The Underwriting-Claims ‘Disconnect’ In Casualty Insurance: An ERM Issue?

By Susanne Sclafane | April 2, 2013

  • April 2, 2013 at 12:59 pm
    Erik A. Sikorski CPCU, AIC says:
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    Ultimately the age old divergent interest between the underwriters, adding premium, and the claims department, paying what they owe, no more no less, remains alive and well within the confines of this discussion. Years ago, claims professionals were properly trained to understand part of their coverage investigation included a review of the underwriting file and discussion of the same with the underwriter, which fostered a team environment upon which analytical discussions were had in determining the impact of reservations of rights and coverage denials, versus “business decisions” to give consideration to policy holder interests.

    Unfortunately, the claims industry is under the spell of metrics and technology, filled with tiny boxes which are required to be checked in triplicate prior to making a decision. As such, the claims department lacks the intellectual capital among the claim handling staff, and intestinal fortitude among the leadership to properly investigate a coverage issue and have an enlightened discussion regarding coverage. Sadly, today’s claim departments are driven by absolutes in the form of compliance guidelines which remove the ability to interject thought into any discussion. As such, there can be no fruitful discussion with any department, thus explaining the arbitrary nature of claims handling in the new millennium and the lack of communication with underwriters.

    When claims departments allow gifted claims minds to lead the department, hire and train bright claims professionals, and abandon the absolutes of checking a box in the widget environment, then and only then will there be meaningful partnership between claims, the policy holder, and underwriting.

  • April 9, 2013 at 12:21 pm
    HUH! says:
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    Most claimants would agree that the company doesn’t want to pay any more than it has to, but many of thos same claimants believe a claims adjuster’s job is to make sure that nothing gets paid if there is any way at all to deny the claim — and that denials come in a wide variety of creative detail. Education of the public is a critical part of the process. How insurance companies and agents educate their clients may be what has the biggest impact on just how bitter — or sweet — the aftertaste of a claim is.

  • April 24, 2013 at 12:27 pm
    Catherine Zacharias CPCU,AIM says:
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    I am somewhat mystified by the allegation that decisions on disputed claims are always being made without underwriting input. Throughout my career in Claims (since 1984) there has always been collaberation and discussion between the 2 groups – at least at the 2 companies I have worked for. In addition,there is often consultation by UW with Claims before writing a new kind of business/account.



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