Claims is changing in all sorts of ways. Ethics features in many of them. Where do you want to start?

Choose from one of these 'ethics and claims'  themes. If you just want to browse, click here, or use the search box below.  


Accountability

Insurance claims is changing. New technologies and new business models are presenting strategic opportunities that firms are pursuing with enthusiasm. Yet this reshaping also presents new challenges to the accountability of claims professionals. 

Find out what the issues are...

The Liberty Mutual fine raises important goverance issues for claims people (article)

The Great Accountability Challenge - looks at 7 issues raised by digitisation (article)

Accountability in an era of algorithm driven insurance – between a rock and a hard place? (article)

And do check out the '20 changes' guide opposite. It points to where the accountability challenges are to be found.  

ethics of insurance claims

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Some Insight on Accountability in Claims

Claims is changing, and it will continue to change for some time. The big question is how those processes of change are overseen. The Liberty Mutual case put the insurance sector on notice that long standing laws and regulations are not ignored in the race to innovate.

This means knowing the right questions to ask about the ethics of insurance claims, and then being able to pick apart the answers and judge their adequacy. And claims directors will find that they are expected to both provide those answers to their board, and ask those questions of their suppliers. Ethical due diligence is becoming the norm.


Fairness

Fairness is both simple and complex - everyone has a sense of what it feels like, but many find it difficult to explain in operational terms. My work with claims teams has helped them give voice to fairness, as well as to understand how others might approach it. One regular theme has been the 'thinking patterns' that make it difficult to see fairness in everyday claims situations. 

Find out what the ethical issues look like...

How to weigh up the fairness of your claims service (article)

And these four articles look at some of the challenges that claims people can face in everyday decision making...

  • Part 1 – Framing (article)
  • Part 2 – Attributing (article)
  • Part 3 – conformity (article)
  • Part 4 – Fading (article)

Some Insight on Fairness in Claims

Claims is where trust is won or lost. And the language of trust is centred around fairness. So what evidence are you collecting to show that your claims decisions are fair? What analysis are you doing to identify pockets of potential unfairness? Don’t be lulled into a false sense of security by a high net promoter score. It tells you little of what claimants can experience. Remember that about 20% of claimants feel like complaining at some stage during the claims process.

Client Project

A client wanted assurance that its front line people knew enough about the ethical issues that mattered most, so I created a tiered set of assessments with feedback on each question and some multi-level ethical dilemmas as well. The outputs highlighted where gaps existed and allowed extra training to be provided where it was needed most. It also gave them an evidence trail for how those ethical issues were being addressed. 


Data and AI

The use of data and analytics in claims represents a 'significant opportunity’ for the sector, said one leading UK insurer recently. And expectations that artificial intelligence (AI) will produce insight and cost savings in claims management are running high. Yet AI could also introduce some slippery slopes that claims professionals need to keep a close eye on. 

Find out what the ethical issues are...

Four challenges that insurers face when using AI in claims (article)

20 Changes that Influence the Ethics of Insurance Claims (article)

Does this spell the end for insurance claims? (article)

Watch out for more articles on this during 2019.

Some Thoughts on Data and AI in Claims

The automation and analytics being introduced into claims processes are certainly clever stuff, yet might they also undermine a key requirement, for each claim to be weighed up on its individual merits. The algorithms at the heart of analytics work on statistical correlations, and while these can bring great insight into the process, they can only do so reliably on the group level, not the individual level. Remember that you can quote someone an outlier price, but you can’t offer them an outlier settlement. You have to offer them their settlement.   

Claims - the beginning of a new era

Click on the guide to go to the CII download page 


Fraud

Tackling fraud is an ethical thing to do. It penalises those who commit it, deters those who are tempted by it and benefits those who never would have thought of doing it in the first place. But the ethics of claims fraud don’t stop there, for how you tackle fraud also has an ethical dimension. 

Check out the guide opposite for the big ethical questions facing insurance fraud. And then have a look at this blog posts...

Ethical nudges and their role in tackling insurance fraud (article)

Proportionality and the Ethics of Private Investigations (article)

Could this be the Achilles Heel of Insurance Fraud? (article)

Should insurers share claims data to make their systems more accurate? (article)

insurance fraud

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private investigators

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Optimisation

As claims people use more and more data to help them understand claims and tailor services, opportunities to innovate are presenting themselves. And one that is now emerging involves the optimisation of claims settlements. In other words, using a claimant's "willingness to accept". Claims professionals should be aware of the ethical risks that this controversial practice introduces. 

Find out what the ethical issues are...

Is this the most controversial claims innovation of all? (article)

Could this be the Achilles Heel of Insurance Fraud? (article)

7 reasons why claims optimisation needs to be seen as a failure (article)

These are challenging posts, in which I do not pull punches. Yet it's vital that claims people weigh up these practices with their eyes wide open. It's what a critical friend is there for.


ethical risk assessment

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Some Thoughts on Optimisation in Claims

Allowing ‘willingness to accept’ to influence the settlement calculation introduces new and significant exposures to the accountability of senior claims people under the UK's Senior Managers and Certification Regime. And that is accountability on both the individual and corporate levels. I’ve seen optimisation dressed up in various ways by suppliers, yet in every case, they were clearly leveraging characteristics that could make a regulator’s eyes pop out. Some say it's where data and fairness meet, but what if it's more of a collision?


I help claims people to understand more about ethical issues so that they can make better decisions...

I help insurers build a clearer picture of the ethical landscape that surrounds claims. This improves their focus and allows them to set better priorities. Decisions are improved and customer experience enhanced.

I often act as a critical friend during reviews of claims processes, helping to highlight the ethical potholes in the customer journey. These discussions help your people see things differently

Claims is changing in many ways. However, what 'could' be done is not always what 'should' be done. I bring an ethical perspective and a reputation for pragmatic foresight to your claims planning process. 

The next few years will see a renewed emphasis on due diligence in claims supply chains. Of course they’re all good people, but how are they looking after your responsibilities for integrity and fairness?

If you'd like an informal chat about how I might help your firm, get in touch via the contact form below

ethics and claims

A Good Read

The 'Blind Spots' book by Ann Tenbrunsel and Max Bazerman is worth reading. It explores why we sometimes do, and sometimes don't, make ethical decisions. Their findings would be of particular interest to people engaged in delivering business standards in insurance claims.

Any Questions? Get in touch...