Presentation on theme: "Why Can’t We All Just Get Along?. AS GOOD AS IT GETS Carol Connelly:“They said my plan didn’t cover it and said it wasn’t necessary anyways.” Carol Connelly:"— Presentation transcript:
AS GOOD AS IT GETS Carol Connelly:“They said my plan didn’t cover it and said it wasn’t necessary anyways.” Carol Connelly: [Pause] “Why, should they have [paid for the treatment]?” Doctor: “Well” – Carol Connelly: “Fucking HMO bastard, pieces of shit!!” Carol’s mother:“Carol!” Carol Connelly: “I’m sorry.” Doctor:“That’s ok – I think that’s their technical name.” Audiences throughout the nation applauded this exchange.
PUBLIC ADJUSTERS National Association of Public Insurance Adjusters adopted the following Rules of Professional Conduct and Ethics: Members shall conduct themselves so as to command respect and confidence. They shall work in harmony with one another, with their clients, and the insurance company’s representatives, so as to foster a cordial and harmonious relationship with all branches of the insurance business, and with the general public. Members must be fitted, by knowledge and experience, for the work they undertake. They must not endanger the interests of the public adjusting profession, or risk injustice to assureds or to the insurance companies, by attempting to handle losses or claims for which they are not qualified, and for which they cannot find competent technical assistance. Members shall not acquire any interest in salvaged property or participate in any way, directly or indirectly, in the reconstruction, repair or restoration of damaged property, except with the knowledge, consent and permission of the assured.
4-220.201 Ethical Requirements Code of Ethics. The work of adjusting insurance claims engages the public trust. An adjuster must put the duty for fair and honest treatment of the claimant above the adjuster's own interests, in every instance. The following are standards of conduct that define ethical behavior. An adjuster shall exercise extraordinary care when dealing with elderly clients, to assure that they are not disadvantaged in their claims transactions by failing memory or impaired cognitive processes. An adjuster shall not knowingly fail to advise a claimant of their claim rights in accordance with the terms and conditions of the contract and of the applicable laws of this state. An adjuster shall exercise care not to engage in the unlicensed practice of law as prescribed by the Florida Bar. Public Adjusters, Other Ethical Constraints. In addition to considerations set out above for adjusters, the following ethical considerations are specific to public adjusters. A public adjuster shall advise the insured and claimant in advance of their right to choice of counsel to represent the insured or claimant, and that such choice is to be made solely by the insured or claimant.
4-220.201 Ethical Requirements The public adjuster shall notify the insured or claimant in advance of the name and location of any proposed contractor, architect, engineer, or similar professional, before any bid or proposal by any of these persons may be used by the public adjuster in estimating the loss or negotiating settlement, and the insured or claimant may exercise veto power of any of these persons in which case that person shall not be used in estimating costs. The public adjuster shall ensure that if a contractor, architect, engineer, or other licensed professional is used in formulating estimates or otherwise participates in the adjustment of the claim, the professional must be licensed by the Florida Department of Business and Professional Regulation. A public adjuster shall not prevent, or attempt to dissuade or prevent, a claimant from speaking privately with the insurer, company or independent adjuster, attorney, or any other person, regarding the settlement of the claim.
Conduct of Public Adjusters They inflate or exaggerate the scope, value and amount of the loss. They are “difficult to deal with.” Some do nothing for their money other than to solicit the loss. Three recurrent themes of criticism regarding conduct of Public Adjusters involves the following:
THE NATURE OF DISPUTES AND EMOTIONAL RESPONSES The following “ten commandments” constitute a brief summary of Allstate claim policy - the philosophy underlying the Allstate ideals of superior claim service. 1.Let us seek to build our policyholder goodwill and cordial relationship by good, fundamental claim thinking and claim handling. 2.Think first before suggesting any failure on the part of the insured. Weigh the nature of his error and the necessity for saying or doing anything about it. Investigation or inspection may prove such failures on his part are not important to his claim and may not relieve us of any particular form of obligation which we are so anxious to perform through the Claim Department. 3.Be sure you know and understand thoroughly: the policy coverage's and requirements; what we expect from our insureds and why; which failures by the insured are serious and which are best overlooked for the moment, at least, while the adjuster attends to the claim and does the things that he is bound to do.
THE NATURE OF DISPUTES AND EMOTIONAL RESPONSES The following “ten commandments” constitute a brief summary of Allstate claim policy - the philosophy underlying the Allstate ideals of superior claim service. 4. When it is necessary to call to the attention of the insured his failure to meet fully a policy obligation (and it may very well be necessary upon occasion) it should nevertheless be done with such tact, kindness, friendliness, and courtesy as to avoid as much as possible the natural human adverse reaction to any sort of fault finding or criticism. 5.You well know that the work of the claim man is one in which controversy is inherent. Because controversy cannot be avoided, there is an absolute necessity that we at all times be prepared, with poise and tact, to minimize not only its immediate effect upon the matter at hand, but also its long-term cumulative effect upon our public relations.
THE NATURE OF DISPUTES AND EMOTIONAL RESPONSES The following “ten commandments” constitute a brief summary of Allstate claim policy - the philosophy underlying the Allstate ideals of superior claim service. 6.We must make conscientious efforts, constantly, not to allow ourselves to become so inured to controversies, misunderstanding and grief (which are every day thingsto us but which are exceptions to the average policyholder or claimant) that we are led to treat people with a lack of consideration, unkindness, or discourtesy. 7.If we not only possess a disposition to be sympathetic and friendly but, just as important, if we conduct ourselves in a manner which makes that disposition apparent and have a cheerful manner through it all, we will arouse a feeling of reciprocity in the policyholder or claimant. Actions cause like reactions. Of course, we must be Specific also when there is need, and we must alwaysprotect the company’s interests with acumen. But to be firm and keen and alert to protect the Company’s interests does not in any ase require that we be discourteous or tactless. If rebukes are necessary upon rare occasions, they must be gentle and be delivered at the right time.Do not use vinegar; honey is much better.
THE NATURE OF DISPUTES AND EMOTIONAL RESPONSES The following “ten commandments” constitute a brief summary of Allstate claim policy - the philosophy underlying the Allstate ideals of superior claim service. 8.Let us be courteous in every contact we have with our policyholders, who are our customers, and with the general public, whether we are dealing personally, by letter, or by phone. Be courteous even in the face of unreasonableness on the part of the other person. Discourtesy is a part of bad temper. Remember the old saying, “When you are right you don’t need to lose your temper; when you are wrong, you cannot afford to lose it.” 9. Let each member of the Claim Department project himself or herself into the position of the insured when his loss takes place and let us project ourselves into the position of the salesman who sold the policy, so that we will not only be competent claim men and women but cheerful and courteous individuals who may well be considered true representatives of Allstate.
THE NATURE OF DISPUTES AND EMOTIONAL RESPONSES The following “ten commandments” constitute a brief summary of Allstate claim policy - the philosophy underlying the Allstate ideals of superior claim service. 10.No gifts, material considerations, or other things of monetary value are to be accepted at any time by any Allstate employee or members of the family of such employee from persons, policyholders, claimants, financial institutions, firms or corporations with whom we do business or with whom we might do business.
Motivations of People in Negotiations He wants to feel good about himself. He wants to avoid being boxed into a corner. He wants to avoid future trouble and risks. He wants to be recognized by his boss and others as a man of good judgment. He wants knowledge. He wants to keep the job and get promoted. He wants to work easier, not harder. He wants to meet his personal goals and needs without violating his integrity.
He wants to feel that what he is doing matters. He wants to avoid the insecurity that comes from surprises and changes. He wants to count on you now and in the future. He wants to be listened to. He wants to be treated nicely. He wants excitement, adventure, travel, sex and good food. He wants a good explanation. He wants to be liked. Motivations of People in Negotiations
He wants to get the negotiation over with and get on to other things. He wants to know the truth. He wants to be thought of as honest, fair, kind and responsible. He wants money, goods and services. Motivations of People in Negotiations