trial, recording what witnesses said.
What new tools may prove helpful in
the adjuster’s trade? One increasingly important tool is a drone, capable of taking
photographs of almost anything that might
be important in a claim, but which would
be difficult to capture from the ground. It
might be anything from a close-up of some
flaw that allowed something to collapse, or
it might be a busy intersection that would be
impossible to fully assess from the sidewalk.
Attorneys also have recognized that “
social media” is a great source of information,
and may subpoena everything from corporate emails to personal messages that reveal
what the sender was thinking. Facebook
comments can become evidence and are
available without a subpoena.
Using initiative to find new ways to
document claims is an ongoing effort, but
it must be done ethically. The old trick of
letting air out of a claimant’s tires in order
to film him jacking up the car was and
remains unethical. Yes, courts have ruled
that the defendant has a right to follow and
investigate even a represented plaintiff, but
it must be done in an ethical manner. The
fact that Joe is claiming a disability does not
necessarily mean that he has to spend every
minute in bed, except while at the doctor’s
office. Adjusters may need to be nosey in
order to find out what they need to know,
but must do it in a legal and ethical way.
“Winning by the Rules” says, “The insurance specialist cannot simply be a fill-in-the-blanks and pull-the-handle type
of employee. She [or he] must take the
initiative to complete the task… and the
responsibility for a correct outcome. That
requires ingenuity, intelligence, imagination and fortitude.”
Ken Brownlee, CPCU, is a former adjuster and risk manager based in Atlanta,
Ga. He now authors and edits claims-adjusting textbooks. Opinions expressed
are the author’s own.
The Ethics of Ingenuity
Over the last five decades, major changes in the way property, casualty and marine claims are investigated have undergone
many developments. Telephone adjusting
arrived in the 1960s, once courts permit-ted telephone statements taken with permission to be admitted as evidence.
In the 1970s, there were new ways of
settling claims, like “open-ended releases”
and the use of rehabilitation. Auto damage appraisals came into being despite automobiles becoming more complex. This
eliminated the potential fraud in “send in
three estimates” adjusting. In the 1980s, as
the personal computer was just beginning
to show up on adjusters’ desks, new methods of claim resolution such as structured
settlements, came into being. Suddenly,
adjusters spent more time at their desks
than out in the field investigating claims.
The 1990s brought more changes with
increased use of the internet, integrated
computerized photography (for showing
hail damage on roofs), medical cost con-
tainment procedures, and similar claim-
related processes. By the 2000s the num-
ber of field adjusters started to decrease,
and long-distance claims handling in-
creased. Claims being handled “off-shore”
from Asia or elsewhere was already being
tested. Many important innovations in-
cluded team and computerized claim han-
dling, and pre-approved repair facilities,
but whether these really enhanced the
quality of claim settlement is debatable.
Looking for new techniques
Use of the internet may be a good source
for useful data like court records. “When it
comes to claims investigation,” suggests Matthew J. Smith of Smith, Rolfes & Skavdahl
Co., “click your keyboards instead of your
heels.” Discussing fraud investigation, Smith
considers the electronic trail of funds transfer
as a source of information. But over-reliance
on data comes with a built-in hazard; data
may or may not be accurate, and making decisions on inaccurate data can be dangerous.
Nothing beats a good photograph of the
evidence. The camera has been an adjuster’s
tool for probably more than a century, and
there is an art to taking the right picture in a
correct and documented way. In the last 30
years additional photography has become
available through closed-circuit television.
Such filming may show accidents as they
occur, or a still from a CCT may identify a
car or person. As television news programs
began “on the scene” interviews at accidents and crimes, their video films became
evidence that might be used as res gestae at
Editor’s Note: This is the fourth article in a six-part series on adjuster ethics.