The Role of the Insurance Claim Specialists In Commercial Property Claims

The following article reproduced from www.irmi.com provides some really helpful insight into the commercial insurance claims process.

Both insurers and insureds call on claims adjusters, accountants, and attorneys for help with claims. Generally speaking, however, the claims adjusters, accountants, and attorneys that offer their services to insurers are distinct from those that offer their services to insureds. The majority of claims specialists offer their services exclusively to either insurers or insureds, rather than to both. The discussion that follows briefly describes these experts, outlines the services that they can provide, and identifies the situations in which insureds and insurers typically elect to use their services. (For a listing of claims specialists, visit the claims section of the Resource Directory.)

Specialists Used by the Insurer

Insurers virtually always use at least one type of claims specialist in the handling of every claim: claims adjusters. Depending on the particulars of each claim, the insurer may also elect to use insurance claims accountants and attorneys.

Staff and Independent Adjusters

Insurers use two different types of adjusters to investigate and settle claims: staff adjusters and independent adjusters. Staff adjusters are employees of the insurer; they adjust claims only for the insurer that employs them. Independent adjusters, on the other hand, are separate business firms that offer claims-adjusting services to insurers for a fee. Staff adjusters receive a salary from the insurer, whereas independent adjusters usually charge insurers for their services on a time-and-expense basis.

Insurers vary with respect to their use of staff versus independent adjusters. Some use staff adjusters exclusively, while others use independent adjusters exclusively. Still others use both, depending on such factors as the location of the loss and the type of claims expertise needed. An insurer may engage an independent adjuster on a case-by-case basis, to handle particular claims, or may designate an independent adjuster to settle all claims of a certain type or size or all claims under a particular policy. There are a number of large, well-known independent adjusting firms. There are also a number of small independent adjusting firms, many of which are operated by former employees of the very large firms.

Regardless of whether the insurer uses a staff adjuster or an independent adjuster to handle a given claim, the role of the insurer’s adjuster is to determine the following.

  • The cause of the loss
  • Whether the policy provides coverage for the loss
  • The extent of property damage
  • Which items should be repaired, which items should be replaced, and what should be done with the damaged property
  • The cost to repair or replace the property
  • The amount that the insurer should pay the insured

The insurer’s adjuster can also advise the insured on what steps to take to prevent further damage and to minimize the loss, and, if requested, direct the insured to firms that can provide the necessary cleanup and repair services. In performing all of these tasks, the adjuster involves experts from other fields, if necessary.

Insurance Claims Accountants

For large, complex claims, especially those involving business interruption and extra expense losses, insurers often hire accounting firms to calculate the estimated loss and to evaluate the insured’s calculations. Typically, the accounting firms that insurers use are “boutique” accounting firms that are devoted entirely to insurance claims accounting for insurers. These firms, sometimes referred to as forensic accounting firms, do not do other types of accounting work, and they do not make their services available to insureds.

Attorneys

Of course, insurers sometimes also involve attorneys in property claims. Insurers typically involve attorneys in property claims when there is some question as to whether the loss is covered, to provide guidance as to whether the claim should be paid or denied, and to prepare for a court battle if one is expected. If arson or some other type of fraud is suspected, it is advantageous for the insurer to have the attorney direct the investigation, because the information gathered is then protected by attorney-client privilege. The same is true of property losses that may have been caused by a third party. In such cases, the insurer may involve an attorney in anticipation of a later subrogation action against the third party. The insurer may elect to use a staff attorney, particularly for coverage opinions. Often, however, an outside firm is engaged. Although there are exceptions, most attorneys that make their services available to insurers do not make them available to insureds (and vice versa). Attorneys usually charge insurers for their services on a time-and-expense basis, although graduated percentage-of-recovery fee schedules are sometimes used in connection with sizeable subrogation actions.

Specialists Used by Insureds

Although it is not required, the insured may also elect to engage claims specialists to assist in settling a commercial property claim. Reasons often cited for an insured’s decision to hire a claims specialist include the following.

In a claims situation, the insurer and the insured have naturally opposing interests. The insurer’s interests are generally best served by making payment of the least possible amount, whereas the insured’s interests are generally best served by receiving payment of the greatest possible amount.

Loss Assessors & Other Names

Claims specialists are known by different names in different parts of the world. For instance claims assessors, insurance adjusters, claims adjusters, loss assessors Manchester, loss adjusters, insurance claims specialists, insurance claims adjusters and so on. Whatever the title they go by, they essentially perform the same function ie to help clients obtain a comprehensive and complete settlement of their insurance claim which covers all losses and all remedial work required for property renovation.

Since the insurer has a claims specialist representing its interests, the insured needs a claims specialist representing its interests to be on equal footing with the insurer.

Hiring a claims specialist allows the insured’s personnel to continue to focus on business operations, rather than spending their time on achieving a satisfactory insurance settlement.

Agents and Brokers

Agencies and brokerage firms of all sizes usually can be counted on for help in resolving coverage disputes for their clients, since they specialize in arranging coverage. The availability of other types of help depends largely on whether the insured’s agent or broker has someone with extensive claims handling experience on staff. The major national brokerage firms generally have experienced claims specialists on staff to assist their clients with claims. Many of these specialists have the expertise to guide the insured through the recovery process and to help the firm’s management determine and then achieve their post-loss priorities, even when there is no disaster recovery plan to follow. (One such seasoned professional describes this part of his job as “creating the client’s contingency plan after the fact.”)

Claims specialists of this caliber can also guide the insured’s staff in preparing a thorough and effective proof of loss for the claim. The classification of a given expense can make a difference in the amount paid by the insurer, so this kind of expert claims assistance is extremely valuable. For instance, the cost of providing pizza and soft drinks to employees working nearly around the clock to hasten the insured’s recovery will probably be reimbursed as a loss mitigation expense—but only if the documents submitted to the insurer explain how incurring this cost contributed to the loss recovery. Note, however, that even when the agent or broker can provide truly expert claims assistance, the responsibility for actually preparing the documentation required for loss payment normally rests with the insured.

Many agencies simply are not large enough to have an experienced claims specialist on staff. In that case, the agent’s usual role is to notify the insurer of the loss, put the insured in touch with the insurer’s claims representatives, stay in touch with both the insurer and the insured to ensure a smooth process, and attempt to intervene on the insured’s behalf if it appears that the client’s claim may be unjustifiably denied.

As a rule, there is no separate, identifiable charge for claims assistance that the agent or broker provides. It is considered a normal account service and is contemplated in the agent’s fee or commission.

Inspection Software Specialists

Construction site Insurance claims investigations benefit from the use of specialist lifting equipment inspection software particularly when a major failure of an item of lifting equipment has failed resulting in personal injury or physical damage to  the build in progress.

Equipment like chain hoists, winches, lever hoists, jacks, griphoists and require regular inspections and after an incident a detail failure mode analysis which the lifting inspection software readily facilitates.

Insurance Claims Accountants

Sometimes insureds turn to accounting experts for assistance with a claim, just as insurers do. Some insurance claims accounting firms offer a full range of claims adjusting services, as follows.

  • Investigating the cause and extent of damage
  • Determining what repairs are needed
  • Obtaining estimates on the cost of repairs
  • Assembling any documents needed to prepare a proof of loss
  • Preparing the insured’s proof of loss
  • Negotiating with the insurer on the settlement

In practice, however, these specialists are seldom involved in straightforward, direct-damage-only losses. Their specialty is handling very complex claims, particularly those that involve business interruption and extra expense losses, because of the need to quantify and document the financial loss suffered by the insured. Accordingly, insureds often elect to use an insurance claims accountant to handle the business interruption and extra expense portion of the loss only. In these instances, there may or may not be other claims specialists involved in other aspects of the claim.

Whether the involvement of an insurance claims accountant is warranted depends on several factors.

  • The complexity of the claim and the degree of difficulty in quantifying the insured’s loss
  • The availability of a claims specialist on the agent’s or broker’s staff to instruct the insured’s accounting staff in preparing the documentation required for a complex business interruption claim
  • The qualifications of the insured’s accounting staff
  • The amount of time the insured is willing to have these individuals spend on preparing the insurance claim

Whereas insurers use “boutique” insurance claims accounting firms that provide services only to insurers, insureds use either the business insurance division of a public accounting firm or a “boutique” insurance claims accounting firm that provides services exclusively to insureds. There are relatively few “boutique” accounting firms that offer their services to insureds. Insurance claims accountants typically charge for their services on a time-and-expense basis.

Attorneys

In connection with commercial property claims, insureds typically hire attorneys to contest the denial of a claim or a settlement offer that is deemed unacceptable. Attorneys may also be involved when there are injuries in connection with the property damage or when there is damage to property of others. Finally, the insured may elect to hire an attorney to handle a commercial property claim that involves a pollutant release or some other potential violation of regulatory rule or law. In such situations, it may be advantageous to have the attorney hire investigators to gather the facts, because the information is then protected by attorney-client privilege. As previously mentioned, most attorneys that make their services available to insurers do not make them available to insureds (and vice versa). Although percentage-of-recovery fees are sometimes encountered, attorneys working on commercial property claims usually charge insureds on a time-and-expense basis.

Public Adjusters

Public adjusting firms offer claims-adjusting services exclusively to insureds, rather than to insurers. Once engaged, public adjusters usually handle the insured’s claim from start to finish. They investigate the cause and extent of damage, determine what repairs are needed, get estimates on the cost of repairs, assemble any documents needed to prepare a proof of loss, prepare the insured’s proof of loss, and negotiate with the insurer on the settlement. Public adjusters usually receive a stipulated percentage of the insured’s loss recovery (up to 10 percent) as compensation for their services. In marketing their services, public adjusters generally assert that the increased loss recovery that they can secure for the insured will more than cover their fees.

Public adjusters are known for their zealous efforts to secure the most favorable loss settlement possible for the insured. Unfortunately, however, there have been incidents of fraudulent conduct on the part of some public adjusters. Consequently, public adjusters as a group do not enjoy a favorable reputation. Insurers generally scrutinize claims submitted by public adjusters much more carefully than others. Also, an insured that elects to hire a public adjuster may find that the agent’s or broker’s claims representative is unwilling to be involved in the claim.


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Obviously, at the end of the day, were going to make the decisions that we believe are in the best interest of the consumers. We just have to be careful that we don’t sacrifice long term consumer protections for short term consumer protections We don’t want to cause insurance products to become less reliable, or less available, or less affordable in the long run because of decisions that we make that might have some perceived short term advantage for Waterboy Blackpool consumers. IJ: You said the insurance industry’s goal is to take care of consumers. That is a point that is very important and often lost on those outside the industry. How could the industry could do better at making that point known? Altmaier: Its a good question. I think the best thing that they could do is just make sure that as they operate, especially on the claims side, is to make sure that they are putting their best foot forward. A saying that we like to banter around in the office is that youre only as good as your worst claim. You have to take care of every single claim that comes in the door because thats why consumers buy insurance products. Its a promise to them that when they have a claim, the companys going to be there to indemnify them for that loss.

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Taub: Are there any innovations or new products on the horizon? Smith: People began to think of us as the Uber of Inspections. Companies needing a nationwide footprint of service coverage with very customized reporting and on-site data collection began requesting on-demand field services performed by our Lookers. What made us unique is that we were able to perform multiple services, not just provide auto inspections, heavy equipment inspections, property inspections, notary services, etc. WeGoLook was able to perform all of these services no other traditional field services company can do this. WeGoLook Lookers are now part of the process. Yes, as the A Novel Update Concerning Public Adjusters gig economy or sharing economy has become increasingly popular, most services focus on individuals, not consistent corporate services.

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Sunday, April 16, 2017 Homepage 6:00 a.m. Sunday, April 16, 2017 Homepage 0 It is often said that insurance companies make money by not giving it away. That kind of belief comes about because dealing directly with an insurance company on a claim can often be frustrating and nonproductive. Florida has a special statute that provides that when an insurance company fails to pay a valid claim on behalf of one of its insureds that the insured has the right to hire a lawyer who is paid a court awarded fee against the insurance company. This is true regardless of what kind of insurance claim is involved. If a life insurance company refuses to pay an claim within 60 days of the time a death occurs, the beneficiary under the policy is entitled to hire a lawyer and the insurance company is responsible for that lawyer’s attorney fees. Insurance Claims against insurance companies can arise in a variety of circumstances in addition to life insurance claims. People insure themselves to protect against significant medical bills, disability, and for a variety of other reasons. The law provides that an insurance company, under those circumstances, has a contractual liability to pay valid claims. Insurance policies are supposed to be written to protect insureds and not the insurance companies. Therefore, the law provides that every insurance policy, because it is written by the insurance company and not by the insured, is interpreted to protect the insured whenever possible. When an insurance company tries to wiggle out of its responsibility to its insured, the law is designed to protect the insured when a dispute arises.

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Our agriculture researchers are continually striving to define the impacts of crop damage to improve adjustment procedures that more accurately reflect losses in an ever-changing agricultural landscape, wrote Zarnstorff and Houx, who lead the NCIS research program. NCISs research team gets ideas All About Insurance Claims Advice from field adjusters, claim supervisors, and academic researchers. Projects typically last for three years and include several locations, and NCIS usually starts about six new projects each year. In 2016, researchers started looking into canola pod filling, corn green snap, chickpea pod and seed numbers and cotton node removal and defoliation. Today, NCIS has 17 ongoing research projects across 13 states from Washington to South Carolina, and from Saskatchewan, Canada, to New Mexico. All of the research is contracted to local universitiestypically extension researchers. Academic researchers have deep expertise in specific crops across the vast agricultural landscape in the U.S. And, since most of the researchers are state employees, they are focused on providing good information to producers. Having these researchers conduct the experiments means that the research is unbiased and transparent, Zarnstorff and Houx wrote. The academic separation gives farmers who buy coverage confidence in the insurance products and eliminates the perception that the adjustment procedure is stacked against them.

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