Sometimes, in an effort to be helpful, agents try to “assist” their policyholders in making a claim, but end up delaying the claims process. There have been circumstances where agents have actually written witness statements for policyholders and/or their employees. It is invariable that witness statements written by agents contain inaccuracies. These inaccuracies may create discrepancies that result in lengthening the claims investigation process, which obviously does not benefit the policyholder. The same result often happens when the agent gets involved in calculating claim amounts or inventory losses. If a policyholder asks you to assist him in calculating a loss or for formulating witness statements, respectfully explain that there is a good chance that your participation would lengthen the claims process. Always feel free to refer the policyholder to the Claims Representative.
If an Agent can not tell a policyholder whether his loss is covered and if he/she can not assist the policyholder in presenting the claim, what can the agent do?
PLENTY. The agent can monitor the claims process by contacting the Claims Department concerning:
- Whether all requested information has been provided;
- Whether any additional information is needed;
- What the policyholder can do to facilitate the claims determination;
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the claims department plans to do next; and
- What the agent can do to assist the claims representative.
The agent can also serve to inform the claims representative of concerns that the policyholder may have. The agent can ask the claims representative to contact the policyholder and provide him/her with a status report. The agent can then contact the policyholder and report that the claims representative will be calling within a specified period of time to give him/her a report concerning the status of the claim.
In summary, the following are dos and don’ts relating to the actions of agents after a loss.
- Report the claim (even if you think it is not covered);
- Facilitate the flow of information from the policyholder to the Claims Department;
- Monitor the progress of the claim; and
- Call upon the Claims Department to give your policyholder status reports when the policyholder perceives the claim is not moving.
- Under any circumstances, represent that the policyholder is covered or not covered after a loss is reported;
- Become directly involved in creating information to be given to the insurance company (such as witness statements or inventory lists); or
- Tempt your insured by giving him/her scenarios under which a suspected non-covered claim might be covered.