The Quest for the Perfect Claims File

March 30, 2016

Understanding the difference between objective and subjective data is of utmost importance when handling a claim, said Don Myles, a partner with the Arizona law firm of Jones, Skelton and Hochuli.

Myles, a presenter at the annual Combined Claims Conference held in Orange County, Calif., earlier this month, explained why a perfect claims file is a myth. To avoid allegations of bad faith claims handling, he explained what should and shouldn’t be included in file notes and the importance of addressing problem files early.

“The real purpose is to tell a story and that story be consistent throughout the claims file,” said Myles.

Myles explained the difference between objective and subjective data.

Anyone that reviews a claims file and understands the actions taken by the adjuster is probably looking at objective information. On the other hand, subjective information is when an adjuster injects his or her own feelings about the claim into the file notes.

“You get into some problems of trying to explain your position if it’s subjective as opposed to objective,” he said.

For example, there may be signs of fraudulent activity; however, no real proof.

“You may have those thoughts but it doesn’t mean you should articulate them in a claims file,” Myles said.

Whatever the reasons a claim is deemed a problem file, it’s a good idea to avoid procrastinating and deal with it, Myles said.

That’s because an adjuster’s recall of a discussion or event can fade with time.

“The problem is can you remember something under the pressure of a deposition years later,” Myles said, noting that a jury is unlikely to believe anything that isn’t documented.

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