Claim Procedural Guidelines

The moment a client calls with a claim is the moment to begin selling your agency through service. Outlined below are 18 steps in the claim-servicing process, with a brief explanation of each.

CLAIMS PROCEDURAL GUIDELINE

1. Receive report of loss: Clients calling in will most likely be shaken and upset. This is the time to lend an ear and let them tell the story. Remember to listen for key words and phrases.
2. Access coverage documentation: Find the appropriate coverage record on the computer screen (or if you're not yet automated, get the file with the appropriate policy declarations). Check to make sure there are no outstanding late payment or cancellation notices pending.
3. Update activity log: Make a notation of the call on the activity log (also known as a transactional log, trax, conversation sheet, or conversation record). Include the name of the caller, your initials, the date, the time, and a brief summary of the loss. Consolidate the information on the activity or trax log by noting, 'See loss notice dated (today).'
4. Complete loss notice: While on the telephone, pull the appropriate ACORD loss notice or go to the appropriate space on the computer screen. Tell the insured (or claim-ant) that a form must be completed for submission to the insurance company and ask, 'Is it all right if I ask for information in the order we need for the claims office?' (In all my years of working as a CSR, I've never had a caller tell me 'no.') This eliminates unnecessary dialogue and gives the CSR control of the conversation.
5. Transfer call to claim representative: If the agency has a separate claim department, this is the time to introduce a claim representative to the client. Most clients experience losses infrequently and are not familiar with claim people (if they are, you may have a different kind of problem!). You should be as accommodating and sympathetic as possible until it's time to actually submit the loss notice either to your agency's or the company's claim department.
6. Request additional information: Send a letter, note, or postcard to remind the client or claimant of any additional information you may need. Next, suspend the loss notice until you've received the repair estimate, actual repair bill, or whatever additional information requested. Use a suspense system to establish a follow-up.
7. Open claim file or record in claim log: Whichever option the agency uses for master control of open claims, this is the time to log the loss. Some agencies prefer to keep a copy of each loss notice in a suspended file for regular review; other agencies maintain a log which is simply a list including the insured's name, the date of loss, the submission date, the type of claim, and the appropriate policy and company. (A quick review of the log allows you to stay on top of claim-payment status.)
8. Report loss to company: Mail or fax a copy of the loss notice to the appropriate company representative. In the case of personal injuries, advise the claim representative to watch for the notice. For policies billed directly by the company, include a statement that the policy has not been verified for premium-payment status and ask for verification that all premiums due are current.
9. Assign adjuster or determine agency authority: The draft authority - a contractual arrangement between the company and agency for agency to settle or pay a claim from its office - for each company should be highlighted for quick reference. Prepare a 'quick reference' sheet, identifying draft authority by company, and by line. Make arrangements with an adjuster to contact the claimant immediately. (Allstate's Claim 'Promise Line' guarantees a call to the insured by the adjuster within one hour of the agent's call to the claim office.)
10. Mail claim acknowledgment: A letter or postcard restating the company's responsibilities as well as the insured's should be sent as soon as you hang up the telephone. The minor expense and time invested in preparing and sending a reassuring note will go a long way toward cementing a positive service relationship with a client.
11. Transmit additional documentation to company: If and when additional information is necessary, copies should be made and forwarded to the company or to the adjuster for claim-payment preparation.
12. Suspend: Every effort should be made to close claims within 30 days. This isn't always possible, but the important point is to maintain some standard for prompt claim payment and closure.
13. Receive claim draft: These deserve top-priority status and processing. This is a chance to shine by delivering the coverage promise.
14. Document client database: Update the client's activity log with the amount of payment and when it was received, processed, and transmitted to the claimant or insured.
15. Deliver claim draft: When a loss has generated an especially uncomfortable situation for a client, personal delivery of the claim payment can enhance a service relationship. During this personal visit, be sure to use 'naive listening' techniques when asking the client how he or she felt the claim was handled. Naive listening means allowing customer feedback with no coaching, without showing prejudice or becoming defensive. Simply listen and take notes.
16. Update claim log (created in step 7): Indicate on the log that the claim is closed and the date of closure. You may want to note the client's perception of the way the claim was handled.
17. Close claim file/remove suspense: Remove the pending copy of the loss notice. Inform the producer of record and/or the manager that the claim is closed.
18. Thank all parties: A brief thank-you note to all concerned interests builds relationships. Communicating periodically keeps your name in the forefront of others' minds. The note should say something like 'Thank you for allowing us to be of service in your recent claim.' (If you didn't deliver the draft personally, you may wish to continue: 'We hope you'll take a moment to call or drop us a note with your impressions of how you were treated. If all went well, we'd like to know; if not, please tell us how we may improve our service in the future.') The note should continue, 'When we can be of further assistance to you or anyone you know, please call us first!'