Feb 18, 2013 2 min read

6 places a claims manager should look for ethical risks

Let’s assume you’re a claims manager, tasked to ‘do something on ethics in 2013’. Where might you start looking for ethical risks associated with how your claims teams work? Ordinarily, the ethical risks you focus on are those that have a bearing on things like strategy and reputation, but let’s put that approach aside for a moment and take more of a ground up approach instead. Here are six places that the claims manager could look at first.

Look to how customers are being engaged. How is your technical expertise being balanced with their relative ignorance of how insurance works? How clear are you making the process to them? Are you setting clear and realistic expectations for claimants? And are you reassuring them about the service they’ll be receiving, as opposed to reeling out one fraud warning after another? Questions like these touch on ethical issues like fairness and equity.

Look to where your information about the claim and the policyholder are coming from. Do you know the provenance of all your information and if so, how does your decision making process weigh up its relative quality? Do you know if investigators have conducted themselves responsibly? Are you assessing the data in a neutral way? Questions like these touch on ethical issues like privacy and fairness.

Look to your supply chain. Are you confident that suppliers providing you with a ‘joined up’ service operate robust procedures for conflict of interest? Do you have a clear picture of all payment streams flowing up and down your supply chain? And what checks can you make on how responsibly those services are being performed (see investigators above)? Do contracts have clear expectations on how suppliers should conduct themselves? Questions like these touch on ethical issues like conflicts of interest, corruption and privacy.

Look at how you’re making decisions on claims. Are the decisions being made along your claims process sensitive to the concerns of claimants? Do you know what those concerns are? How well are decisions being explained to claimants? Are decisions, when taken, implemented quickly? How do you monitor feedback and complaints, and what are those numbers telling you? Are your decisions being upheld with the FOS? Questions like these touch on ethical issues such as fairness and equity.

Look at how performance is being monitored across your claims service. What metrics carry most weight and how might they influence issues like those outlined above? Do you know what claimants want most from your claims service, and are you monitoring that? Conflicts of interest is the ethical risk to watch out for here.

And finally, look at the values and ethics statements issued by your firm, as well as the Code of Ethics of the Chartered Insurance Institute. Are they having a meaningful impact on how your claims teams work? Could more than half your staff tell you what their firm’s values are? If they’re to mean anything, it is in the circumstances your people handle every day.

These six avenues will help you overcome those “…but what am I looking for?” moments. There is a danger however that they’ll give you a fuller but still unorganised picture of what ethical risks to address, and little in the way of priorities or strategic alignment.

Duncan Minty
Duncan Minty
Duncan has been researching and writing about ethics in insurance for over 20 years. As a Chartered Insurance Practitioner, he combines market knowledge with a strong and independent radar on ethics.
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