Canadian Underwriter
Feature

Adjusting Claims for Seniors


September 30, 2010   by Jon Brewer


Print this page Share

Right now, the first wave of baby boomers are approaching their mid-sixties. It is estimated that roughly 20 per cent of Canada’s population will be over 65 by 2030. Seniors are more independent and active than ever before. They remain in their own homes, and drive their own cars longer than previous generations. Consequently, adjusters in the property and casualty insurance industry will be adjusting more claims involving seniors in the coming years.

Today, seniors enjoy better health than ever, but there are still common medical problems found among older Canadians. Adjusters who deal with bodily injury claims, almost instinctively consider pre-existing health conditions when dealing with elderly claimants. However, an awareness of the common health issues of seniors can be beneficial to adjusters of all types of claims. It can assist in understanding the claims occurrence itself, and also in how to best approach an older individual involved in a claim.

Hearing loss

Seniors frequently suffer from varying degrees of hearing impairment. As such, they might fail to hear the honking horn of another vehicle, resulting in an atypical accident. Or, they might not hear the sound of the water rushing from a burst pipe, even when awake, resulting in an unusually large water damage claim. An adjuster who might routinely be justifiably skeptical when investigating these sorts of losses, should consider the possibility that hearing loss might be a factor when an older insured is involved.

When communicating with an elderly person, claims professionals should also take into account the possibility of diminished hearing. Those with hearing difficulties will often advise the adjuster at the outset of a conversation. Otherwise, the adjuster should diplomatically determine if a hearing impairment exists. If so, the adjuster should speak

Reaction time

Diminished reaction time is another challenge often facing seniors. While a common factor in automobile accidents, this problem can also potentially lead to more significant property loss claims. For example, a senior with slower reaction time might not extinguish a cooking fire before it spreads, resulting in a larger claim. Adjusters should certainly not fault insureds in such cases.

Memory loss

Memory loss is also common among older Canadians. However, in a large number of instances this is not due to Alzheimer’s. There are many potential contributing factors, such as declining physical health, medications and reduced social interactions. Again, the skeptical claims representative ought to consider this when an older insured has difficulty recalling all of the details of a loss. Adjusters should also bear in mind that others may call the recollection of an elderly witness into question.

Claims professionals may need to exercise extra patience with an insured with memory impairment. Claims are unfamiliar and complicated to most insureds, and adjusters may need to repeat themselves frequently. Respectfully requesting insureds to repeat back their understanding of what the adjuster has just told them can help reinforce their memory and understanding of the process. Written explanatory documents, such as “critical path” letters, are also useful.

Avoid generalizations

These are a few of the common medical problems facing older Canadians. While consideration of these impairments is important, it is equally important to realize they do not plague all seniors. Adjusters should avoid generalizations, instead assessing every situation independently. Speaking loudly and slowly to every senior is not good practice. Instead, consider the medical factors that could affect the person, and then make subtle adjustments while speaking to a claimant, as needed.

Senior psychology

While awareness of medical issues facing seniors is important to adjusting, it is even more important to understand the social psychology of seniors. In order to adjust claims professionally and effectively, and to avoid misconceptions about seniors, it is valuable to have an accurate understanding of the way seniors think and feel. Far too often, seniors are treated like children, when in reality they deserve respect. These are people who have had many experiences and gained much wisdom through their life. Claims professionals will develop a better rapport with older insureds if they treat them with the respect they have earned.

Sometimes, adult offspring of the insured will try to take control of their parents claim — reversing the role of parent and child. Unless they have legally documented control over their parents’ affairs, or are insureds as defined under the policy, the adjuster ought to diplomatically explain that the insurer has a contractual obligation to the insured, only.

Research shows that older people want to be in control of their own lives, as much as possible. An insurance claim, by definition, disrupts insureds’ control of their lives. They may have suffered an injury that affects their normal activities, or they may have had to move out of their home due to a fire. The disruption caused by a claim may well be felt more acutely by older insureds.

It is critical that claims professionals involve older insureds in the claims process. Their input should be sought in any area where options are available. Of course, the adjuster should not go outside the terms and conditions of the policy. For example, on a home fire claim, the insurer would typically determine whether to repair or rebuild. However, once a rebuild decision is made, the adjuster could ask an older insured if they know a contractor they would like to have bid on the project, as opposed to simply selecting bidding contractors with no input from the insured. The insured can be encouraged to make their own selections on finishes, within the restoration budget established. They should also have some say in temporary residences.

While the degree of recovery that can be reasonably expected for an older insured might be different than that of a younger insured, the adjuster should not treat the rehabilitation of the injured any less seriously.

Older Canadians, just like the rest of the population, do not want to be dismissed or ignored. Claims professionals should actively listen, determining what the insured wants, rather than telling the insured what they should do. They should treat their claims with the same degree of urgency as any other.

Seniors also often indicate they are lonely, and enjoy the company of others. They might have lost their spouse or many of their friends, while their adult children are often busy with their own lives. The adjuster might, for this reason, find an older insured talking a little bit more — outside the realm of the claim — as a means to have some company for a few minutes. While this may take up some extra time in the adjuster’s busy schedule, it could serve to offer up an understanding of the insured. This could actually save time in the long run, decreasing the likelihood of disputes or complaints. Furthermore, the adjuster may find the extra few moments of conversation enjoyable — and might actually learn something.

Gerontology, the study of aging, is a fascinating field. Claims professionals do not need to be gerontologists to adjust claims for seniors. Nevertheless, the more understanding of this rapidly growing demographic adjusters have, the better prepared they are for the coming years. Perhaps the best way to understand seniors is to simply spend time talking to and, more importantly, listening to them. An adjuster may just find this to be a fulfilling experience, and gain some wisdom in the process.

Jon Brewer is a staff adjuster with Johnson Unifund Assurance.