TransAmerica-Sets Aside $for Future PayOut?

[Newby]

Because quite frankly, a lot of blame does lie with the agent. Short of getting medical records, how you can tell if someone needs help with ADLs, uses a wheelchair, oxygen, and several other health factors that don't require prescription medications? However, spending 30 minutes or more in a home, an agent can easily spot some of those clues. A wheelchair, the person never gets out of the chair, an oxygen tank or concentrator, the person is constantly short of breath, etc. Even evidence of tobacco use when the person claims to be a non-smoker. Or even just that general feeling the person is being less than honest.

Not all. People lie to agents all the time and some companies seem to be less than fair in handling claims.

I would say a lot is willful blindness on the part of agents, combined with some dishonest agents. I recall one of old timers, maybe it was Scott or Louis, posted about agencies that clean-sheeted everything and just hoped the person lived beyond 2 years.

The agent can definitely set the tone of the appointment. Agents who teach people that if they lie but make it 2-years they are non-contestible are teaching people how to get away with fraud. Contestibility ends after 2-years but the crime of fraud does not. And that's exactly what I tell people who are going down that path.

I tell people that there is only ONE reason to pay insurance premiums. And that is so the insurance company pays your beneficiary when they die. If you apply with fraudulent information you give the insurance company an open ticket to deny the claim.

 

[VolAgent]

Yes, but if the guy was right about the 40%, and I have no way of knowing if he's right, there's no way that 60% is on the agents.

I know some times it's on the agents. There's one CL agent here and one SF agent here that Scott and I run across all the time that apparently have never written someone up as a smoker. Still, I can't believe those 2 agents are responsible for 60% of claims not paid.

They aren't, but they and agents like them do account for a lot. If we take this company and let's assume they are fair in claims, then probably 20% from dishonest agents, 20% from sloppy, careless agents, and 20% from insured dishonesty. Obviously, for companies that aren't fair in claims, that changes. I only do business with companies I believe are fair in claims. I dropped one years ago because I felt they were not.

Clearly all numbers are just my assumptions. Others may give it all different weighting.

And again, an agent who doesn't notice the person never got out of their chair isn't dishonest, just sloppy and careless. Yet it could still be a denied claim if the company asks about ADLs, and the person did need help and it was in their medical records.

 

[NSRH]

I believe this is why we are finding many insurance companies getting into the call center business. They believe there is more control in telesales since most carriers will require all calls to be recorded and stored for a period of time. This limits any clean sheeting, or fraudulent activity since its so easy to review any and all conversations.

In one case we recently had, we had to review a call that was over two years old, and this was a request by the WI department of insurance.

 

[jdeasy]

I believe this is why we are finding many insurance companies getting into the call center business. They believe there is more control in telesales since most carriers will require all calls to be recorded and stored for a period of time. This limits any clean sheeting, or fraudulent activity since its so easy to review any and all conversations.

In one case we recently had, we had to review a call that was over two years old, and this was a request by the WI department of insurance.

I don't think that makes any difference. The guy that told me that the industry average is 40% has a mandatory phone interview.

AmAm's reputation on claims paying is about as bad as it gets. They have always had a phone interview.

 

[NSRH]

I don't think that makes any difference. The guy that told me that the industry average is 40% has a mandatory phone interview.

AmAm's reputation on claims paying is about as bad as it gets. They have always had a phone interview.

I would venture to say that having an entire presentation recorded would limit clean sheeting and fraud, or at least make it easier to find. Wouldn't you say?

 

[jdeasy]

I would venture to say that having an entire presentation recorded would limit clean sheeting and fraud, or at least make it easier to find. Wouldn't you say?

No, I wouldn't say.

Are you saying that more contestable claims are paid when the application was done all by phone?

 

[VolAgent]

I don't think that makes any difference. The guy that told me that the industry average is 40% has a mandatory phone interview.

AmAm's reputation on claims paying is about as bad as it gets. They have always had a phone interview.

Ignoring the carrier in this case.

It does make a difference. However it cuts both ways. By recording the entire phone call, there is no opportunity for the agent to coach the applicant to lie. However, since no one is seeing the applicant, it makes it much easier for the applicant to lie on their own.

So it depends on who you believe is the bigger driver of denied claims, agents or insureds. If you believe it is agents, then a complete call recording is great. If you believe it is insureds, then you just got a bunch more denied claims and bought more claims were the person just makes it past the contestible period. If you give both equal weighting, then you are roughly back where you started.

 

[jdeasy]

Ignoring the carrier in this case.

It does make a difference. However it cuts both ways. By recording the entire phone call, there is no opportunity for the agent to coach the applicant to lie. However, since no one is seeing the applicant, it makes it much easier for the applicant to lie on their own.

So it depends on who you believe is the bigger driver of denied claims, agents or insureds. If you believe it is agents, then a complete call recording is great. If you believe it is insureds, then you just got a bunch more denied claims and bought more claims were the person just makes it past the contestible period. If you give both equal weighting, then you are roughly back where you started.

If there were figures available that showed more claims were paid when the application was taken by phone then I would tend to believe it's true.

No one seems to be forthcoming with those numbers either way. As I said earlier, the only company I've ever heard about sharing the actual percentage with agents is CL and they supposedly told the agents that they pay 48% of contestable claims.

I don't even know if that's true. Just what was reported by some CL agents.

My personal experience is far different tan those numbers except with one company. And I don't write that company any longer.

 

[NSRH]

No, I wouldn't say.

Are you saying that more contestable claims are paid when the application was done all by phone?

No I said, "I would venture to say that having an entire presentation recorded would limit clean sheeting and fraud, or at least make it easier to find."

Im not sure how you can deny that, but to each their own.

 

[jdeasy]

No I said, "I would venture to say that having an entire presentation recorded would limit clean sheeting and fraud, or at least make it easier to find."

Im not sure how you can deny that, but to each their own.

You are simply putting your marketer spin on it. That's why I can deny it.

Give me some real numbers to make your argument.