Ethics for Claims Professionals

1) Introduction
2) Why should we study ethics?
3) Module Outline
4) Definitions
a) Ethics
b) Morality
c) Values
5) Moral and Ethical Dilemmas: A Continuum
6) From where our ethical principles come
a) Socialization
i) Education
(1) Family values
(2) Cultural values
ii) Ethical Behavior Affirmed by Reason
b) Religion and Philosophy
i) Judeo-Christian Tradition
ii) Secular Humanism
c) Law and Politics
i) English Common Law
ii) Founding Fathers, Constitution, and Bill of Rights
(1) Judicial Review and Due Process
(2) Federalism
(3) Separation of Powers
(4) Rights of the Individual
7) Recap

1) Introduction
2) Values Embraced by our Society
a) Growing importance of individual rights
i) Freedom of choice and self-determination
ii) Freedom from coercion and exploitation
iii) Freedom of thought, religion, speech, publication, expression
iv) Freedom from discrimination based on race, religion, gender, age, national origin, or disability
b) Trust, Honesty, and Equality
3) Theories of Ethical Behavior
a) The “is/ought” problem
b) Duty-based Ethics
c) Ethics based on Consequences
d) Empathy and the Golden Rule
e) Social contract
f) Situation and Contextual Ethics
4) Developing an Ethical Compass
a) Ethical decisions are matters of conscience
b) Discerning duty and loyalty
c) Weighing options
d) Conflicts
e) Consistency vs. hypocrisy
5) Recap

1) Introduction
2) Core Values
a) Honesty and Trust
b) Good Faith and Fair Dealing
c) Equal treatment under the law
d) Contracts constitute promises
e) Valuation and market value
f) Express or implied warranty
g) Equal access to legal recourse
h) Equal opportunity and non-discrimination in terms of employment and advancement
i) Reasonable conduct and standards
j) Transparency
k) Antitrust
l) Corporate responsibility
m) Accommodations for disability
n) Gender neutrality and equality
o) Environmental responsibility
3) Recap

1) Introduction
2) Sources of obligation
a) Legal
b) Contractual
c) Ethical
3) A matrix of duties
a) Insured
b) Claimant
c) Company
d) Agents; Vendors/providers; Government entities
e) When fraud is suspected
f) “Whistle-blower” issues
4) Fair Claims Practices – Adjuster ethics codified
a) National Association of Insurance Commissioners
b) Standard for resolution of claims
c) Acts of omission vs. acts of commission
d) Complaint process mandated
5) Ethics and good claims customer service: A continuum
a) Disclosure of coverage benefits
b) Maintain integrity of investigation and evidence
c) Personal conflicts of interest
d) Gifts and kickbacks
e) Special treatment and favors
f) Allegations of failure to mitigate
g) Reporting to underwriting
h) Privacy and confidentiality
i) Personal distaste and customer service
j) Sympathy and compassion
6) Recap

1) Introduction
2) Case Study 1
a) Cover This!
b) Things to consider
3) Case Study 2
a) Relativity
b) Things to consider
4) Case Study 3
a) What’s Cooking?
b) Things to consider
5) Recap

1) Introduction
2) Case Study 1
a) The Price of Justice!
b) Things to consider
3) Case Study 2
a) Competent Counsel
b) Things to consider
4) Case Study 3
a) One-Way Ticket
b) Things to consider
5) Concluding remarks
6) Recap