2021 JulyAug PIA New York by PIA Northeast

July/August 2021• New York

PAGE 18

BE A PROACTIVE & TRUSTED RESOURCE Agents light the way for clients through claims

CLAIMS 5

Bizarre insurance claims

What is bad faith?

Enhanced digital options help

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DEPARTMENTS 4 July/August 2021 • New York

In brief

9 Legal 15 E&O 29 Staffing 37

Ask PIA

Officers and directors directory

Readers’ service and advertising index

COVER STORY 18 Be a proactive & trusted resource Agents light the way for clients through claims

FEATURE 25 Want to be a reliable adviser for claims? Lead with enhanced digital options

Statements of fact and opinion in PIA Magazine are the responsibility of the authors alone and do not imply an opinion on the part of the officers or the members of the Professional Insurance Agents. Participation in PIA events, activities, and/or publications is available on a nondiscriminatory basis and does not reflect PIA endorsement of the products and/or services. President and CEO Jeff Parmenter, CPCU, ARM; Executive Director Kelly K. Norris, CAE; Communications Director Katherine Morra; Senior Magazine Designer Sue Jacobsen; Editor-In-Chief Jaye Czupryna; Advertising Sales Executive Susan Heath; Communications Department contributors: Athena Cancio, Alexandra Chouinard, Patricia Corlett, Darel Cramer, Roberta Lawrence, Zack Littrell, Crystal Ringler and Calley Rupp. Postmaster: Send address changes to: Professional Insurance Agents Magazine, 25 Chamberlain St., Glenmont, NY 12077-0997. “Professional Insurance Agents” (USPS 913-400) is published monthly by PIA Management Services Inc., except for a combined July/August issue. Subscription rate for members is $13 per year, which is included in the dues; subscription rate for nonmembers is $25 per year. Professional Insurance Agents, 25 Chamberlain St., P.O. Box 997, Glenmont, NY 12077-0997; (518) 434-3111 or toll-free (800) 424-4244; email pia@pia.org; World Wide Web address: pia.org. Periodical postage paid at Glenmont, N.Y., and additional mailing offices. ©2021 Professional Insurance Agents. All rights reserved. No material within this publication may be reproduced—in whole or in part—without the express written consent of the publisher.

COVER DESIGN Roberta Lawrence Vol. 65, No. 7 July/August 2021

IN BRIEF

ASSOCIATION NEWS

Virtual Conference 2021: Offerings for mind, body and agency The pandemic caused organizations to rethink their business practices and offer individuals access in new ways. Your association has continued to evolve, and PIA Northeast Virtual Conference 2021 was another step in that evolution as it brought together agents, brokers, vendors and companies (to name a few) via an immersive, virtual platform that made it easy to forge new connections.

A look at PIA Northeast Virtual Conference Theater personalities to improving communication and virtual selling strategies; to the hidden disorder of hoarders and understanding the cannabis business.

Welcome to PIA Northeast Virtual Conference 2021 “While we are all familiar with how to use in-person events to network and to interact with people, the virtual option provided a way for us to get together with people we may not have a chance to see often, especially given how crazy 2020 was,” said PIANY past President John C. Parsons II, CIC, CPIA, AAI. “In my opinion, no conference at all would be the worst option. There was something on the menu for everyone at this year’s conference.” If you didn’t attend Virtual Conference 2021 in June, here’s a look at some of what you missed.

Education and development Known for its quality continuing-education sessions and networking opportunities, PIA Northeast offered attendees the chance to earn up to 13 CE credits by choosing from five different sessions on topics such as: business income and the pandemic, complying with Reg. 187, personal-lines and commercial-lines trivia, the National Flood Insurance Program, and the errors-andomissions issues with verbal agreements. However, since PIA Northeast wasn’t bound to the confines of a brick-and-mortar space, it also was able to offer attendees access to professional development and lifestyle seminars. Topics ranged from increasing your LinkedIn social selling index series, account rounding and cyberrisk; to the value of listening, and understanding

“While I love that PIA Northeast offered access to CE and networking opportunities—it was great to learn bartending techniques during the Networking Reception with Cocktail Mix & Mingle—I thoroughly enjoyed the professional development and lifestyle sessions,” said PIANJ immediate past President Steven C. Radespiel. “I think about these types of things day in and day out, so it’s nice to have all of these resources in one spot, where I can go back to review, and my co-workers can log on and access the material now. If the conference was a ‘live event’ I would have had to pick-and-choose the members of the office who could have attended the event, now everyone in the agency can benefit from it.” Conference attendees also had access to lifestyle sessions by a nutritionist, who discussed how to boost energy, mood and prevent chronic disease like diabetes and heart disease; a yoga instructor, who showed people how to recenter and find new ways to stay positive and healthy; and a wellness coach, who talked about how stress affects our health negatively, and how to improve health through better stress response. Additionally, attendees had access to featured speakers, C-Suites and InsurTech demonstrations, and spaces where they could network and catch up with colleagues.

NBA star keynotes NBA star Walter Bond keynoted the event and spent time answering conference attendees’ questions. Bond discussed how people can use transformation to reach (continued on page 6.)

PROFESSIONAL INSURANCE AGENTS MAGAZINE

BY THE NUMBERS

BIZARRE Insurance Claims

On Fire

We know the common claims—trees falling on cars, houses flooding in the spring. While each claim is serious to the person who is affected by it— and the insurance producer who helps to reconcile it—some claims can make us chuckle (after we get off the phone). Here are just a few property/ casualty claims that actually have happened to U.S. customers:

At her destination wedding, one woman’s wedding dress caught fire, then her groom threw her in the water to extinguish the flames. A typical policy for wedding coverage would cover this faux pas!

A burglar accidentally locked himself in a victim’s garage while the homeowner was on vacation. He managed to escape when the homeowner returned a week later. Then, he filed a claim against the homeowner for mental anguish— and he was awarded $500,000.

Help

Next time your insureds decline jewelry insurance, tell them about the U.S. woman who had coverage when a goose swallowed her diamond ring and flew away!

Honk Honk

Sssnakes

like cool, dark places. A homeowner in Texas noticed a rattlesnake peeking its head out his toilet—and, a whole nest of them under his house! His homeowners policy was able to cover the snakes’ removal.

Gamer Rage

Two brothers found out the hard way that their insurance carrier wouldn’t cover the cost of their new TV, which was broken when one brother hurled his gaming controller at the screen during a heated video-game battle.

Gamer Rage

ts a o g t o G

A man honked the horn of his shiny, red sports car at a herd of goats that wouldn’t move out of his way. But, goats have horns, too. And they weren’t afraid to ram the side of his car. Luckily, the man had comprehensive coverage for his auto.

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ASSOCIATION NEWS (continued from page 4.) their full potential. To highlight the importance of one’s potential, he reminded people that when they were little and someone asked them what they wanted to be when they grew up, no one replied: “Average.”

Can’t quarantine laughter Even though we weren’t the Parachute Industry Association, comedian Greg Schwem recognized that we were the Professional Insurance Agents and he took the time to discuss how important humor is in the workplace. “We are afraid to laugh because of how it might look to someone else,” said Schwem. “However, humor is what gets us through difficult situations.” He reminded everyone that despite the pandemic, there was still a lot to laugh about right now. And, while many people and organizations are falling into pandemicfatigue ruts, he congratulated PIA Northeast for not using the words pivoting or reimagining—two words that have become overused during the pandemic—when describing the conference.

Walter Bond, keynote speaker He also told people about the importance of having coaches in life—noting that everyone has had coaches all through their lifetimes. “A coach understands when someone needs a little extra tutoring. A little extra oneon-one time,” said Bond. “Great coaches build your confidence and they set expectations.” Think about who your coaches have been, and who you’ve coached throughout your lifetime. During his presentation, Bond asked three questions, which he considers to be the cornerstones to reaching your full potential and achieving success: • Who is your coach? • Are you coachable? • What is your system/way? “Here’s what happens in business—great organizations have a way,” said Bond. “You got to have a coach and develop a system for everything.” To elaborate on what kinds of systems that are needed in the insurance industry, Bond asked the attendees to think about the systems they have in place for generating sales, upselling products, identifying prospects, gathering referrals and reaching out for renewals. He also discussed how to adopt what he called the shark mindset. Using this mindset, you can alter the trajectory of your business drastically. To do this, one needs to:

He also offered some handy tips about what to avoid asking comedians if you happen to strike up a conversation with one. Remember: It’s never a good idea to ask a comedian to say something funny, right now.

There’s still time to enjoy PIA’s virtual conference “I really enjoyed the Theater, which provided access to all the videos, and having access to both prerecorded videos and past live events that I missed,” said PIACT President Shannon Rabbett, CIC. “There was so much extra content that you wouldn’t get at an in-person conference.” If you found it difficult to access all the content— including the event sponsors and the 50 exhibitors— during June 8-9, your login credentials will allow you to access all the resources for the next year. You can start conversations with the exhibitors through the online platform, too. And, if you didn’t attend the event, but want to see what is available, you can purchase access to the on-demand content for just $29—but note that you won’t be able to earn CE credits. For more information, contact the PIA Conference & Education Department at conferences@ pia.org or (800) 424-4244.

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What is bad faith? The claims process can be a nerve racking and frustrating experience for many policyholders. They pay their premium and when a claim arises—reasonably or not—they expect quick resolution of the claim in their favor. When that does not happen, you often will hear the accusation that the insurer was acting in bad faith. But, what does this mean? To understand this fully, a person needs to understand how bad faith is defined and what constitutes common law.

Bad faith Claims of bad faith arise when an insurer refuses to investigate a claim in a reasonable period or denies coverage for a legitimate claim. Traditionally,

bad faith comes in two varieties: common-law bad faith and statutory bad faith—lesser known varieties include Nacho Cheese and Cool Ranch Doritos.

LEGAL

BRADFORD J. LACHUT, ESQ. Director of government & industry affairs, PIA Northeast

Common law The common law is unwritten law created by judicial opinions as opposed to by legislation or regulation. The common law predates statutory law and essentially amounts

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to courts of law making up said law as they go along. While that sounds problematic—and it can be—the common law is kept under control by stare decisis, which is the legal principle that a court is bound to follow the decisions of similar cases that have come prior.1 Even if you have never heard the term common law before, you have likely experienced it. If you have ever been involved in a lawsuit or watched The People’s Court you have seen the common law at work. Virtually, all the United States’ civil and contract law exists only in common law. The defining features of the common law are that individuals—as opposed to state entities—are permitted to initiate a lawsuit, which is referred to as a

private cause of action. Common law litigants also may be able to recover punitive and compensatory damages in addition to contractual damages depending on the jurisdiction. Applying the common law to insurance, courts have found that insurers owe a duty of good faith and fair dealing to their policyholders. If an insurer were to violate that duty, a policyholder could sue under the common law for damages. To establish a case of common-law bad faith, policyholders generally must prove two elements. First, they must show that the policy covered the claimed loss, and that said claim was denied. This element is straight forward. Second, the policyholders also must show that the insurer was unreasonable in denying the policyholders’ valid rights under the insurance contract—this element is a little trickier to prove.

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What is and is not unreasonable is a question that has launched a thousand law firms. Through the years, courts have identified different factors that could give raise to a finding of unreasonableness and thus bad faith; there is no single definition of what is unreasonable. The existence of a misrepresentation of policy terms, delays in investigating claims, and failing to act in a timely fashion to close out a claim have all been cited as examples of bad faith. It is this uncertainty that has given rise to the second variety of bad faith: statutory bad faith. Statutory bad faith is not much different from its older common-law sibling. Just as with common law, it deals with an allegation that an insurer has breached its duty of good faith and fair dealing. Unlike with the common law, the elements of what constitutes a breach are much clearer. Look no further

than the National Association of Insurance Commissioners Model Unfair Claims Settlement Practices Act. The UCSPA, which has been adopted throughout much of the United States, defines 14 different acts that—even if committed individually—would constitute bad faith. Among these acts is making a claims payment without indicating the coverage under which the payment is being made, and failing to provide the necessary claims forms, accompanied by directions, within 15 days. Once we know that the UCSPA has a clear and broad definition of bad faith and that most of the country is following that particular law, the natural question is: Why don’t we see bad-faith claims all the time? Because, the answer is not found in what acts constitute bad faith, but instead in how the acts occurred.

To qualify as bad faith under the UCSPA, an act must be intentional and must be committed with frequency that would constitute a general business practice. So, singular occurrences of bad faith are not actually instances of UCSPA bad faith (it may be common law though). That might seem weird until you learn that the UCSPA was designed to empower state insurance departments to investigate systemic bad faith and not to protect individual policyholders.2 The lack of a private right of action (i.e., a lawsuit brought by a private individual, not a state entity), means that a policyholder’s primary recourse is to file a complaint with his or her state insurance department. The lack of a private right of action in the UCSPA gave rise to the second type of statutory bad faith. As you could probably guess from the previous sentence, the key feature of this statutory bad faith is inclusion of a private cause of action that is found in the common law. This type of statutory bad faith is a bit of a hybrid of the common law and the UCSPA model. It takes the specificity of the UCSPA, combines it with the private cause of action and the damage mechanisms found in the common law, and adds a dash of a new element that we have yet to see: the ability for third parties to bring bad-faith claims. This latter element makes bad-faith legislation particularly noxious to the insurance industry. Third-party badfaith claims arise when an insurance company does not use reasonable care in evaluating a claim and settling the third party’s damages. Unlike with their first-party counterpart, third-party causes of action generally are not recognized under the common law. So, their inclusion in bad-faith legislation essentially creates an entirely new cause of action.

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The combination of specific causes of action, especially third-party actions, and the possibility of huge damages has made hybrid statutory bad faith controversial. Trial attorneys love the idea, and the insurance industry hates it.

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Have conversations with your clients before they have claims, so that they understand the process and they will have realistic expectations during the claims process. Lachut is PIA Northeast’s director of government & industry affairs. This also can be problematic—see essentially the entirety of the U.S. Supreme Court’s decisions in the 1850s.

This also may seem weird until you remember the UCSPA was created by insurance commissioners.

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E&O

BOB PORTEN Account underwriter, Utica National Insurance Group

nify your agency, not the third party. But, most claims are closed without a loss payment. Why? Well, in some cases the underlying carrier may have wrongfully denied coverage. In addition, consumers play a bigger role than you may think in making sure they have adequate protection for themselves. Other reasons include good documentation on your part, as well as several defenses that support the

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agents’ role in the insurance transaction. (Did I mention good documentation?) The bottom line is that if you have a claim or incident that could become a claim, you need to report it to—and work with—your E&O carrier so it can investigate and determine liability. Don’t assume that your agency is liable for every uncovered loss a client may have. Misconception No. 2: If my client has an uncovered loss, I can pay for it, and then turn it into my E&O carrier for reimbursement. Reality: Most E&O policies spell out your duties in the event of a claim. This includes reporting it as soon as possible, cooperating in the defense, and not assuming any obligation, making a voluntary payment or incurring any expense—except at your own cost. If you admit liability or make any voluntary payments, you may prejudice the E&O carrier’s ability to provide an adequate defense. Don’t put your agency or your E&O coverage at risk. You want your E&O carrier on your side, so work with it from the start. Misconception No. 3: If the extent of client damages that are uncovered are within my E&O deductible, I can just settle it on my own and not involve the E&O carrier. Reality: Sadly, this happens all too often. But as the adage goes, he who represents himself has a fool for a client. This would be the case even if the claim is not in a suit. One can’t deny that some situations are just flat out errors and omissions, and that the facts suggest there are just no defenses. Still, you want to bring your E&O carrier in from the start. It has the experience to assist you in what to say and not say, making sure the claim is not over paid and getting proper releases of further liability. You may innocently pay for uncovered damage to a motor vehicle only to find out later that a passenger was hurt and is making a claim for bodily injury for hundreds of thousands of dollars. By then, you may have prejudiced the E&O carrier and its ability to defend, violated the conditions of your policy and put your agency at great risk. Some courts have thrown out an agent’s attempts to self-settle when subsequent facts give rise to greater liability issues. What’s more, the way in which you self-negotiate a claim can expose the agency to business law/good-faith law violations. Misconception No. 4: If I bring my E&O carrier into a matter that is within my deductible, or which I am not liable, or believe will just go away, it will nonrenew my policy or increase my premium. Reality: Consider the consequences if you don’t involve your E&O carrier in a matter. In the big picture, each factual circumstance must be evaluated on its own merit. Every E&O carrier has its own way of dealing with claim activity and frequency. Just because you heard this or that happened to another agent because he or she reported a claim or incident doesn’t mean the same will happen to you. You need to feel comfortable working with your E&O carrier, so consider your relationship with the carrier. Having an E&O policy should be more than just the ability to prove to your markets you have E&O coverage, so you can do business with them or, as need be, to turn in a worst-case claim. Your E&O carrier should be viewed as a resource. Your relationship and ability to communicate with the persons who make the decisions about your claim,

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your policy and your premium should be a big part of what you are paying for when you buy E&O. Misconception No. 5: I can hire and work through my own attorney to handle an E&O claim without bringing my E&O carrier into it. Reality: It would be a shame to pay for an E&O policy and not use it when you need it. Hopefully, by now this article has convinced you to involve your E&O carrier from the start. If not, if you hire your own attorney without involving the E&O carrier, you do so at your own risk. If your E&O carrier is worth its salt, it has experienced people handing your claim, so there is a good chance it and its attorneys have seen it all, and know of the defenses that are available to agents that you and your own counsel may not. Make sure you know how to report a claim if you have one. Know and feel comfortable with the expertise of the E&O carrier in handling claims—that’s why you pay your premiums. Misconception No. 6: The uncovered client’s claim is with an insurance company with whom the agency has a contract—and this contract includes defense and indemnification language. I can report it to the company and it will defend and protect the agency. Reality: You lose nothing by notifying your E&O carrier first and you have everything to gain. After your contracted carrier has done its investigation into the facts and finds out that your agency made an error, or violated your binding authority, its first comment to you may likely be, “If you haven’t notified your E&O carrier as of yet, you need to do so.” Reporting an incident or claim to your E&O carrier after another

party (especially one that may be an adverse party) has had a head start on the investigation is a dangerous game. You may not realize it, but at that point you already may have stacked the cards against yourself and significantly impeded your E&O carrier’s ability to foster a defense for your agency. Again, notify your E&O carrier first. If appropriate, the E&O carrier can work with other parties, including your contracted insurance companies, to consider the best course of action.

Work as partners Here’s another important reason to call your E&O carrier first: Some E&O policies have a reporting feature that provides for the reporting of detailed facts regarding an incident or circumstance, but do not consti-

tute an actual or immediate claim. The E&O carrier still will consider the date you originally advised it of these same facts or circumstances to be the date the claim was made, should an actual claim develop. If you have a claims-made policy, this would be important should anything happen to your E&O policy in the meantime, such as a lapse or gap in coverage. It is always the right choice to report a claim, or potential claim, to your E&O carrier. If somebody has suffered a loss that is not covered, you cannot count on them to seek redress from another party. When big money is at stake, your long-standing client relationships can deteriorate quickly. The safer course is to report the matter to your E&O carrier, so you can work as partners to bring about proper resolution. Utica National Insurance Group and Utica National are trade names for Utica Mutual Insurance Company, its affiliates and subsidiaries. Home Office: New Hartford, NY 13413. This information is provided solely as an insurance risk management tool. Utica Mutual Insurance Company and the other member insurance companies of the Utica National Insurance Group (“Utica National”) are not providing legal advice, or any other professional services. Utica National shall have no liability to any person or entity with respect to any loss or damages alleged to have been caused, directly or indirectly, by the use of the information provided. You are encouraged to consult an attorney or other professional for advice on these issues. © 2020 Utica Mutual Insurance Company

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ANDREW LEEDS VP of Claims, Plymouth Rock Home Assurance Corp.

BE A PROACTIVE & TRUSTED RESOURCE Agents light the way for clients through claims

ndependent agents are a trusted resource for homeowners looking to purchase home insurance and select the best coverages for their needs. Whether it is explaining the different carrier options, sharing best practices for home ownership, or what to do if something goes wrong, agents wear multiple hats.

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Great agents are more than just a homeowner’s gateway to a home insurance policy. They are a resource to the client long after the policy is bound. Advice offered could be something as simple as sharing some simple do’s and don’ts of home ownership, recommending local contractors, or just helping their clients learn the area. One part of the agent relationship is helping clients understand when they should or shouldn’t file a claim and what to expect when they do. When it comes to home insurance, homeowners don’t always think about its importance until something goes wrong and they suffer a loss to their property. At that point, the intangible benefits of an insurance policy and the promises of the agent and carrier are put to the test. Most homeowners will never file an insurance claim, but for those who do, the process begins at a time they didn’t plan for and when their most valuable assets are damaged. In short, one of the most stressful times in people’s lives. Reality sets in and the policyholders see the claims process as something they need to do, but don’t want to do. One might expect that this ranks just slightly above going to the dentist. This is when great agents and carriers differentiate themselves. They immediately put clients at ease and provide a seamless process to get them back on their feet. Insurance agents who are true partners strive to prepare their clients and mitigate risks before an incident occurs. But despite the best preparation, accidents and weather will happen and insurance claims are inevitable. Agents should be prepared to provide their clients with the proper resources and know-how to successfully navigate the claims process. This begins at step one—reporting the claim and ends when clients’ property has been repaired or replaced; a process that can sometimes take months. Knowing a few tips and tricks can help make navigating that process much easier. Here are a few ways agents can go the extra mile when it comes time to setting up their clients with a solid policy, and in the event of an emergency, share best practices for the claims process.

Documentation Agents can help homeowners prepare for the unexpected by recommending they document any damage through photos, written descriptions and even video to ensure the insurance carrier has the complete picture. If an incident leads to a gaping hole in the homeowner’s wall, a simple photo of the hole won’t suffice. Taking a picture from various angles can help give perspective to how big the hole is and where it is on the wall. Using a measuring tape or nearby object to get a sense for size, showing its proximity to the ceiling or the floor and even making note of the debris that came from the plaster are all important things to document that homeowners might not automatically think to do. Even better, at the outset of binding a policy, agents may recommend building a home inventory list in which homeowners make note of all items in case that they are stolen or damaged due to an unforeseen incident. [EDITOR’S NOTE: PIA Northeast members can access an example of a home inventory checklist that they can share with their clients in the PIA QuickSource library (QS90272)]. If the idea of listing all their personal items seems daunting, you can remind your clients that taking a video/photo tour of the home every couple of months to record what the house looks like and where objects are is a great alternative.

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Agents also can advise homeowners to keep accurate records of purchases and appraisals to ensure they are reimbursed fully. This includes everything from receipts of large purchase and repairs, to making sure appraisals for scheduled items are updated. Lastly, any documentation of the home and its contents before an event can be stored digitally in the cloud, in a water- and fire-resistant box, a safety deposit box or with an out-of-town relative. These records are extremely helpful for clients and claims teams alike and greatly accelerate the claims process.

Timing Time is of the essence when it comes to filing claims. A condition of most policies is the requirement that clients must prevent further loss from occurring. By reporting claims immediately, the client gains access to a carrier’s network of mitigation and restoration specialists. Often these resources can be on the scene within hours boarding up windows, tarping roofs or mitigating water damage in the house. As time elapses, damage continues to occur and the opportunity to repair items lessens. When items cannot be repaired, they must be replaced, which can extend the restoration period greatly. In some cases, coverage for the loss could be denied if the client failed to take necessary steps. Agents should emphasize to their clients that as soon as a loss occurs, they should either call the agent or get in contact directly with the carrier. Waiting is never the answer. Once a claim has been made, as a courtesy and to strengthen the relationship, the agent might consider following up with the client to ensure he or she has engaged with the carrier and understands the claims process.

Carriers often will set claims length expectations with a client, and the agent can use that information to set a follow-up with the client to ensure the claim is being settled in a timely fashion. If a carrier does not set expectations, that should be a red flag prompting the agent to call the carrier for clarification. Communication is key throughout the claims process. Often when communication breaks down clients have a poor customer experience. Agents can prevent communication breakdowns by touching base with their clients, using calendar reminders and as a last resort, calling carriers to make a direct connection.

Online and mobile resources Online and mobile have become an increasing part of everyday life. Clients are doing more of their

business digitally and often without human interaction; in some cases, it is becoming the preferred method of interaction. To meet that demand, insurance carriers offering digital tools that create better customer experiences remove bottlenecks and make the claims process more convenient for homeowners. A simple tip that all agents can offer their clients is to create an online account to manage their policy information. Additionally, clients should download the carriers’ mobile applications. The benefits of digital go far beyond convenience or preference. When catastrophes strike, carriers often are overwhelmed with claim-first reports. Clients can wait for extended periods of time just to report their claims. Having an online account or mobile application often allows clients to report their claims electronically. In many cases, these platforms are tied directly into a carriers’ claim system bypassing first-report call centers. Reporting claims digitally can speed up response time, give clients access to their claims files and allow information to flow directly to claims adjusters for expedited processing.

Prevention The adage goes, an ounce of prevention is worth a pound of cure and that couldn’t be more true with home ownership and insurance. The best way to make a claims experience easy is not to have one. There are a few simple things agents can advise their clients to prevent claims from happening, or greatly reduce the impact if a loss occurs, which include: Preventive maintenance. Conduct an annual inspection of the property and its systems. Understand what needs routine maintenance and complete it when

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convenient. Failure of heating/cooling equipment, as well as deterioration of the external building system of the house are frequent contributors to loss. Automatic water cutoff valves. Installing these smart devices can significantly reduce the severity of water losses within the house. If that isn’t an option, hanging a high-visibility tag from all shut-off valves in the basement can make finding the one you’re looking for easy in an emergency. Install a centrally monitored alarm system. Having a service that monitors the house both for theft and fire can help mitigate loss and act as a deterrent. Better yet, having one of these systems may entitle clients to discounts with their insurance carrier. Routine landscaping maintenance. In fire prone areas, removing dry brush, trimming shrubs and grass, and pruning overhanging limbs can help wildfire from spreading to the house. Having a barrier of crushed stone or dirt between the foundation and the lawn also can help reduce the chance of fire. Change the batteries in the smoke and CO2 detectors twice a year. Batteries can drain at unpredictable rates and homeowners never want to be without this important safeguard for their family. Also, the detectors themselves have expiration dates—it’s important to observe the manufacturer’s instructions on when to replace them. Keep a small fire extinguisher under the kitchen sink. Cooking-related fires do happen and an ABC fire extinguisher can keep a small fire from becoming an inferno that could be devastating for the family, not to mention the house itself.

What does insurance cover? When it comes to future accident prevention, it always is beneficial for agents to go back to the basics and discuss with their clients the actual use of homeowners insurance. Taking a look back on their policies can help them become

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more aware of what is and isn’t covered—so hopefully next time they will make the investment to trim back the tree limbs to avoid a branch going through a window. According to the Insurance Research Council, there were five claims filed and paid per 100 insured houses in 2019. This trend shows that claim frequency has decreased over the last two decades, but claim severity has increased significantly.1 While claims are few and far between for most homeowners, it is crucial that agents emphasize the importance of following claim-filing best practices to get them what they need and to get their home back to safety. While it’s not always an agent’s job to handle the claims process, a good agent continues to be a trusted resource for their clients throughout the entire insurance journey by setting them up for success and educating them proactively—and reactively when needed. Leeds is the vice president of claims at Plymouth Rock Home Assurance Corp. In his role, he leads a growing claims team and develops innovative, technology-forward processes specializing in delivering efficient and quality policy services and benefits to customers. Leeds is a B.S. and MBA graduate of Boston College and previously served as a captain in the U.S. Army. The Insurance Research Council, 2019 (bit.ly/3yu2cFm)

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CARL CANALES Senior vice president and field executive, Northeast region, Liberty Mutual, Safeco Insurance

Want to be a reliable adviser for claims?

Lead with enhanced digital options

One morning, I deposited a check using my bank’s app on my phone and then a text alert prompted me to track the status of a recent online order. Both tasks were done before my coffee had finished brewing.

cient, and fewer claims inquiries to your agency means you’re also more efficient—so your staff can focus on growth-oriented work. And of course, satisfied customers tend to stay longer with their carrier and your agency.

Later, I called a medical office for an appointment, but I happened to call over lunch and I left a message on voicemail. The next day, I still didn’t have an appointment.

For an independent agent, a claim event presents an opportunity to act as a trusted adviser, guiding your client through the process. As an agent, you’ve likely seen many claims and have a good idea of what the process looks like, but customers don’t always understand it. Agencies that are digital first recognize that they need technology to play that role successfully, and guide a client through anything from a minor auto accident to a total property loss.

It’s clear which of these experiences best meet the expectations of today’s consumer. And, the COVID-19 pandemic has accelerated those expectations as more consumers adopted new digital habits—think food delivery apps and telemedicine. In our industry, we know that digital capabilities have a positive effect on satisfaction at every stage of the customer journey. In fact, customers who use an online account for tasks such as paying a bill, signing a document, tracking a claim and more have a retention rate nearly three points higher than those who do not.1 Carriers place significant focus on digital tools for claims handling because the ease, convenience and faster cycle times that result, make for a particularly potent mix of positive outcomes. Digital tools make carriers more effi-

Here are some approaches to borrow from these deeply digital independent agencies: • Ensure clients are aware of the digital claims tools available to them and the value they offer. • Be prepared to offer these capabilities when the time is right. And, understand that point in time may be different for each client.

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• Make it easy for customers to adopt claims technology. • Be familiar with the digital claims options offered by each of your carriers, so you can advise and support your clients when they need it.

Awareness When you get new customers, you likely arm them with all sorts of information about your agency and the carrier you’ve recommended for them. If you’re presenting the carrier’s app or online account as an extra, or something they may want to consider, it’s time to shift your strategy and lead with digital as the primary way to communicate, stay informed and get things done. By now, most carriers have online portals that help clients file a claim, and

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access information about their claim as it progresses. Some companies have a smartphone app that allows your customers to file a claim, check the status of it, communicate with their adjuster and upload documents from their mobile phone or tablet. In some cases, clients may be able to complete a claims inspection digitally, which is one of the ways digital capabilities drive down cycle times. For example, if your clients were in fender benders with no serious injuries, they could pull up the carrier app, which will guide them through taking pictures of the damages, the license plates and VINs. This way, the adjuster may be able to get the photos he or she needs to make an estimate without having to schedule an in-person appointment. Often, the customer can request a tow and find an in-network repair shop through the app, as well. Some companies use video-conferencing capabilities to adjust certain property claims so no in-person adjuster visit is necessary.

When the time is right, make it easy The most successful digital agencies never stop talking with clients about the digital capabilities available. And, they use key points in the customer journey—such as a claim—to revisit the value and encourage adoption. For example, a claim initially reported over the phone likely still can be tracked online. Some carriers allow you to file a claim online on behalf of a customer, which then allows you to essentially warmtransfer the customer over to the self-serve option on the app or online account. Some carriers also have advanced their technology to offer agents who are filing a claim

to opt-in customers for text notifications, which allows the claims handler to begin communicating via text with the policyholder immediately. Is your agency keeping up with the technology offerings of your carriers? If your client already is texting with his or her claims adjuster, the carrier has now set a certain expectation with the policyholder for how business is done. So, if you’re advising on that claim, there’s a good chance your client will want to hear from you in the same manner. Your social-media channels, monthly email updates and your website are all great tools to keep clients engaged and aware—and make it easy for them to act when they’re ready. If a storm or other weather event is forecasted for your area, social media allows you to share information in the moment and provide links to carrier sites and app downloads, so customers are prepared in advance of any weather event. If you hear about a new enhancement on a carrier app, why not take that opportunity to share it with your clients, along with a direct link to download?

questions about the technology that carriers are offering. Take some time to get familiar with each of those systems and capabilities, so you’re in the best position to provide valuable guidance when you’re needed. Being able to access claims details and track the progress during the lifecycle of a claim also provides independent agents insight and an additional opportunity for connection with clients as their trusted agent. Some carriers offer agents access to an exclusive claim-file view that provides details, such as financial transactions and communication updates. Independent insurance agents play an important role in helping customers through the entire claims process. When someone has experienced an accident or loss, he or she wants a quick response on a favorite communication channel, easy access to information and help understanding what his or her policy covers. Digital tools combined with your guidance can help your client quickly report on the claim, point him or her to the needed information and tools—and leave the client feeling supported throughout the experience. Canales is the senior vice president and field executive of the Northeast region for Liberty Mutual business lines and Safeco Insurance. He has been in the insurance industry since 2001, most recently as Safeco’s Northeast region general manager. Canales served prior executive roles in Liberty Mutual commercial lines underwriting, distribution, agency and broker strategy, and marketing. 1

Rise of the Digital Insurance Agency, Liberty Mutual and Safeco, 2021

(bit.ly/3hHrABO)

Build loyalty with your customers Newsletters work Fulfill and enrich your business with consumer newsletters. We’ll handle it all. • Full color content

Your website should have a section dedicated to claims with your digital channels and those of your carriers featured prominently. Check with the carriers you work with to see if they offer website banners or QR codes that make it easy for you to refer clients directly to important claims resources.

• Expert information for insureds

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Know your stuff With a more digitally focused claims process in place, part of your adviser role may be to answer

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Marijuana laws and what they mean for employers The legalization of marijuana has expanded over the last few years impacting various states and territories around the nation. In fact, New York, New Jersey, Virginia and New Mexico recently passed legislation legalizing marijuana for recreational use—joining 13 other states (including Vermont), the District of Columbia, Guam and the Northern Mariana Islands. At this point, marijuana is approved for medical use in 36 states (including Connecticut and New Hampshire), while several other states have decriminalized possession, which usually results in a civil penalty instead of a criminal charge. However, these new laws conflict with the federal law, which still defines marijuana as an unlawful controlled substance, under the Federal Controlled Substances Act. Ultimately, these new changes leave countless employers—namely small businesses—grappling with how to adjust their workplace policies given the ambiguity and conflicts between federal and state laws, and lack of clear guidance. This is on top of the other issues small-business owners must deal with because of the pandemic. This article will outline what you need to know about the current state of the marijuana laws and your business.

Drug testing The patchwork of marijuana laws poses an issue for employers that conduct drug tests as part of its hiring process. Simply put, laws that allow marijuana use for recreational purposes do not give employees license to be under the influence at work. Nevertheless, employers must keep in mind that if someone tests positive for marijuana, it does not mean that he or she is currently under the influence, since traces of the drug can be detected in a person’s system for up to 30 days. Nor should it be assumed that an individual who tests positive has engaged in unlawful behavior. To address this issue, some jurisdictions, such as New York City, have limited marijuana testing of job candidates as part of pre-employment screening and deemed it an unlawful discriminatory practice, with some exceptions for certain safety sensitive and federal contract positions. Also, various jurisdictions have limited an employer’s ability to take disciplinary action against employees who test positive for marijuana use. Therefore, if an insurance agency has business operations in a state where marijuana use is lawful, it should be wary before taking adverse action against any employee or job applicant if he or she tests positive for marijuana use. PIA.ORG

Managers and supervisors should be able to recognize the signs of drug and alcohol impairment in the workplace, since their observations will be key in taking any action against employees violating drug and alcohol policies.

Medical marijuana and disability discrimination

STAFFING

GALEN MEDLEY Assistant general counsel and human resources consultant, Engage PEO

Presently, marijuana cannot be prescribed for medical purposes under federal law. Therefore, disability protections under the Americans with Disabilities Act are not applicable for individuals who use it for medical purposes—even if a person has a medical referral or recommendation for marijuana recognized under state law. However, there is a possibility there will be movement to loosen restrictions on the federal level within the next few years, to allow marijuana and other cannabis-related products to be medically prescribed. It is conceivable that the current administration may choose to reclassify marijuana and other cannabisrelated products, making them available to be medically prescribed. If that action is taken, people who are prescribed marijuana will be protected from disability discrimination under the ADA.

In the meantime, many states that allow marijuana to be used for medical purposes have anti-discrimination or reasonable accommodation provisions to protect those legally using medical marijuana. Therefore, it is critical that employers know the status of legality of marijuana use in their state or local jurisdiction to avoid running afoul of disability discrimination laws.

Key tips for employers Changes may happen at the federal level. Although marijuana remains illegal on the federal level, that may change soon. A growing number of jurisdictions have legalized it and have enacted statutes to prohibit employers from discriminating against employees who lawfully use marijuana. Employers should proceed with care before taking adverse action against employees who are lawfully using marijuana, particularly when the employee’s use occurs off-premises and outside of working hours. Handle medical marijuana usage with care. The use of medical marijuana by employees in states where it is currently legal should be handled like any other reasonable accommodation. Employers should assist employees who need such an accommodation to ensure that it does not interfere with workplace safety and productivity of others, while also being careful to not discriminate against the employee. Employers should review their drug testing policies to ensure they are compliant with developing marijuana laws in areas where their employees are located, especially with an increase in remote hiring and working.

Consider a partnership. When dealing with issues involving medical marijuana in the workplace and conflict between state and federal laws on such issues, it is best to partner with a Professional Employer Organization that can provide ongoing guidance and support to help management make the best decisions for the agency. Medley is an assistant general counsel and human resources consultant for Engage. Based in New Jersey, he works with clients to provide guidance on a wide range of labor and employment issues. Practicing law for over 15 years, Medley has experience advising clients in a wide range of corporate and government employment-related issues. Prior to joining Engage, he was an in-house counsel for a multistate company handling labor and employment issues across the U.S.

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“Maria Thomas and the Friedlander team always come through when called upon. They are knowledgeable and extremely helpful with their expertise in their Niches. Claim reviews with clients has always been a great bonding experience. The reports and claims data provided make the customer experience as good as it can get. I never hesitate to bring them in! They have helped me with some of my largest accounts. Looking forward for many more years of service! Keep up the great work!” Michael Misiti Vice President Bradley & Parker, Inc. Melville, NY

Up to 35% Advance Discount Retailers

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Retail Group of NY, Workers’ Comp. Safety Group #544*

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Online Video: www.friedlandergroup.com Retail

2003 Bakeries 7998 Hardware Store 8001 Florist Store 8006 Food/Fruit/Deli/Grocery 8008 Clothing/Shoe/Dry Goods 8013 Jewelry Store 8016 Quick Printing 8017 Retail (Not Classified) 8031 Meat/Fish/Poultry Store 8033 Supermarkets 8039 Department Store 8043 Retail (including Food) 8044 Furniture Store 8046 Auto Accessories 8072 Book/Music Store 8105 Leather Store 8382 Self serve gas w/conv. store Residential Care Facilities

8864 Developmental Organizations 8865 Residential Care Facility 9063 Senior Citizen Centers

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9052 Hotels NOC 9058 Restaurants in Hotels

Wholesale 4310 Greeting Card Dealer 7390 Beer/Ale Dealer 7999 Hardware Store 8018 Wholesale Store/NOC 8021 Meat, Fish Dealer-Wholesale 8032 Dry Goods, Clothing, Shoe 8047 Drug Store 8048 Fruit & Vegetables 8111 Plumbers Supplies Dealer-Wholesale Restaurant

9061 Clubs 9071 Full Service Restaurants 9072 Fast Food Restaurants– Including Drivers 9074 Bars & Taverns Social and Health Services

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Audits, lightning damage, ride hailing and more Referral fees for unlicensed entity

Lightning damage

Q. A business entity approaches an insurance agency. The business entity has clients who need a particular type of insurance. For each policy written, the business entity would like to be compensated. Can this business entity—that does not have an insurance license—receive commission as shares after the deduction of expenses or can it create a separate LLC corporation with the same payout?

Q. Lightning hit an electric line leading to an air-conditioning unit on the roof of a building. The unit was damaged. The company claims Exclusion 2.a. applies, relating to “artificially generated electric current, including electric arcing, that disturbs electrical devices, appliances or wires,” so the carrier is denying coverage. The insured contends that lightning is not artificial, so there should be coverage. Who is right?

A. No. A licensed insurance agent may not compensate a nonlicensee for referrals contingent upon the placement of insurance. However, the nonlicensee may be compensated for the referral if the compensation is not based upon the placement of insurance and the nonlicensee does not discuss specific insurance policy terms or conditions with the prospective insured. (OGC Opinion Nov. 29, 2006).—Helen K. Horn, CIC, CPIA, CISR

Class change upon audit Q. After an audit, can a carrier add a new class to a workers’ compensation policy? A. Here are excerpts from the workers’ compensation policy: B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classifications. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classifications, rates and premium basis by endorsement to this policy. E. Final premium The premium shown on the Information Page, schedules and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. These two excerpts give an insurer the right to revise the workers’ compensation classifications.—Dan Corbin, CPCU, CIC, LUTC PIA.ORG

ASK PIA

PIA TECHNICAL STAFF Have a question? Ask PIA at resourcecenter@pia.org

A. Your client is right. Lightning is naturally generated electrical current that can cause power surges that damage equipment, as it did to your client’s air-conditioning unit. Lightning damage is covered without qualification under the lightning peril.—Dan Corbin, CPCU, CIC, LUTC

Workers’ compensation employee waivers Q. An insured has an independent contractor who does part-time clerical work for him at his office. She also works for five to 10 other people at any given time, and with exception of the insured and one other employer, she picks up paperwork and takes it to her own home for processing. She is paid a

flat hourly rate and determines her own hours as to time and number. The accountants for everyone in this group of employers agree she is subject to a 1099 and meets the federal 21 questions as an independent contractor. It appears the New York Workers’ Compensation Board holds this individual as an employee for its purposes because she uses the insured’s premises. I was advised that there is a disclaimer form available in which she can opt out of coverage. I have been through the manual and all the endorsements and am unable to find such a form. Can you advise where I can find it? A. To find information on this topic, you need to see Section 32 of the New York Workers’ Compensation Law:

Section 32. Waiver agreements. No agreement or release except as otherwise provided in this chapter by an employee to waive his right to compensation under this chapter shall be valid. Per this section of the law, a disclaimer form that is intended to provide a means for an individual to opt out of coverage would not be valid and enforceable. Therefore, you have been unable to find an appropriate form. The statement “except as otherwise provided in this chapter” is referring to employment such as one or two officers of a corporation that are permitted by the Workers’ Compensation Law to exclude themselves (for which there is a Workers’ Compensation Board form to accomplish this).—Dan Corbin, CPCU, CIC, LUTC

THE VOICE in the state legislature

Ride-hailing phases Q. What are the phases of ride hailing? A. Ride hailing can be experienced in three phases:

for independent agents

Phase 1: When a driver logs on to the transportation network company application, but the driver is not yet matched with a passenger.

Think of it as the independent agent’s megaphone.

117078 621

Phase 2: When a match is made and accepted, but the passenger has not entered the vehicle.

Learn more: www.pia.org/AAC 38

PROFESSIONAL INSURANCE AGENTS MAGAZINE

Phase 3: When the passenger has been picked up and is occupying the vehicle. Remember, ride-hailing coverage is contingent upon the statutory meaning of livery, exclusions in the personal auto policy and coverage provided by the TNC.—Bradford J. Lachut, Esq.

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