goes okay, so do you have people coming onto your property? Do you have customers coming onto your property? Oh, you do, okay. So you're going to need like general liability and you probably don't want the $1,000 in med pay because it costs $5,000 to go on an ambulance to a hospital now, so you probably want to bump that thing up to you know like 5k or or whatever. So I think that an agent, so that an agent or producer I should say that overarching term either be the broker or the agent, would also be a risk manager in some aspects.

Speaker 3: 7:39

They definitely do fill that consultative role. I think the gap that occurs is you'll have a business who has a broker or agent who will ask those good questions Like, do you have these things in place for loss prevention, to prevent claims? But somebody actually has to execute that work and so that's not really the role of the agent or the broker. Right, and a lot of places don't have risk management staff so, unfortunately, a lot of times it doesn't get done at all. And we see that in the losses where somebody will come in and say, hey, by the way, you should have proper HR training, you should have safety training, you should have PPE, and they're like great, all good ideas, and then nothing gets done. So that need is there. And we see that a lot with especially small to midsize organizations where they don't have anybody handling risk management. They're assuming that the agent or the broker is going to be doing the work and they don't. They provide consultation but they don't do the work.

Speaker 2: 8:34

Right, and so what does an agent do? I think we know what the agent, producer, broker does. They sell the insurance, you know. And again, it's like you said, it's some kind of consultation, like well, do you need this, Do you need that? I recommend this, I recommend that. But that is really kind of it, isn't it?

Speaker 3: 8:54

It really is. I guess the exception would be if you have an agent or broker who, as part of the policy, has these value-added services, and I always tell university professionals you have to look at that. It isn't always about the price of the policy, right.

Speaker 3: 9:10

If you know that you don't have support staff to help you do these things, then you have to look and see if that policy also includes, you know, training that's free, or somebody to come down and do a safety audit or whatever the case may be, because that's important if you don't have somebody who's doing that for you. So some of them have that, not all of them have that. It's usually the cost is buried somewhere if they do have that, but it just it is something to look at for sure, because the coverage is great. You want to have the coverage, but if you're still not doing all the loss prevention efforts to avoid claims, you know that's going to bite you in the butt later on.

Speaker 2: 9:47

Right, yeah, and so I'll tell you who isn't doing the loss managing aspect of it, and that's the adjusters, because we come in after the fact. I mean that's we are literally the the buck stops here kind of deal, and you and I and the reason why I mentioned the Star Wars, you know videos that we had done is that you and I did allude to one of these things about how adjusters, risk managers and or the agents can be really good partners is when the adjuster calls and says hey, by the way, did you know that there's this whole you know swamp in the backyard outside of this preschool and there's alligators in it. Y'all probably want to write an exclusion. I mean, that's about as close to risk management as the adjuster is going to get in that particular thing, because we don't do anything until there is a claim.

Speaker 2: 10:55

I think that's very frustrating for the brokers, agents, risk managers, because we get questions in the claims department well, would so and so or such and such be covered if XYZ happened? And we're like, uh, like what's the policy say? And it's not only what the policy says, but it's also what the policy says and what the facts of that particular claim are. And I hate it when attorneys say quote it depends, end quote, but it depends.

Speaker 3: 11:32

It really does right. So I think that's the you know, as former claims adjuster hat, I loathe the hypothetical. They give you a hypothetical and you think, well, there's a lot of details, that those details matter, the case facts matter. So I can give you a very general response for this general hypothetical.

Speaker 3: 11:53

But then they take that and run with it and then the end of the situation comes up and they're like well, you told me that this is what I needed to do, and so it's just a tough position to be in, because I know they want to be prepared and they want to understand and learn. But hypotheticals are so dangerous because it really does depend, and I'm not a fan of that either. You know you pay somebody $400 an hour for them and tell you, well, it depends, but it really does, it really does Right. Like attorneys, give that same thing with the law.

Speaker 2: 12:17

They give that advice because the case facts matter and and you don't want to give you know something too general that they hold on tight to yeah, yeah and and I think that's where we get to, where we have this misunderstanding and this, this overlap, that maybe risk management and agents I'm just gonna call them agents because I think that's what we all refer them to, rather than, you know, producers or whatever, but I mean brokers as well. But I think that's where we get into this misunderstanding about you know what's covered, what's not. Because I was talking to a friend of mine who is an agent or used to be an agent and we are going to be co-authoring an article, and I said, oh, this will be great, because I'm always going to say it's the agent's fault, because the agent always says, oh, yeah, don't worry about it, it's covered, it's totally covered, you know. And she, and she laughed and she said, well, you know, it's true, we kind of do that, but then we also we need to not do that. I'm like, yeah, because y'all don't have the license to determine coverage and so many people don't understand that. But it is a really fine line where we get into what does the adjuster do, what does the agent do? Because who's going to get called first?

Speaker 2: 13:42

Obviously, the agent is like hey, do I need to turn in a claim. You know this happened. Oh no, it's going to get called first. Obviously, the agent is like hey, do I need to turn in a claim? You know this happened. Oh no, it's going to be underneath your deductible, don't do it, you know. Or oh yeah, no, don't worry about it, it's not covered. Well, you can't say it's not covered, you know. Or oh yeah, go ahead and turn it in. Everything's covered, you know. You get that. Quote. All risk in quote policy, which I hate.

Speaker 3: 14:09

But yeah, yeah, I think it's tough because it claims it's such a specific world and there's definitely a challenge with the agent trying to sell a product, so you want to make it seem like it's this amazing thing, but it also doesn't really do the client service to not be realistic about some of the claims hurdles that they're going to face when it comes to exclusions or when it comes to coverage, because you don't want them to get upset and think like this policy isn't what I thought it would be, or really policyholders thinking in their mind I pay you this money. This means that the things that I think should be covered are covered and they think it's a lack of service or that the agent may have not been honest from the get go. And it's not that. I think it's just there's so much education that needs to be done and it's who's going to do that education. That really is the pain point, I think, for a lot of policyholders.

Speaker 2: 15:04

OK, so first of all, it's you and me, and so all of you insurer CEOs who are listening right now, all y'all need to call Sandy and me, because I guarantee you we can do a 30 second commercial that will educate the insurance consumer and still be funny. I guarantee it, we can do it. I mean, in fact, I would go so far as to say what? Maybe the first five free, and then if they see that we're doing a good job, then we're going to start charging them. I mean, I don't know what do you think? I'm just let's put our money where our mouth is. Anyway, point being, I think too, the issue is because I talked to my students about this as well when we're talking about this misunderstanding between what the agent knows, maybe what the risk manager knows, and again going back to what you were talking about, well, the risk manager knows, and again going back to what you were talking about, well, the risk manager may be the HR person. They went to school for HR, they did not go to school for insurance, and so they probably have the very same education that everybody else in the world has, which is none, like you said, absolutely zero, and they're going around price comparing and they're like, okay, that sounds good, let's go with this one. Not understanding what apparel is and that sort of thing.

Speaker 2: 16:36

Because who wants to sit in on an insurance class? And it's so interesting because I ask my students I'm like listen, guys, y'all are the next gen. How are you going to fix this problem where consumers don't know anything about your insurance policies? And they're all like, oh, let's offer webinars. And I'm like dude, dude. Well, I'm sorry, bruh, bruh, bruh, have you, if you were not required to be in my class, despite the fact that I'm awesome, but if you were not required to be in my class, would you be sitting here for two hours, two and a half hours, once a week with me talking insurance? And every single one of them says no, you know, I mean, mean, I'm like, so why do you think some other person who isn't required to be here, no matter how educational and fun I am, is going to sit through a two and a half hour class, 30 second commercials. That's what we need to do anyway.

Speaker 3: 17:42

Yeah, topic squirrel you know, right like the 30 second thing. I that's what we need to do. Anyway, topic squirrel Right Like the 30 second thing. I think is so true, because people consume information differently. We're used to social media and you know YouTube shorts and TikTok and people are looking for. What can I see in this tiny, tiny 30 second window?

Speaker 3: 18:03

So, I think it is more this trend towards what is bite-sized knowledge instead of. You know, let's do a hour and a half long webinar on Medicare set-asides. Nobody wants to sit through 90 minutes of that. So it's, how do we educate? And even if you create it in these bite-sized pieces, they're not going to get everything, but they'll still get something right. They'll get something versus the webinar that they're not going to bother to attend because nobody wants to sit through anything for 90 minutes straight.

Speaker 2: 18:31

Right, okay, so to totally plug myself, which is what this podcast is all about, anyway, and kindly promoted, the first poem on or in the book Once Upon a Claim is the Three Blind Mice, and the point of that is to teach you how to read a policy. And when I talk to my students about that, I will read that policy. I said, look, I can do it in 30 seconds. Or I'll read that poem, nursery rhyme, and I'm like, look, I can do it in 30 seconds, I can make you a 30 second commercial right here, flat, boom, someone time me, and so I'll read that out. I'll read maybe the first paragraph, after you know which is the moral of the story, and then I'll say something to the effect of like contact your agent to find out more, or you're in good hands when you contact us, or we're a great neighbor because we're going to tell you more about this, or blah, blah, blah. And I'm like that was 30 seconds.

Speaker 2: 19:38

Right, I did not tell you how to read a policy by reciting three blind mice and all of that. But the point is now that you know a little bit more. Um, you, you, you know a little bit to make you dangerous, and it's not to say that we can't keep going on and having a whole series. Anyway, we are way off topic. But you know what I mean. I know you know what I mean Cause I love this about you. This is great. This is what happens to Bill and me. We just get off on topics and tangents and we're like, oh, wow, and three hours have passed.

Speaker 3: 20:11

That's okay. The road leads back. You just make a U-turn, it all works.

Speaker 2: 20:13

Yeah, that's right, it does. The world is round. We keep going that way. So you know, one of the things that I think is a big point, though, when we're talking about the agent and adjuster kind of synergy that we have, is that the insured will see the agent as their person, not necessarily maybe the risk manager like the either either the big risk manager, because I know some some places, maybe Aon or who is it? The Hartford, I think, has some. You know that just go in and they're that's like all they do, but if the insured has a problem, they usually go to their agent, and I have encouraged adjusters here on this podcast do the same thing, man, use that agent to your advantage, because, again, we're all on the same side, you know, yeah.

Speaker 3: 21:27

Yeah, I think it really depends, because this is in work comp specifically, we see employers who have like a really close relationship with their adjuster because they're talking to them every day and when that happens, sometimes they are asking the adjuster questions that they should be asking their agent or their broker, just because they've had that relationship established, and then that becomes a little bit dicey because they look at the and they think, oh, you can tell me what to do. But sometimes the questions are more employment law questions and they're legal questions and even questions that might be beyond the scope of the agent, the broker, and I think that's confusing for policyholders to to understand. Where do they go for these different questions Like who do they reach out to as a resource?

Speaker 3: 22:11

We see that in general liability as well where they have questions for their adjuster and like it's not an adjuster question, that's your internal counsel question, but you shouldn't be asking the adjuster that question. So I think policyholders are really looking for who can give me the answer the fastest, and sometimes that is who do they have the access to. If it's the adjuster that they're talking to all the time, if it's their agent or broker, but sometimes even internally they don't have that relationship to reach out and ask for questions to legal counsel or who they should be asking.

Speaker 2: 22:42

I think that's a great point that you've just made is it's whoever they get they have on the phone at the time. Because and I think again, and this goes back to education aspect for our policyholders is they feel, if we are passing them around, that we're blowing them off. I cannot tell you how many times I have been asked, first of all, like what do you mean? This is denied, what does my policy cover? And B, what am I paying premiums for? You know well, you're paying premiums if a tornado knocked down your house, not the burst pipe or whatever it happened to be. And I mean they obviously don't think that's a funny thing. I do, but whatever, no sense of humor, policyholders. Besides the fact. But I do think that again it goes back to that educational aspect. But I have said this time and time and time again that if you're trying to get in touch with the policy holder and you know that you're going to have a hard conversation, much like what we're going to be talking about in a couple of weeks, pick up the phone and not only a call the policy holder so that they can hear the tone of your voice, and you have to put it in writing anyway, because this is what the Unfair Trade Practice Acts talk about, which, again, we'll also be talking about later on in the year. And then too, you know, I usually start the year January 1st with going over those things again, because it is so incredibly important to go over it time and time and time and time again, because I cannot tell you how many expert witness cases I have because some idiot uh adjuster has not done what they're supposed to be doing. Anyway, bygones, squirrel, what, what thing? What you need to do is is pick up the phone and and, like, call the agent, just like what Chantel was doing with Sandy in our Star Wars thing is like hey, did you know that this was going on? Just want to let you know that I'm going to be denying this claim and you're going to be the very next person that they call, because the agent is going to be like what kind of policy did you sell me? Why did you sell me this policy? And it would be a great opportunity for the agent to sell more insurance.

Speaker 2: 25:17

Oh yeah, like that wasn't covered. I told you it wasn't covered. Here's your piece of paper where you signed it, that I told you that it wasn't covered. But I think now a lot of people, when I say this, like, pick up the phone and talk with the agent, talk with the insured, let them know the sound of your voice and all this I have so much pushback from that saying that, oh, people don't want to be called. You know this Gen Z, they want to be texts. Or the millennials, they want to be texted. And da, da, da, da da. These things do not go across well in text. Yeah, and, and one of the best things that I actually had done for me when I had a claim was I received a text. I received a text and it said your adjuster is going to be calling you between nine and nine 30. Pick up the phone. Yeah, damn it. No, I didn't really say damn it, but it would have been funny had it done that.

Speaker 3: 26:25

But, anyway.

Speaker 2: 26:25

No, but it you know. It said your adjuster is going to be calling. I think it even said it will be from this area code. You know, pick up the phone, because so many of us don't pick up the phone now with all of the spam calls that we get.

Speaker 3: 26:45

Yeah, I think it's really important to tell them that right, so they can prepare, because some people need to prepare themselves for a telephonic conversation, which cracks me up because I've always been a phone person. I'm not, and I get it. I get the appeal of you know the asynchronous communication. I'll reply to you when I get a chance, but the problem with that is you have this email chain that's like four days old, from people going back and forth. I'm like we could have hammered this out in a 10 minute phone call. This is so much longer than it needs to. And you're right, you can't read tone in an email and I know some people who are what I like to call harsh email writers, meaning just the way they write the email feels very.

Speaker 1: 27:29

For all of you who are listening rather than watching on YouTube.

Speaker 2: 27:33

I just raised my hand and pointed to myself I'm like I'm one of those people who just get into it. Dear idiot, your claim is denied. Why did you even put this in here? And then I run it through chat GPT to say please make this sound polite. And then it's like dear valued customer, your time with us? And blah, blah, blah, you are important, yada, yada, yada. Anyway, sorry, I interrupted.

Speaker 3: 28:03

But I love the immediate self-awareness of yes, that's me, yeah, it's totally me. Man, they read into it, even if the tone isn't harsh, sometimes, if it's just direct, and they think like, oh, are you upset, are you, you know? I think so much of that can be avoided If they hear your voice, they can read your tone and they can ask their questions, instead of the just email and text I think there's just a lot that's missing there and text. I think there's just a lot that's missing there.

Speaker 2: 28:31

Yes, and I'll tell you what else. And it's not only those of us and I I mean I am, I am a pretty direct person. I have been, I have been trying to be better at it, now that I'm self-aware of it. But it also deals a lot with how or when the person who is reading it, what their mental state is in, because I could be joking not that I would in a in a work email, unless I'm doing it to another colleague, but not you know what I'm saying. Anyway, and if that person, their, their son, just gave them lip and and they had a flat tire and then they spilled coffee all over themselves and they've got a meeting and they didn't have a shirt to change it. I mean, like everything went wrong that morning and they got my email where I'm like hey, dummy, how you doing. Um, you know they're going to read it like hey, dummy, how you doing, and their mental filter could take that down as something bad and that's when it all goes wrong.

Speaker 2: 29:47

Addition to us as adjusters working with risk managers and agents is that we do kind of miscommunicate often and I have read again in my expert witness files I'm looking at this and I realize the emails going back and forth, that the plaintiff attorney, for example, and the adjuster are talking at odds at one another, whereas if you would have just picked up the phone and said I'm not, I do not understand what you are not understanding, please help me. I don't, I don't. I think I'm explaining myself. Well, obviously I'm not because you, you still don't understand. So, so tell me where I'm going wrong. And and that stops this, which also may stop the, the litigation, which, of course, keeps down your loss adjustment expenses, which insurance companies love when we do that.

Speaker 3: 30:53

I think part of it too is people like I say this all the time people don't read their emails. They just kind of glaze over the email but they're not really reading it, especially if it's like this long thread. So I see so many issues in the claims documentation where I'm going through the thread and I'm like, oh, they weren't reading. They picked the first line and the answer is part of it but not all of it and the context was already down here and somebody already addressed that question and it's just part of everybody's so busy and they're just trying to get this stuff out Like, oh, let me respond to this email, but again, all reasons why to have that telephone call is so important.

Speaker 3: 31:35

You just it's, it's the quickest point from A to B. You get to ask your questions, you get clarity and then everybody's on the same page and then there's no misinterpretation of tones or or feeling that somebody is that you have to be on the defensive, whatever the case may be. Somebody is that you have to be on the defensive, whatever the case may be. It's just so much easier that way and I think we can avoid that if we just have make the call when we need to make the call, but there are. I am surprised I do see a lot of people who don't want it. They don't want to call people, they're just uncomfortable with having the conversation in general. Or that fear of what if the policyholder is upset? What if you know the agent is upset? What if they don't want to have a tough conversation?

Speaker 2: 32:14

And I love that. And I think when we talk about this in a couple of weeks, I will say this and then I'll say it again, and I've said it before do role play. And everybody immediately goes to this sexual fetish thing. It's not what I'm talking about and all y'all need to get your minds out of the gutters. Yeah, okay, um, I, when I was at Liberty mutual, I guess I was too dumb to know better. Basically is what it was. I was too dumb to know better, and so I mean I would pick up the phone, start talking to people. They're going to yell at me. I don't care, you don't know me.

Speaker 2: 32:57

And there were all of these adjusters who came after me, who were again. They were very afraid and I was still probably a very new adjuster adjuster but management, for whatever purpose realized that I was too stupid to know better and started saying, hey, will you be the claimant or the insured and let's role play? Recorded statements and I'm like, yeah, yeah, because what is the thing that the people are most afraid of? And that's being yelled at. None of us want to be yelled at Like, yeah, let's sign up for a job where we're going to be yelled at for eight hours a day. That sounds like a great job. No wonder we don't have any adjusters. People want them to be adjusters. I mean, come on.

Speaker 2: 33:40

And so I accidentally made one woman cry. I didn't mean to, but the point being that I was mean, I was uncooperative, I was all of these things. And people realize, oh, is this the worst that could happen? And I'm like, yeah, that's the worst that can happen. They're like, oh, okay, they got over their fear. But that's what we need to do, because, yeah, when you tell someone, okay, you got pen and paper, I'm going to tell you that your claim is not denied. I'm going to tell you why it's not denied. And then I'm going to send you a letter. And, speaking of the email thing, you can send those letters and emails, but do not send the denial as an email, you know, because, you're right, we skim it. And when we get a formal letter, when we get a formal letter, that's better because, for whatever purpose, we are still, I think, trained to believe that letters are important. Emails are informal.

Speaker 3: 34:44

I think so. I think there's something about the physical nature of having to open a letter where you're like, oh, now it's in my hands, I got to actually read it, versus when it's electronic. There's so much of the scrolling, there's so much of this like it's so easy for us to just go on autopilot and not really pay attention. But yeah, physical letter that does change people's behavior.

Speaker 2: 35:05

Yeah, and again, you can even send that denial letter or reservation of rights letter via email as an attachment. What I'm saying is I would snail mail it still, but what I'm saying is don't put it in the body. You know, I would say, dear policyholder, read attached. Don't put your policyholder, your claim is denied, and here's why in the body. Don't put, dear policyholder, your claim is denied, and here's why in the body. Because, again, people, it's too informal and in my, in my thing, um, yeah, so phone calls, I would text or or email, you know, um, and I always, always asked to, and I don't know if you do this, I guess you do. Well, you work with schools, I think. So you're always like having to call people after 3pm. It's like when am I going to call you? 3pm, you know, but but find out when is a good time to call someone? Like, okay, so when are you going to be near your phone? Because some people work where they can't have their phones handy.

Speaker 3: 36:13

Yeah, or they want to have the conversation, but they don't want to be in an area where everybody's listening to them, and I can understand that too. So it does help to say okay, well, this conversation is probably going to take about however many minutes you think it's going to take. And I always tell them overestimate, don't underestimate. So if you think it's going to be 40 minutes and that way, like when you're done, he'll like hey, great, you answered all the questions instead of going over. So if they're prepared, then you're going to get a better response from them.

Speaker 2: 36:38

Yes, absolutely Do. Do the um Scotty aspect and and say oh, it's going to be 30 minutes, okay, so it's going to be an hour and a half, I'm giving it all. She got captain. I don't know how much more we can give her. Yeah. So what else can agents or I guess what can adjusters do to help risk managers be better at their jobs or help agents be better at their jobs?

Speaker 3: 37:14

workshops. I think it's really just getting on the same page. So I'll share an experience I had when I first started out as an adjuster. I, you know, we participate in file reviews and I did work comp and I would have these file reviews or giving them an update to assess the claim, and it wasn't uncommon for, like the brokers, to just pick everything apart during these file reviews. I'm thinking I don't hear from you, you know most of the time, and then all of a sudden you show up and you're picking apart the work and it's really frustrating because as adjusters, you're dealing with partial information in real time. You have to make a decision based on partial information. Everything is 20-20 after the fact, so hindsight is always 20-20. So the broker has the benefit of hindsight, the adjuster doesn't at that point of time right. So it was really discouraging and I thought why are they just picking apart my work? And then I had someone give me the best advice and they were like they are not as familiar with claims as you are, but they have to show their expertise and their value during these file reviews in front of their client. That's why they're picking apart the work. You need to make sure that you're deferring to them for expertise so they feel included, and that changed the game for me, where all of a sudden I would have something and before the follow-up I would say, hey, here's what I think we should do. However, I'm going to defer this over to you, mr and Mrs Broker, because what do you think, based on your expertise and what you've seen with their clients, do you agree with this course of action? Now they get to play.

Speaker 3: 38:30

Yes, I was deferred to as the expert, I'm part of this decision making process and now you're on the same page. So if later new information comes in or the claim doesn't go the way you expect, it's not just you, you both were part of that decision. You brought them in. So that was a game changer for me to understand the position that they're in, because they sold the policy, because they have to also be experts when they're really not claims experts right, and that's a tough position.

Speaker 3: 38:57

So I think that really helps, if you're an adjuster, to understand that perspective of how do you bring them in as part of that decision-making process, defer to them for questions and they don't have to be the decision maker, but you can say, hey, here's what I want to do. What do you think? What have other clients done? What are your thoughts on this? And then there's some ownership on both sides. So now you're a team and I think I think policyholders appreciate that too. They're like oh well, they're talking, they're working together. I think that's a that creates for a better service.

Speaker 2: 39:26

And I think, too, it goes back to what we're talking about is that that broker or the agent or whomever that is the insured's quote unquote person so many more times? And the reason why I always say call the agent, drag them into it into this whole mess, like, if you're having a hard time getting in touch with the insured, call the agent. You're having a hard time getting in touch with the insured, call the agent. The insured doesn't believe that XYZ is needed. Call the agent because they trust the agent. You're just some voice from three states away, you know, and so I totally love what you're saying is get those people involved. And the insured then sees oh okay, I've made a good decision in getting with this company or whatever. And then if we have to deny it, that agent is like, yeah, you're right, darn adjuster, but then we've got this endorsement right here, you know, or whatever. Yeah, so I like that, I like that thing. Yeah, what else could adjusters do to help out agents or risk managers?

Speaker 3: 40:49

I think it's good for them to give the perspective of what they're seeing as a pattern, because that the number of people who don't look at their loss runs and really understand what's going on. And I think there are risk managers and I'm like talking little, our risk manager meaning the policyholder, right, the person who's they anecdotally know what their losses are, but sometimes that's not what the data shows. And it's good for the adjusters to say like, hey, we've had, you know, a lot of new losses coming out of this one department or we had a lot of this one property. We're seeing a lot of issues, what's going on over here? Because they may be busy and they may not be catching that pattern and the adjuster letting them know that, letting the agent know that too yeah, did you.

Speaker 3: 41:35

When you talk about renewal, have you talked about this property? What's going on?

Speaker 2: 41:56

like. What information do you have? I think that out in California, I believe, actually, the tattoo removal laser machine would miraculously jump off of a shelf and fall to the floor all by itself, and it was amazing. And it always was like three years after it got purchased which is also amazingly right when the warranty was was over, and and and so I mean we would end up having to pay twenty, thirty thousand dollars for these new laser equipment stuff to remove your tattoos.

Speaker 2: 42:49

And we started noticing after like the fourth or fifth one, that a lot of med spas are obviously haunted because these lasers are behind locked doors. Man, and this happened at you know night. It wasn't like the nurse was accidentally dropping them or anything. I mean, the place was closed, right. So it was like a ghost story and you cannot subrogate, by the way, the dead. We've tried, but you can't do it. And how do you serve the notice? I mean, right, we tried at the gravesite, but it just it didn't. We even did Beetlejuice three times and he wouldn't have it.

Speaker 2: 43:35

So you know, we were, we finally went, we, we had this, this form that we called notice to underwriters, which is really to the agent, writers, which is really to the agent and, as the claims department, we would say, hey, we've noticed that there's been a lot of accidental wink, wink, droppings or whatever after three years, and y'all do what y'all want with that. And because I mean we can't, as the claims department, all do what y'all want with that, and because I mean we can't, as the claims department, tell the agents or the underwriters what to do, but they did put on an ACV policy, you know, like okay, so if you're you know, I don't know your laser thing is over three years old, we're gonna pay you ACV and and so we're just, we're just not going to do it and so, yeah, so that is, that is a great example. Claims adjusters, if you're seeing some kind of of pattern, get everybody involved. It's not necessarily SIU material, but see if we can't help the insured get rid of their ghosts.

Speaker 3: 44:54

Yeah Well, and it speaks to the impact of the shortage of adjusters and turnover too, because it means you're not going to see the pattern if you weren't around to see the pattern happen, right. So you have turnover. People are just looking at what's the most recent thing and nobody's looking back to identify those patterns. So that's really tough, like when you have an adjuster who's been with you for a long time. That's so valuable because they know they're like oh yeah, you know what. You usually get a lot of losses this time of year. You usually get a lot of losses at this location. You usually get a lot of losses this time of year. You usually get a lot of losses at this location. They'll see those patterns and they remember that. But when you have a lot of turnover, a lot of that is missed.

Speaker 2: 45:34

Yeah, so I think one of the things and tell me if I'm wrong, as we kind of like wrap up here final takeaways and all this kind of stuff how do you feel and I'm just going to ask as more like an agent risk this kind of stuff how do you feel and I'm just going to ask as more like an agent risk manager kind of deal when the adjuster basically tells y'all like to back up off me because you are not the claims adjuster, I'm the one who is determining coverage and I know that you're preening or whatever. But maybe back off, I mean, you can be an advocate, I don't have a problem with that, and God knows adjusters get the claims. Coverage is wrong. Tell me that. But don't come up all in here saying, well, we get bad customer service, Please. I got like 150 more of these phone calls I got to hear about, you know.

Speaker 3: 46:35

I think a lot of it is expectation setting. So it's if you have a policyholder who maybe hasn't gone through the claims process a lot, they may have a very different idea of what kind of communication and how frequent it should be, because in their mind again, this is part of this idea that they think oh, you're a service provider, I pay you money, you provide me the service that I want. That's not how it works. So it's setting the expectation of here's when I'm going to contact you, and there are times during a claim when there is no activity for a period of time. It doesn't mean the claim isn't being worked, but it does mean that you'll be notified when there of our role is to make sure that we are setting those expectations for the employers and for the clients so that they understand yes, here's what the adjuster's job, here's our job, here's your job and here's how you can expect communication to flow, because some of them think it should be.

Speaker 3: 47:43

You know I want a status update every week. I'm like that's not really reasonable. Things aren't necessarily happening every single week on certain claims. There wouldn't be an update. So it's just making sure that you set those expectations, because I do think every time you're pulling the adjuster to say, give me an update on this, that means they're not actually working the claim. So it's important to be mindful of that for policyholders. And the other thing that kind of a pet peeve of mine is TPAs and carriers have put so much work into creating portals where policyholders can go in and you can see you can see the documentation, you can see letters that there's a denial. You can see all of that and nobody wants to use the portal.

Speaker 3: 48:28

They're like I want the adjuster to call me and tell me I'm like okay, but that's not the best use of their time but you're also not answering the phone when we sorry, yeah.

Speaker 3: 48:38

And then it's like they like go into the, all that information is there. But they're like well, I, I prefer, prefer the service where they call me and tell me I'm like, okay, cool, okay, cool. But guess what, they're not doing that Now they're not working, the claims and things get behind. So you can't have it both ways. You got to pick your poison here. Do you want the constant phone calls where nothing's really getting done, or do you want to take the effort to log into the portal to have access to the information? That it's your policy, it's your claim.

Speaker 2: 49:08

So I try to push for that. I love that. You, what you, what you said, basically, and and I encourage adjusters to do this when, at the very first phone call that they have with the insureds, which is, mr and Mrs insured, this is your claim, this is how long it's going to take, you're not going to get your settlement next week? Yeah, I mean, you're just, you're just not, especially if it's a catastrophe claim and and again, it's overestimating, it's setting this expectations.

Speaker 2: 49:43

I worked at a third party administrator and so we worked, you know the continental United States, and so I would say look, I'm going to assign this out to an independent appraiser. He has 24 to 48 hours to send that back to me acknowledging the assignment. He also has 24 to 48 hours to contact you. If you don't hear from him within, let's say, five business days, you call me and let me know. But then he's supposed to go out within five to seven business days to look at the property. Well, we're now into and I would break this out to the insured we're now into two weeks after the loss, mr and Mrs Insured, you know. And so giving them that timeline because they think that we're going to be out there, you know, at 11 o'clock at night looking at the roof or or whatever, and we're not, and and so letting them know, well, I've got I don't know 15 business days to do that.

Speaker 2: 50:48

15 business days is three weeks. Y'all, that's three weeks. That's almost a month Now. You normally don't want to take that long, but but I love the fact that you've said that you're setting these expectations. So, adjusters, we're kind of shooting ourselves in our foots. Our foots, our feets, I don't know. We're shooting ourselves, dang it, we're shooting ourselves. Um, if we're not doing that, you know setting these expectations. I love that idea, yeah.

Speaker 3: 51:21

Yeah, and I think my my big piece of advice that I would always give when I worked at TPA and I had a team of adjusters and I would would tell them never tell them, I'll call you back later or I'll call you back when I'll get an answer. You have to give them a day, a day and a time Always overshoot. So if you think it's going to take you three days to get it, you need to tell them. I'll get back to you in five days and then when you do it in three days, you're a hero and if you didn't, you gave yourself a cushion. But if you say like, oh, you know what, let me find out and I'll call you back, in their mind that could be okay. I expect to call in 30 minutes because they don't understand what it takes for you to get that information.

Speaker 2: 51:56

Yes, because they don't know what's going on behind the scenes and they think that you are ignoring them. I love that. What I would do and I would add one caveat to that too is, if you do say I'm going to call you by 4 pm, central Time, put it on your calendar. Do not think that you are going to remember because you are not going to remember. Because if you do not call these people back, you are the lying SOB that they thought you were Okay. You are the lying SOB that they thought you were.

Speaker 2: 52:39

Put it in your calendar, even if you say, listen, I'm going to call you in two days, put it in your calendar. You've got to do it because you are not going to remember. You're, you're just, you're not going to do it. And if you call them and you get voicemail and the voicemail is like this voicemail is full, you can't leave a message, and you send them an email. I tried to leave you a voicemail at this number, couldn't do. I've reached out to you, like I said I was going to, because otherwise you were the lion sob that ever thought we were okay. So I think we've, like killed this subject, but we'll talk about it again some more I think we fixed it.

Speaker 2: 53:24

We fixed all the problems we fixed the whole world thing. Yeah, the whole world, but you know where?

Speaker 1: 53:31

can we send the?

Speaker 2: 53:32

bill exactly.

Speaker 2: 53:33

We're gonna send it to everybody, um, but what we also have, uh, in two weeks we have another listener question. So yay guys, if y'all have listener questions, if y'all like, we have six listeners, so our six listeners. Please give us a email, let us know what burning questions you have. We have a listener question from listener Dave, so it's going to be super exciting. We're going to be talking about dwellings and kind of like what the landlord's duties are If a building or dwelling can't be rented because of some maybe horrific crime happened, or I've actually had them where the tenants were cooking meth in the house. Yeah, so much fun, so fun. I love claims. Claims are so much fun. So, yeah, that'll be coming up in two weeks as well. So drop us a line. Please like, subscribe, comment, share all that kind of fun stuff, because it helps the algorithm pick us up.

Speaker 3: 54:45

Tell your stories. Everybody's got a claim. Story.

Speaker 2: 54:47

Yes, absolutely Tell your stories. Yes, yes, absolutely Tell your stories. So, sandy, we will see you in two weeks, all right?

Speaker 3: 54:54

Looking forward to it. Thanks, bye.

Speaker 1: 54:57

Thanks for joining us on the art of adjusting podcast, where we talk about life as an insurance adjuster.

Speaker 2: 55:03

If you enjoyed this podcast or this episode, please give us five stars and a review. It does help the algorithm pick us up.

Speaker 1: 55:12

Hit that subscribe button real quick and tell all of your adjuster friends to check this out as well. For independent adjusting services, go to wwwautinclaims, and for anyone interested in working as an independent liability adjuster, go to the contact us tab to join our roster.

Speaker 2: 55:30

In the meantime, you can contact me at theartofadjustingcom for consulting and training purposes.