Lapse One Month, Motorcycle Crash the Next.

[LGilmore]

Here is the thing and I hope you understand why I am saying it this way... it is not your job to tell him anything about a claim he's going to file. That is the responsibility of the claims underwriter who's job it is to research the claim and decide if it should be paid or not.

While it sounds pretty clear cut that the guy isn't going to get what he wants. It is somebody else's job to make that call. You want to give him the paperwork he needs, feel bad about his situation with him and then send it on if asked to. Beyond that you bring yourself into actionable territory where your words one way or another can bite you in the ass.

So, it's not that I disagree with you at all. I just don't want to see you pulled into something that is clearly between this person and the insurance carrier. Anybody else involved beyond customer service is putting their licensing at risk.

Sorry I sound like a d ick on this, but this stuff backfires on agents all the time.

 

[VolAgent]

Here is the thing and I hope you understand why I am saying it this way... it is not your job to tell him anything about a claim he's going to file. That is the responsibility of the claims underwriter who's job it is to research the claim and decide if it should be paid or not.

While it sounds pretty clear cut that the guy isn't going to get what he wants. It is somebody else's job to make that call. You want to give him the paperwork he needs, feel bad about his situation with him and then send it on if asked to. Beyond that you bring yourself into actionable territory where your words one way or another can bite you in the ass.

So, it's not that I disagree with you at all. I just don't want to see you pulled into something that is clearly between this person and the insurance carrier. Anybody else involved beyond customer service is putting their licensing at risk.

Sorry I sound like a d ick on this, but this stuff backfires on agents all the time.

I think you misread this. I felt it was more about trying to keep the guy from committing insurance fraud. Lying in the reinstatement is almost certainly insurance fraud.

I would have given him two choices. I can send it in as is and tell them what you've previously told me, or you can send me a properly filled out one and I can destroy this one. Your call. I'm documenting it either way.

 

[LGilmore]

no, no I know what you were trying to do and not implying your dumb or a bad guy or anything like that. But you have to be careful in how you would approach this.

You should never make any comment about insurance fraud in a claims situation, EVER. Again not our job. Courts will say not our job, if it is or isn't is not our call.

I would leave it after reviewing the claim form with the question/statement along the lines " is everything correct to the best of your knowledge?"

If they say "yes" send it on. If they say "well er ah... " ,"Let me send you a clean copy to do over." You don't mark on it, you don't make corrections, they fill it out and you forward it on.

I don't know if you've ever been pulled into a lawsuit for anything business wise. The ONLY thing that saved my ass, was following things to the "T", or I would have been on the hook for hundreds of thousands of dollars. I did not overstep my bounds, I did not make any changes or do any actions outside the scope of my licensing. Judge took about 3 minutes to throw the case out.
I know it sounds d ickish and is against most of our characters, as most of us want to help. But clients forget very quickly everything you do to help, if it means they win something. Clients, especially one who you feel would commit fraud is going to have no problem throwing you under the bus if it means $5 more a month.