Viewpoint: J.S. Held CEO Refutes ‘Claims Surrogate’ Label

By Jonathon Held | October 22, 2020

  • October 26, 2020 at 5:10 pm
    Irene Ochoa says:
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    Outsourcing is not new, but the use of “trend” to describe increasing usage seems appropriate, from my perspective, as is Mr. Merlin’s use of “surrogate” in an increasing number of instances. As a broker, I’m privy to both sides of the claim process and witness too many times a practice that, even unintentionally, encourages policyholders to perceive specialty vendors as adjusters or insurance company staff with an ethical and fiduciary duty to them, the policyholder. This is simply not accurate.

    The insurance company adjuster must take unquestionable, full-ownership for these responsibilities.

    Often, claims are a traumatic, confusing time. Therefore, it is imperative insurance companies make clear (verbal & written) the vendor’s purpose and limitations. It is equally important vendors make clear, as often as necessary, that they are NOT adjusters, they do NOT have authority to limit scope of damage. They CANNOT make coverage determinations or discuss policy coverages, limitations or exclusions. The insurance company adjuster must take full ownership for these adjusting responsibilities, and contrary to Mr. Held’s statement, I hold “deliver[ing] the news” to policyholders in a clear, concise manner supported by policy language, as prescribed by state requirements is unquestionably one of an adjuster’s most basic, important and regulated duties.

    Ideally, vendors would stay in their lane, but the simple, common act of limiting a policyholder’s damage description is an inappropriate coverage denial. Because all limitations must be reviewed in full context and supported by policy language. A simple statement of “that didn’t happen on the same day” can also be an inappropriate coverage denial because it requires knowing and appropriately applying that policy’s definition of an occurrence. There are too many ways for a vendor to overstep to be listed here, but you get the idea why insurance adjusters must fully control the process.

    Consulting firms may seek to provide clear unbiased opinions and pride them themselves on objectivity and indeed many do just that. However, there are many insurance articles written documenting a less than perfect record. Thankfully, Attorney William F Merlin, a nationally known and respected advocate for policyholders, is well within his lane bringing this issue to our attention. Whatever, our role, we can agree policyholder rights must be protected.

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