Claims posts

Four challenges that insurers face when using artificial intelligence in claims
The use of artificial intelligence in claims represents a 'significant opportunity’ for the sector, said Ageas. It also introduces some slippery slopes, four of which I explore here.
Does this spell the end for insurance claims?
Aviva have a new system called Ask it Never, designed to eliminate the need to ask customers any questions when giving them a quote. The list of implications is impressive!
Could this be the Achilles Heel of Insurance Fraud?
Telling claimants that you’re collecting data to combat fraud, and then using it to optimise claims settlements, could turn out to be the Achilles Heel of insurance fraud.
Is this the most controversial claims innovation of all?
With claims optimisation, are insurers abandoning all remaining hope of sustaining trust in a digitised market? It is innovative, but hardly ethical.
Has the UK regulator got it wrong on big data?
The UK regulator of financial services has shelved its plans for a market study into the use of big data[...]
Does this claims practice represent an open door into a dark room?
At the heart of the training I deliver on conflicts of interest is this: a conflict of interest is a[...]
The wrong way to handle a conflict of interest
The ‘Ethics and Insurance’ blog has been a bit quiet of late, after my house was struck by lightening during[...]
A Disclosure Disruption for Commercial Insurance
Much of the attention being given to the impact that big data will have on insurance focuses on the personal[...]
The Pursuit of Non-Disclosure: a curious example from the life sector
Insurers are talking about significant levels of non-disclosure in life insurance, yet the message being conveyed has many layers to[...]
Weighing up the fairness of your claims service – pt2
In last Friday’s post, I outlined four dimensions of fairness that were relevant to delivering a service like insurance claims,[...]
How to weigh up the fairness of your claims service – pt1
Fairness is a complex thing. Insurance people often have a tendency to latch on to one way of looking at[...]
Ethical Awareness for Claims People – pt4 – Fading
Hindsight is a complex thing when it comes to ethics. You may look back at something you’ve done and have[...]
Is motor insurance becoming a magnet for enforced disruption?
The market for personal motor insurance is described by those on both the inside and outside as dysfunctional. It has[...]
Ethical awareness for claims people – pt3 – conformity
People have a tendency to think differently in a group than how they might do so when on their own.[...]
Ethical Awareness for Claims People – Part 2 – Attributing
At the heart of the role that claims people have lies the weighing up of a range of factors that[...]
Ethical Awareness for Claims People – pt1 – Framing
This is the first of a four part series of posts looking at ethical awareness for claims people. In each[...]
Name and shame: an effective response to misconduct?
When there has been misconduct at an insurance firm, how would you feel about the names of the individuals involved[...]
The top posts on the ‘Ethics and Insurance’ blog – 2015
What have been the most popular posts on the ‘Ethics and Insurance’ blog? Here is a quick look at the[...]
Why corporate social responsibility is failing to build trust in UK insurers
Two thirds of people will repeatedly buy from companies that are socially responsible. So said a leading figure in the[...]
Pre-approved insurance – what are the implications?
How might consumers react to recent signs of insurance being offered on a pre-approved basis? Is there a sense that[...]
What lessons should insurers learn from the VW scandal?
The scandal currently engulfing the car maker Volkswagen will undoubtedly feature in many an ethics course for years to come,[...]
A revealing window into insurer thinking on big data
A recent conference on 'big data and insurance' opened a window into the UK insurance sector's current thinking on what[...]
Why story telling is vital to delivering the new conduct standards
The first of the new conduct standards for insurers being introduced by the UK regulator from March next year is[...]
The dangers of unintentional discrimination
There’s concern that insurers’ use of big data will result in some sectors of society suffering discrimination. Data mining could[...]
Medical records and consent: a time for change
The UK data regulator’s recent warning to UK insurers to keep within the law when seeking access to a proposer’s[...]
How ethical is it for firms to demand payments from a supplier?
Earlier this year, a survey by the Federation of Small Businesses found that 5% of businesses had been asked by[...]
How to start getting results from ethical due diligence
The UK insurance sector has been told in no uncertain terms that it isn’t doing enough ethical due diligence. The[...]
A confrontation over insurers’ right to know
The trade body for UK doctors has recently issued revised guidance to its members about requests from insurers for copies[...]
Why that magic element of big data could be fatal for insurers
Earlier this year, I wrote a post called ‘Data, Equality and Insurance’, about a small survey that I’d undertaken into[...]
Big data: has the Financial Ombudsman missed something significant?
The Financial Ombudsman Service (FOS) has been weighing up the implications that big data will have for its work. And the[...]
Ethics and Loss Adjusting pt3 – negotiating on a slippery slope
Loss adjusting firms sit in the middle of complex supply chains, surrounded by insurers, brokers, contractors and the like. Appointments[...]
Ethics and Loss Adjusting pt2 – the Fairness of Settlement
There’s one question that every policyholder has in mind when discussing their claim with a loss adjuster. It’s a question[...]
Data, Equality and Insurance: a small survey
The insurance market is entering a new phase, in which underwriting and claims practices are being transformed through access to[...]
How ethical is intermediation?
Is intermediation ethical? This was a question put to me at a recent insurance event I was speaking at. It’s[...]
Ethical nudges and their role in tackling insurance fraud
It's common now when taking out an insurance policy or reporting a claim, to be greeted with a warning about[...]
Four lessons insurance firms should learn from the Wonga affair
Big data could revolutionise a firm’s understanding of its customers. Yet it could also blind the firm to common sense[...]
Proportionality and the Ethics of Private Investigations – Pt 2
Insurers’ use of private investigators has been criticised for being “aggressive and inappropriate”. In response, their trade body, the Association[...]
Private Investigators : 2 ethical issues that need extra attention from ABI members
Insurers in the UK now have new guidelines on the instruction and use of private investigators. While the guidelines have[...]
Social Sorting: could it be the stuff of nightmares for insurance firms?
Privacy is an ethical issue that the UK insurance sector often thinks about, usually in terms of it being something[...]
Conflicts of interest: a challenge for more than just insurance brokers
Conflicts of interest have been in the ‘insurance news’ a lot recently, chiefly because of the UK regulator’s review of[...]
Why data is the key regulatory challenge in financial services
Data is the key challenge facing the regulation of UK financial services. So said a representative of the Prudential Regulatory[...]
Disclosure: something that’s inevitable for insurers and brokers?
Transparency is an integral part of how trust is established and sustained. Being open with someone about something that’s relevant[...]
Are independent ethics committees valuable or window dressing?
What makes an ‘independent ethics committees’ work? Can they act as an effective counterbalance to business ventures that operate close[...]
How to manage your conflicts of interest much more effectively pt2
In an earlier post, I looked at the first of two problems I often encounter when reviewing how insurance firms[...]
Please don’t talk about data misuse! …and other ambiguous terms.
The language we use when talking about an ethical situation is important. Words can sometimes convey more than their simple[...]
Aviva’s data theft response is revealing
Aviva's handling of the news of an apparent data theft by two of its own employees has been revealing. Some[...]
A critical step for everyone investigating insurance fraud
How's this for a proposal? It should be mandatory for everyone involved in the investigation of insurance fraud to pass[...]
Warnings from South Korea: the impact privacy can have on insurance
Back in 2012, I singled out privacy as the number one ethical issue that will confront the insurance sector over[...]
Who is the fairest of them all? How to use fairness to weigh up choices. pt2
If, as the UK regulator emphasised recently, fairness is to be the dominant theme of 21st century financial services, how[...]
Two simple tests for deciding on the fairness of your decision. pt1
‘Fairness’ crops up a lot in insurance regulation – the chief executive of the UK regulator said recently that the[...]
3 big ethical questions that motor claims directors need to answer
3 ‘distinctly ethical’ questions stand out from the provisional findings of the Competition Commission’s investigation into the UK private motor insurance.
How to avoid crashing your ethics metrics in 2014
As many of us approach a new business year, make sure the metrics you're going to be using for ethics deliver the insight your firm needs.
Conflicts of interest – are you ready for 2014? It’ll be busy!
Conflicts of interest look to be the big ethical risk for insurance firms in 2014. How are your firm's being handled? Here are 8 steps to get you started.
Three warning signs that a firm is struggling with its ethical ‘tone from the top’
Delivering an ethical 'tone from the top' can be a challenge at times for some business leaders. So what are some warning signs to look out for?
Insurance, data and a politician – a cautionary tale about privacy
How one insurance organisation got into hot water when it released claimant data that it thought had been suitably anonymised.
Ethics training: rounding off 2013 and planning for 2014
People working in the UK insurance sector are wanting more training on ethics and the ethical issues that matter most to their work. How can firms respond?
Has the investigation of insurance fraud suffered from too much ‘group think’?
UK insurers are failing to exercise proper control over their investigation of insurance fraud. Could too much 'group think' have been responsible?
A revealing window into the ethical culture of UK loss adjusters
If there’s a ‘stigma’ attached to a loss adjuster working for the policyholder, what does that say about the ethical culture of loss adjusting firms?
Insurance and Innovation – Part 2 – why ethics is a vital ingredient
If a firm's corporate culture doesn't emphasise the importance of ethical behaviours, then their capacity for innovation will be diminished. Here's why.
Ethics, Insurance and innovation – Part 1 – why change seems inevitable
With insurers under a lot of pressure to reform their claims operations, could the ethical culture at a firm contribute towards its capacity for innovation?
Why underwriters need to use predictive analytics with care
What are the ethical implications of insurers using predictive analytics for underwriting purposes? There's a clear line that underwriters should not cross.
One vital rule for insurers to remember about predictive analytics
Predictive analytics offers many benefits for insurers, but there is one vital rule that must never be forgotten, especially with regard to potentially fraudulent claims
An Inconvenient Truth coming out of FCA Thematic Reviews
Is the FCA's use of thematic reviews taking control of the setting of best practice standards within the insurance and financial planning sectors? And if so, should those sectors accept this?
Ethics and Claims – 5 big issues Insurers should Focus on
Claims departments are under pressure to reform how they work. Here's why they need to stand back, see the bigger picture and reflect upon why they do what they do.
How watertight is the Flood Insurance agreement for consumers?
The new agreement on flood insurance in the UK is a step in the right direction, but it does raise several questions as to its fairness.
It’s good to talk – using ethical dilemmas as part of your training programme
Encouraging staff to talk about their firm’s values is one big gain from using ethical dilemmas in training, but there are other gains of much wider impact for the business.
The new uncertainties that anonymised data will introduce
How insurers use anonymised data has clear ethical implications, as well as risks that could trap the unwary and lead markets astray.
The ethical minefield that is anonymised data
The way in which insurers handle anonymised data can raise all sorts of ethical questions, with implications for policyholders, underwriters and regulators
Ethics and insurance claims – part 5 – the pivotal role of ethical culture
Part 5 in my series about ethics and insurance claims. Ethical culture is at the heart of how staff engage with claimants and determines the conclusions about fairness and trust that claimants are left with.
Ethics and Insurance Claims – Part 4 – the balancing act that is Privacy
Balancing openness and privacy can be a delicate task for claims departments, but it’s a crucial one that benefits us all, as individuals and businesses.
Ethics and Insurance Claims – Part 3 – mapping the layers of conflicts of interest
For the insurance sector, being in a conflict of interest is like having the flu – there’s nothing unethical about it; it’s just something that happens to us all. So the ethical question to be addressed is not how you avoid conflicts of interest, but how you recognise and respond to them.
Ethics and Insurance Claims – Part 2 – Getting Compensatory Justice Right
Insurance is an important part of how compensatory justice is delivered, but there are big ethical implications if this is not done efficiently and fairly.
Ethics and Insurance Claims – Part 1 – Information Asymmetry (2 of 2)
In the second post about ethics, claims and information asymmetry, I’ll look at some examples and outline how insurers can take some first steps to managing it.
Ethics and Insurance Claims – Part 1 – Information Asymmetry (1/2)
This is the first in a series of posts about the ethical issues associated with insurance claims. I’m going to start off with what is probably the most significant of all such ethical issues, information asymmetry.
The key ethical issues associated with insurance claims
Insurance claims are pivotal experiences in the relationship between the insurer and the policyholder. In a series of posts, I'll be exploring the key ethical issues associated with insurance claims, starting this week with information asymmetry.
Some Thoughts on the FCA’s Thematic Review of Personal Lines Claims
News that the FCA is considering a major review of how personal lines claimants are being treated could have all sorts of ethical repercussions.
Windows are opening into the Ethical Culture of Insurance Claims
Could insurers' reactions to a recent survey of policyholders' experience of personal lines claims services open a window into their ethical culture?
Getting serious about assessing your firm’s ethical risks
A structured approach to assessing ethical risk that recognises market, firm and employee driven issues will help you focus more on underlying causes.
Pitfalls to avoid when measuring ethics
Measuring ethics is tricky, but necessary. Here are some of the pitfalls that measuring ethics can encounter, during the design, implementation and use phases.
Ethical culture and the mindset of claims handlers: definitely one to watch
The mindset of claims handlers can speak volumes about the ethical culture of their firm. And the ear of the FCA is starting to tune in. Here's why.
12 questions an insurer needs to ask about their use of private investigators
The FSA is reviewing how well insurers have been managing private investigators. Here's a quick checklist to help insurers do a quick assessment of where they stand.
Are there ethical lessons that adjusters can learn from auditors?
How auditors have been grappling with ethical issues like conflicts of interest could be a learning experience for loss adjusters.
6 places a claims manager should look for ethical risks
You're a claims manager tasked to 'do something on ethics in 2013'. So where do you start looking for ethical risks associated with how your people work?
How insurance history could have been different if ethics had been measured
Four examples of how insurance history might have been different if ethics had been measured. Time now for your firm to adopt some?
Ethical Dilemmas – challenging, interesting, important
It may be tempting to ‘learn as you go’ when next faced with an ethical dilemma to resolve. Here are three reasons why some preparation is worthwhile.
Having a business objective for ethics says a lot about your firm’s ethical culture
A recent study indicated that most insurers fail to set a business objective for ethics, yet to do so is a key indicator of a firm's ethical culture.
Just how Ethical is Contribution?
How ethical is it for an insurer to seek a contribution from other insurers on risk for the same claim? There’s more to it than meets the eye.
Ethics Ebooks available for Free Download
I've published some ebooks on topical ethical issues for insurers, available for free download at my consultancy website. They cover consent, privacy and insurance fraud. Enjoy them!
Privacy and Consent: some examples for a proactive insurer
Insurers need to challenge engrained thinking about consent to reflect the new regulatory and reputational landscape. Here are some examples for a proactive insurer to get started with.
Privacy, identification and the need to know: who decides?
As many firms accumulate data about us to build a competitive advantage, the question of their right to know versus our right to privacy comes to the fore.
Privacy and Identification – pt4 – we all like to put our best side forward
Identification is one of the key privacy issues that insurers need to attend to. It is however perhaps the most difficult one for them to get right. Here's why.
Privacy and Surveillance – pt3 – insurers need some mutual self insurance
How well have insurers been managing the balance between the privacy concerns that surveillance can give rise to and the need to effective counter fraud measures? And what's in it for the insurance sector for doing so?
Privacy and Surveillance – pt3 – a balancing act
Surveillance is one of the key privacy issues that insurers need to pay attention to. In this post, I’ll outline why surveillance can be so unsettling and later this week, set out why it’s an issue that insurers need to manage carefully.
Privacy and Secondary use pt2: referral fees and slippery slopes
Secondary use has been a problematic ethical issue for insurers, causing the motor market to be labelled as dysfunctional. It creates a tension for insurers that needs to be resolved in order for trust to be rebuilt.
Privacy and Secondary Use : pt1 : Context, consent and control
It's with secondary use that the UK insurance market has had most privacy problems in the last year or two. The first of two posts explaining why.
Privacy and Aggregation pt2 – ethical challenges for claims managers
In this second post about the aggregation of data, I look at the ethical and operational challenges it throws up for the insurance sector
Do the parts always add up? Privacy and Aggregation pt1
What privacy issues are policyholders most concerned about? In this short series, I begin with aggregation.
Insurance and the Privacy Controversy
Over the next 5 years, I believe tensions between the insurance industry and the general public around privacy issues will grow to be as controversial as the misselling of payment protection insurance is today. This is the first of a series of posts exploring privacy and insurance.
Privacy: did this insurer go too far?
Insurers have to maintain public support for their crackdown on insurance fraud. That means avoiding surveillance practices like this one.
A grim tale about motor insurance and ethics
This grim tale from the US motor insurance market should serve as a reminder that every decision made in business is in some way ethical.
Flood, fairness and risk assessment – pt3
If a policyholder takes steps to reduce the risk, surely that's a good thing. This doesn't seem to be the case with flood insurance. Insurers want to rely on big structural defences. It's an approach inherent with dangers, not least that it might not work.
Great to see launch of the Insurance Fraud Register, but …
Today's launch of the Insurance Fraud Register represents a big step for the UK insurance sector, not least in how it has to now deliver a necessary service in a fair and transparent way. Several issues have clearly been resolved, but others remain to put support from the public at risk.
Parliament urges greater scrutiny of how insurance fraud is investigated
If the recommendations of a recent report by an influential group of UK MPs are adopted, the way in which insurance fraud is investigated will come under heightened public scrutiny
Might egocentrism affect judgements about insurance fraud?
How should insurance fraud investigators handle everyone's innate tendency towards egocentrism, especially when deciding on fraud cases outside of the court system?
Can you ever get enough risk data from Telematics?
How much can we expect from telematics? Some huge claims are being made for it, but a short cast back in history shows why expectations need to be cooled.
Motor Insurance and Fairness
The practices described in the recent OFT report into motor insurance may well have led to all sorts of unintended consequences for insurers. A couple are outlined here, along with some thoughts relating to a central issue for consumers: fairness.
How wide the Code?
Should a code of ethics refer to sustainability issues like the environment and supply chains? It can get a bit complicated...
More on OFT, motor & ethics
A more detailed analysis of the ethics of what the OFT found when investigating motor insurance claims. Are referral fees unethical? How did corporate cultures appear to leave ethics by the wayside? The FSA and MoJ have some questions to ask, of individuals, insurers and themselves.
OFT’s motor report
The OFT's report into UK private motor insurance makes for grim reading. It turns a spotlight onto practices that range from the dysfunctional to the wholly unethical.
Telematics – pt3 – fairness
If insurers become the lead provider of telematics technology, then spin-off services could produce all sorts of unintended consequences, particularly around the public's view of fairness.
Telematics – pt2 – the ethical upside
Telematics certainly raises some ethical concerns, particularly around privacy. It does however have an important ethical upside.
Telematics – pt1 – data
What should insurers do to resolve the question of who will own the data created by their use of telematics in products like motor? One particular step might make a real difference, if handled properly.
Ethics and Fraud – pt2
The second of two posts about the ethical dimension to how insurance fraud should be tackled. Insurers need to look at these six themes as a step towards securing the long term support of consumer groups, and the public at large, for this important initiative.
Ethics and Fraud – pt1
Tackling insurance fraud is an ethical thing to do, but the way in which insurers go about tackling it also has an ethical dimension. In this and a subsequent post, I set out the key themes around which a set of principles could be fashioned to embed some ethical thinking into how insurers tackle fraud.
More on Insurance Fraud
A delay in the launch of the Insurance Fraud Register should allow time for some key issues to be resolved. Heading up that list is consumer representation on its governing body.
Dangerous add-ons
Those selling insurance add-ons need to remember the lessons from payment protection insurance. This policy has its opt-out so hidden that it deserves investigation by the regulator.
Ethics and Information
As three insurers plead guilt in an Irish court to having information obtained illegally by a private investigator, is it now time for the insurance sector to see a clearer and stronger tone from the top to drive out these practices once and for all?
The IFR and defining fraud
Are insurers really going to launch a national database of proven fraudsters without agreeing what they mean by fraud first?
What is ‘proven’ fraud
The Insurance Fraud Register will be a national database of 'proven fraudsters'. So what is meant by proven and who decides that?
Informed consent
Does informed consent apply to insurance? How much should insureds know about what the insurer gets up to after the declaration has been signed?
Motor and the OFT
UK motor insurers are using a business model that is ethically dysfunctional. The recent OFT report is a precursor to demands for some significant market reform.
Adjusters & conflict – part4
Some thoughts on what a loss adjusting firm (and others in the insurance market as well) can do to improve their handling of conflicts of interest
Tracing an EL insurer
EL insurers need to be much more proactive in responding to claimants searching for details of their employer's EL policy. That’s what acting with integrity is all about.
Adjusters & conflicts – part1
Conflicts of interest have been a divisive issue for the loss adjusting profession in recent years. I explore the issues in a short series of posts. Part 1
Values at the IFB
The Insurance Fraud Bureau needs to reconsider its values and put some honesty and integrity into them
Investigating Claims
The insurance sector needs to take great care in how it manages the use of private investigators on potentially fraudulent claims, otherwise it could find its ethics sliding down the same slippery slope as the media
Corporate Litigation Funding
Do senior directors in the insurance market understand what conflicts of interest really are? There are lessons to be learnt from Allianz's venture into corporate litigation funding.
Bribery – the big risk for insurers
The Bribe Payers Index highlights the risks insurers face from bribery on construction projects
RSA and repair costs
When a leading UK insurer is accused by a judge in court of artificially inflating costs and introducing ficticious charges,[...]
Credit Hire Conflict
Credit hire companies are having a difficult year. The collapse of Brittannia Car Hire Services and financial problems at Helphire[...]
Information exchange
The increased attention being given to insurance fraud has led to calls for greater exchange of information between companies in[...]
AIRMIC and the model clause
It’s been a few years now since I was a member of AIRMIC. Their recent announcement of a model clause[...]