An insured calls to report a loss that appears to be questionable. What are the ethical responsibilities of an agent for this type of claim? Do the responsibilities differ if the producer is a broker? That’s the “Question Of Ethics” posed by NU columnist Peter R. Kensicki for his next piece, scheduled to appear in NU's Dec. 11 edition. Click ahead on this entry for more details and to respond--either right here and now, and/or for our print edition.
Feel free to respond to this question right here, on my blog (I'll forward your responses to our columnist), or to Professor Kensicki directly at ethics@eku.edu.
All responses for the blog and magazine column will be kept confidential (in other words, no names and no company affiliations will be published). All we ask is that you identify whether you are an agent or broker, insurance company official or risk manager, to give readers perspective about where you are coming from.
If you are responding directly to our columnist, please send your comments to Professor Kensicki by Nov. 1. His column is due to me shortly thereafter.
To read Prof. Kensicki's earlier columns this year and get a better idea how he works, click here, here and here.
Comments (4)
You educate the insured as to what is covered and what is not covered.
Then you ask the client to reconsider making the claim!
I then give them the "800" number to call back if they go ahead with the claim.
Posted by joe | October 10, 2006 11:51 AM
Posted on October 10, 2006 11:51
I am with Joe. If "questionable" is a nice way to say that the insured is attempting to commit a fraud, one cannot assist in the claims process, regardless of whom one owes a professional duty.
If there are truly issues of fact and causation, which can be argued in good faith, then one must advocate as appropriate.
Posted by James | October 10, 2006 12:21 PM
Posted on October 10, 2006 12:21
My insured came in the office a week before Christmas. He claimed that only his son's gifts were stolen, not anyone else's.
He said,when questioned, that it happened two days prior, and that he thinks entry was made in a basement window.
He did not call police because he didn't think they could be found.
When questioned how he knew that only his son's gifts were gone, he said his wife wraps all members in different colors. He was advised to call in the claim, but he refused. He thought we would write the draft in our office.
He let his policy lapse on renewal.
Posted by Ted Kluemper | October 11, 2006 10:09 PM
Posted on October 11, 2006 22:09
As an agent, unless you have 100 percent proof that this is fraud, you need to report the claim. Step back and let the company claims department do their job.
The companies usually think that all the agent does is muddle the claim. I used to feel differently about this, but I have had the companies burn me too many times.
If they had backed me up, maybe I would feel different. This is why the company has the big building and big staff
Posted by Anonymous | October 12, 2006 3:42 PM
Posted on October 12, 2006 15:42