sionally deviate from the guide. Checklists may reflect a complete “soup to nuts”
approach in getting all ducks in a row and
leaving no stone unturned.
The field claim adjuster’s mission and
challenge is to use this book and any
checklist as a guide—but not necessarily
follow it in a robotic fashion. Good judgment means that, in some cases, not every
item on the checklist needs to be ticked off.
In other cases, there may be investigative
steps warranted that are not necessarily reflected in the checklist. One must always
be careful in approaching claims with a
checklist mentality. Checklists provide useful templates, but good judgment can and
should enter in as well, depending upon the
exigencies of an individual claim.
If a checklist embodies best practice
in claims investigation, then the adjuster
must be careful in deviating from the
template. In those situations, the adjuster
should clearly document in the claim file
the reason for omitting or deviating from
the checklist. Failure to provide such rationale in the claim file notes may come
Six Reasons that Claims
1 They often represent best practices.
2 They facilitate consistency in claim
3 They minimize the chances of adjuster
4 They encourage investigative
thoroughness, at the risk of overkill.
5 They are useful training tools for
6 They promote efficiency by not
reinventing the wheel every time a
novel case arrives in the claim office.
back to haunt the adjuster and his or her
employer. Here, it may be appropriate to
abide by the maxim: “If it isn’t document-
ed in the claim file, then it was not done
For a more thorough discussion on the
rationale and utility of checklists in pro-
fessional settings, I highly recommend
another book, The Checklist Manifesto:
How to Get Things Right, by Atul Gawa-
nde. While his focus is in the medical
realm, the book has implications for oth-
er professions as well, including but not
limited to insurance claims adjusters.
Kevin Quinley, CPCU, aIC, aRM, is the
principal of Quinley Risk associates, LLC.
He may be reached at email@example.com or at www.claimscoach.com