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The public expects - every insurer will do its duty

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Publication date:

25 November 2019

Last updated:

25 November 2019

Author(s):

Roger Flaxman

Understanding the common themes of disputed claims and the expectations behind them.

Delegates attending the recent CII Professional Focus regional tour of Britain were shocked by revelations of unprofessional conduct by some insurers and their claims representatives. Addressing the CII initiative to regain public trust in the profession, Roger Flaxman’s 50 years’ experience in the industry and 20 years acting as an 'expert to the courts' made for a thought-provoking 40 minutes, with examples of actual claim histories. 

Flaxman opened with the case of neighbouring semi-detached homeowners on a steep-sloped road suffering from unrelenting subsidence. They have had to wait 19 years for repairs whilst their respective insurers disagreed about the method and cost of repairs; whilst the homes were gradually sliding down the hill. They eventually became too difficult to repair and had to be demolished. 

“The two neighbouring families brought up their children and sent them to university in the time it took to settle a straightforward subsidence claim; all because of “warring factions” in the insurance process. The personal cost included a mother’s mental breakdown and over £100,000 in wasted Assessors’ costs trying, in vain, to get the insurers to listen to their plight. Why does anyone in our insurance profession want to be associated with such abhorrent treatment of our customers? 

The golden question is what did our profession do to lose the trust of the insuring public that we have now to regain it?”  

Giving further examples so damaging to our reputation they included commercial insurers forcing businesses into bankruptcy to avoid paying large claims, an insurer’s agent recklessly misrepresenting facts to obtain pecuniary advantage and a household insurer making a young family of six camp, for several months, in the front garden of the ruins of the home.

 

Common themes of disputed claims 

Flaxman says: “There are 12 themes common to nearly all disputed insurance claims and the top three include:

  • A presumption of mistrust or dishonesty of the Insured from the outset of a claim.
  • Entrenched positions by insurers or their agents.
  • Demands for “mitigating” action; often to the detriment of the Insured.

Whilst we all acknowledge that fraud and dishonesty is a real problem for insurers, it goes against all the principles of common law, our codes of conduct, and common decency to presume that every policyholder claimant is dishonest. Most people are reasonable if you treat them with courtesy and respect; and that includes not using insurance jargon and aggressive legal phrases to intimidate the policyholder."

 

Reasonable expectation – and the expectation gap

To set the scene of the public’s ordinary expectation of the insurance sector, Nelson’s flag signal to his fleet at the battle of Trafalgar “England Expects that every man will do his duty” (to win the battle), was astutely remodelled to become “The Public Expects that Every Insurer will do its duty”. Flaxman related the public expectation of England’s navy to public expectation of services, generally, in a world where consumer protection, government regulation and compensation for 'disappointment' has become the norm. 

“Whether an expectation of the armed forces, the government, the NHS, the goods and products sold in our high streets or the services offered by regulated financial institutions, the public has come to expect accountability of, and trust in, the things that it takes for granted amongst the essentials of modern living.”

 

“The public expects every insurer will do its duty” 

So what is a reasonable public expectation of the insurance sector?”, asked Flaxman.

"Every claim will be met with-

Courtesy, Speed and in Good Faith

Except:-

  • If the claim is clearly and unequivocally excluded by the policy exclusions;
  • If the Insured is clearly and unequivocally in breach of an essential policy condition;
  • If the Insured is clearly and unequivocally dishonest or fraudulent." 

Of course”, said Flaxman, “this has to be tempered by the reasonable expectations and commercial necessities of the insurers but if good faith and integrity is actively exercised in the sale, distribution and claims handling of insurance contracts the majority of the public will be well served most of the time.”

 

The impediments to avoiding disputes with policyholders 

“Not everyone engaged in insurance is responsible for the maltreatment of policyholders. However, since the profession recognises that the public’s loss of trust must be regained so we must address the cause of the maltreatment by the few. In my experience the pressures of the expectations of modern employees in combination with the technology that increasingly removes human judgement from day to day transactional activities, leads to the following impediments: 

Time shortage: Under-resourcing: Lack of training:

Targets: Bullying: Pride

Fear of discovery of error – and the consequences

Naturally, in response to this exposé some may say “we pay 95% of all claims”. Is that really reassuring of a cynical general public?

Could more public trust be won? by the successful and fair treatment of a complaint, a dispute or a misunderstanding than by advertising –

Food for thought…..”

 

 

Roger Flaxman ACII, Chartered Insurance Practitioner, Academy of Experts; is Principal of Flaxmans, Insurance Dispute Resolution experts.

Refer to website: www.flaxmanpartners.co.uk

This document is believed to be accurate but is not intended as a basis of knowledge upon which advice can be given. Neither the author (personal or corporate), Society of Claims Professionals or Chartered Insurance Institute, or any of the officers or employees of those organisations accept any responsibility for any loss occasioned to any person acting or refraining from action as a result of the data or opinions included in this material. Opinions expressed are those of the author or authors and not necessarily those of the Society or Chartered Insurance Institute.

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