Ethical Awareness for Claims People – Part 2 – Attributing

  • 28 January 2016

At the heart of the role that claims people have lies the weighing up of a range of factors that will have contributed to the loss being claimed for. Some of those factors will relate to the claimant themselves: do they seem honest; did they take reasonable care; are they being open with me about their claim? And in judging the claimant in this way, claims people have to take care that they do not fall into a trap that we have all encountered in some form or other.

The trap is to judge someone differently than we would judge ourselves. We have a tendency to take what are called ‘situational’ factors into account when judging our own behaviour, but tend not to do the same when judging the behaviour of someone else. So for example, that driver overtaking us is going too fast and driving dangerously, but when we find ourselves driving just as fast, it’s for a reason that we see as worthwhile (such as being late to catch a train) and anyway, we’re better drivers than they are. But then, who knows whether that driver might have been rushing his wife to the local maternity unit?

Quick to judge the character

What this adds up to is a tendency to be quick to judge the character of a person, without waiting, or trying to find out, the situational context for what they did or how they behaved. Those ‘situational’ influences are downplayed, replaced instead to judgements of character – “they must be a bad person if they did that”. This is not to say that what they may have done can be excused, but it does help explain why they did it. And in insurance claims, that explanation might be crucial for the outcome of their claim.

Claims people have to bear in mind that most claimants know little about insurance or about making a claim, that claims are often messy things, and that what a claimant did in reaction to a situation may often be far from straightforward, in comparison to what someone looking at events in hindsight in an office. Claims people should guard against too readily ascribing outputs to the character of the claimant, rather than the circumstances that the claimant found themselves in.

This is particularly the case when investigating cases of potential insurance fraud. It’s all too easy to enter a frame of mind that ‘sees’ characteristics of fraudulent activity and so arrive at a judgement on a case without spending all time or money establishing the full details. We all attribute motivations to the every day actions of people around us, but at work, the claims professional is under an ethical and regulatory duty to treat the claimant fairly, even when their claim seems dubious.

Steps insurers can take

It’s difficult, of course – the claims person is sitting in an office, never having seen or met the claimant. All too often, they have to rely on a telephone conversation or two with the claimant, with all the emotional complications of loss, power and money at work there. To help their people in such circumstances, insurance firms can take steps such as these:

  • teach claims people how to think like claimants. By putting themselves in the shoes of the claimant and envisioning the pressures they may have faced, this helps tune the claims person into more of the situational factors at play, rather than just relying on remote character judgements.
  • remind claims teams that correlation is different from causation – just because an earlier claim like this was fraudulent doesn’t mean this one will be fraudulent too, even if they shared several common features.
  • encourage an open culture that supports dialogue and challenge around claims. This helps reduce any drift towards ‘group think’ and the tendency to judge a claimant as “another one of those”.