What role do you play in claims handling?

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What role do you play in claims handling?

Claims require brokers, policyholders, insurers, adjusters and contractors working together through open communication

Suzanne Sharma on February 15, 2011

Water damage can lead to mould and with people spending about 90% of their time indoors, it can create a major health issue, it was revealed at the Ontario Insurance Adjusters Association (OIAA) 2011 Professional Development & Claims Conference on February 9.

Mould can also result in costly claims for homeowners if those responsible for handling the claim don’t take action immediately. This includes the broker, policyholder, insurer, adjuster and contractor, and each play a different role in mitigating the loss.

The broker, who is at the front end of the line, is there to sell the right policy and manage the overall claims process, said Stephanie Beattie of the Centre For Disaster Recovery.

Meanwhile, it is the insurers job to refer a knowledgeable and experienced contractor.

“As an insurer, you’re not hiring [contractors],” stated Beattie, who led a session on property mould claims. “It puts you at a position of exposure and affects your business if you refer an incompetent contractor.”

Contractors must be properly trained, familiar with job hazards, and most importantly, know of any regulations that are specific to their job tasks and functions.

For example, contractors should have Infection Control training, which is required by the Canadian Standards Association (CSA), stated Beattie. “This is mandatory and they should know the minimal requirements. If there is incompetence on a claim and the file goes sideways, who will be held liable? The insurer that made the referral.”

Adjusters, on the other hand, may be responsible for mediating with the contractor, viewing the overall wording of the policy, and providing advice.

Beattie added that policyholders also play a role in the claims process. It is their job to contact their broker as soon as there is water damage, allow access to their home, and not touch any equipment that is being used to restore damage.

Most importantly, each party should have open dialogue with one another.

“Communication on the [claims] files is probably one of the biggest reasons that claim dollars are out of control,” said Beattie. “There isn’t enough communication upfront about what the expectations are.”