Discussing Claims with Insureds. A common and often key personality trait of CSRs and producers is that they are people pleasers, especially relative to customers. When it comes to claims, being a people pleaser can get agencies into trouble. In fact, most of the E&O claims I’ve seen and heard of relative to discussing claims with insureds result from someone in the agency trying to be extra helpful. For example, a producer lending an empathetic ear to his client’s claim concerns might reply, “Oh, we’ll take care of you.” More than one insured has heard that to mean the claim would be paid.
No one in an agency should ever convey that a claim will be paid or that a claim will not be paid. An insurance contract is between the insured and the insurance company. Behind the scenes an agency may influence whether a claim should be paid, but never should they communicate directly with an insured as to whether the claim should be paid. This includes even repeating what a claims adjuster, especially an independent adjuster tells the agency. Companies have been known to change their minds about claims at the last instant, just before the check is cut.
If accurate, do tell the insured you will work to resolve the claim, work to speed the claims process, learn the status of the claim, find the adjuster, and so forth. Just do not advise a client a claim will or will not be paid.