If Adjusters are from Mars then Investigators must be from Venus
Part 1 of 2
David M. Brani, P.E., Ph.D.
David Brani Engineering, LLC
During the course of claim investigations, many adjusters find themselves in need of quality forensic investigators to determine the ‘why” of something that happened to enable them to reach sound decisions regarding damages, coverage and potential subrogation. The initial relationship between adjuster and investigator is in many ways like starting a courtship. Neither the adjuster nor their retained investigator benefit when there is unnecessary drama or strife between the two. A long term working relationship is mutually beneficial to both. Yet, despite the good intentions of both, the relationship may end negatively.
In some instances conflicting personalities cannot be overcome. However, there are times when unrealized expectations are the culprit. Fundamental expectations are not met out of ignorance. As with dating, the phrase “adjusters are from Mars and investigators are from Venus” may come to mind.
This article attempts to teach Martian to investigators. A second article to follow looks at the language of Venusians. The hope is that both groups have a better understanding of the other to foster a positive working relationship.
Insights from Adjusters
Specific to this article, I interviewed insurance professionals for their insight as to what fosters a good working relationship. Topping the list for many was the desire for honest answers. A common pitfall is equating the term good news with a message that the insured was not at fault. As an investigator, what can be better than delivering good news. When warranted, nothing.
But adjusters find that some investigators will shy away from a critical assessment of the insured’s actions for fear of upsetting the adjuster. Instead of hearing the bad and the ugly from the investigator, the adjuster finds out from an opposing party – often at the expense of additional time and cost.
The adjusters surveyed value a candid assessment with straightforward and clear conclusions. Being well informed in a timely manner leads to the most expeditious resolution of the claim. For these adjusters, truly bad news for them is when an investigator fears that the adjuster will take personal offense to criticism of the insured.
A comment from one adjuster for this article was that he/she did not appreciate receiving “reports that are vague or ride the fence (we hire you for an opinion…give one!!!)”. At first reading, one may conclude this statement is reinforcing the negative connotation that an investigator is simply a “hired gun”. However, the correct takeaway is that adjusters hire experts to do the heavy lifting when the facts warrant.
Many investigators come from an engineering or other technical background where a team works collaboratively to resolve problems. Claim investigations that result in legal action expose the investigator to vigorous and often harsh scrutiny by opposing counsel and their experts. This combative aspect of the work may negatively influence some investigators in their decision making process. Concluding that there are no other parties technically culpable or that the cause of loss is undetermined removes the burden of having to defend one’s position at a later date. Simply invoice and close the file.
Frustration with report writing was another common thread amongst the adjusters surveyed. One criticism was reports that lacked a detailed basis for the conclusions or conversely, the inclusion of extraneous information. Adjusters expect details on “why the pipe broke” but do not want an essay on “the history of piping” especially if they perceive they are being charged for this history lesson.
Some adjusters express frustration with reports that require them to play the game of Where’s Waldo to identify the conclusions. One adjuster stated that some reports lack sufficient context for the reader. In particular, the writer presumes the reader has the same level of background knowledge as the investigator. Technical reports should be easy to follow and read, particularly when a claim appears to be headed towards litigation. The report will be read by a jury of ordinary citizens, many of whom lack the technical expertise to understand engineering theories.
Rounding out the responses of the adjusters I interviewed for the qualities they look for in an investigator are quick response time, open communications, including the ability to reach the investigator by phone when information is needed, the ability and willingness to testify at trial, and adherence to standard guidelines for the preservation of evidence and identifying other potential parties who may be responsible for or contributed to a loss.
Many adjusters have long standing relationships with experts they engage to conduct investigations of claims. When contemplating engaging someone new that you are unfamiliar with, take the time to interview the expert, request redacted copies of reports they have written in the past to assess the quality of their reports, discuss their willingness to and experience with testifying at trial, and request references from others they have worked with in the past. Affirm that they adhere to industry guidelines and best practices when conducting their investigation and they maintain the chain of custody during the investigation and storage of evidence. These pro-active steps have the added bonus of fostering a healthy dialogue between you and the expert.
Be prepared to accept the expert’s conclusions. If you have doubts about their conclusions, don’t be afraid to ask questions to clear up your concerns. Many investigations truly do result in a finding that the cause of a loss cannot be determined, particularly when the loss scene is so badly damaged you cannot identify the culprit of the loss. A healthy working relationship is a two-way street that begins with good communication and honesty in conveying expectations and facts discovered during an investigation.
This is the first article of the two part series. Look for the second part of this article which will discuss what investigators find both beneficial and frustrating when working for the insurance claim professional.
If you would like to contact the author for more information about this subject, you may call him at 678-549-0352 or e-mail him at email@example.com.