As the recession bites, sales of protection products may fall and claims may increase. Ann-Marie Dec and Jill Harvey ask if talking to customers is the solution.
Protection product sales have already been affected by the economic downturn, prompting insurers to ask what they can do to attract new customers and to retain policyholders.
There is no doubt insurers have been the subject of criticism and poor publicity in respect to declined claims over recent years which has greatly affected consumer confidence in protection. The Association of British Insurers (ABI) and providers are working hard to improve that position by embracing the ABI Statement of Best practice for non-disclosure. But, in order to further restore customer confidence, insurers should strive for impeccable customer service to differentiate themselves to potential customers. This is especially important at the claims stage.
So, how can tele-claims help with customer service? It seems strange that when customers are at their most vulnerable, in ill health or injured, insurers display a lack of empathy by simply sending a form to fill in.
For claimants with income protection (IP), critical illness or total and permanent disability policies, there are a host of difficulties with the form-filling approach:
it is impersonal at a potentially difficult and emotional time; it can be stressful when ill
to concentrate and write factual descriptions meaning that information can easily be forgotten; claimants may not understand what is required, not knowing what detail to give and how much background is needed; and they may be alone with no one to assist with the process. The result of this insensitive approach is a poor ‘relationship' between the claimant and the insurer and any negative prejudices may continue to fester or be cultivated further.
Tele-claims could not be more different. When a customer makes a claim, an interview tailored to their circumstances is carried out over the phone. A friendly and empathetic nurse can guide the claimant through the process and, at the same time, obtain a clear picture of the claimant's position for the insurer. A report is produced that records the questions and answers. This is then provided to the claims assessor who can make a sound and fair assessment. The report can also be provided to the claimant if the insurer chooses to do so.
- As well as being a far more compassionate approach, there are additional benefits to the process for the insurer and claimant:
- A faster process as a tele-claims interview and report can be completed in a few days
More information can be discussed during an interview so the insurer alleviates any allegations of ‘fishing' for unrelated information
Less reliance on expensive home visits
- It is a methodical process that overcomes the problem of incomplete claim forms
- A thorough process that obtains full information relating to the claim.
In addition, the tele-claims method is an interactive process. The claimant is able to ask any questions they like and the insurer can give guidance on how the claim will progress.
Tele-claims is not a new method and several companies have developed successful in-house approaches. Specialists such as MorganAsh and Scor Global Life have created services providing enhancements that most claims departments would not have access to. This includes qualified nurses experienced in conversation management and tele-interviewing, and detailed scripts covering every aspect of the claim, including bio-psycho-social angles to give a full understanding of the claimant's circumstances.
These services also have the advantage of giving the claimant the chance to talk to an independent nurse not connected to the insurance company.
Tele-claims questions are tailored to the particular insurer, product and nature of claim but, in principle, will cover:
- Personal identification
- Lifestyle in simple form
- Medical condition
- Social situation; help available, motivations, support needed
- Financial position if relevant.
A key aspect of the interview is the manner in which claimants are managed and guided through the questions. Equally important is the rapport built with the claimant and active listening skills are used to capture the information volunteered.
Improving Public image
The interviews cover sensitive information and often take place at a difficult time for the claimant which is why an empathetic approach is appreciated.
Tele-claims is not just a customer-service benefit. Although paramount to clients, in times of recession when claims are likely to escalate, any service has to do more than provide excellent customer care.
As more information is received through tele-claims interviews than from traditional claim forms, many claims can progress without the need to gather further information, saving time and considerable costs.
The interactive process allows the claimant to understand the assessment procedure and the conditions of the policy better. Claimants often form their own conclusions if their claim will not progress and many withdraw them. This has the benefit of saving costs and, more importantly, reducing the amount of declined claims which is invaluable in times when customers may seek to compare insurers' claims statistics.
With more accurate information about the claimant's circumstances and the bio-psycho-social aspects of the claim, an assessor can triage it to determine if it is likely to be valid and, if so, whether payment can be expedited or whether more intensive investigation is required. In the case of IP, the call will gain all the information required to know whether rehabilitation or some other type of flexible claims management solution might be appropriate. The savings insurers can make through achieving an early return to work can be significant.
Tele-claims can also help identify non-disclosure and ensure that full details of any claimed condition not previously disclosed can be gained. It is better to gather the information as a natural part of a conversation rather than later in the process.
The ABI recently warned of an increasing number of fraudulent claims on general insurance. The tele-claims approach can be an excellent way to identify exaggerated or fraudulent claims as it is more difficult to fabricate facts to a person over the phone than it is to write them down on paper forms when there is more time to consider responses. With detailed questions and a rapport built, it is difficult for a claimant to use guarded answers.
Getting to the truth
Conversation management techniques and paralanguage assessment can be used to detect inconsistencies or situations where the claimant is not providing a complete picture during the interview. By subtle prompting, the interviewers can get to the facts and reduce inconsistencies in the claims interview report. Where inconsistencies are not overcome during the interview but are suspected, the appropriate forensic investigations can be quickly instigated. All calls are recorded and archived so that they can be accessed at any time.
The financial benefits are significant and can be summarised as:
- Less invalid claims are paid
- Higher detection of fraud and/or non-disclosure
- Timely identification of claims suitable for rehabilitation can reduce long-term IP claims
- Fewer intensive investigations required
- Claims reserves can be reduced
- Improved claims processing reduces administration costs
- Fewer nurse claims visits and doctors reports are required
- More claims withdrawn, saving on claims administration time
- Less conflict and less complaints with the Financial Ombudsman Service
- Reinsurers are offering a significant reduction in reinsurance rates in line with improved morbidity (up to 10% for IP).
Of course, there are some costs in using the service, however, this is considerably less than the cost of an equivalent home visit and, if just one claim is identified as invalid, the cost is easily mitigated.
2009 will certainly see a recession and difficult financial times for many. The start of the claims process is the ideal place to show insurers care by talking to customers at the time they really need it.
At the same time, insurers can safeguard the integrity of their portfolio for the benefit of all customers with timely payments of valid claims and more strenuous investigation of exaggerated or potentially fraudulent ones.
The economic downturn is a concern for many but it can also be an opportunity to show customers that insurers will treat them with the care and empathy they deserve at a difficult time. This will help the industry to build on its efforts to improve customer confidence. n
Ann-Marie Dec is claims manager at Scor Global Life and Jill Harvey is underwriting and claims manager at MorganAsh
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