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The course, “Ethics for Claims Professionals,” is designed to familiarize adjusters with the ethical standards for fair and honest dealings. The module is presented by John Curl, Ph.D., Manager of SIU and Quality Assurance for Sequoia Insurance Company in Monterey, California.

In this course, John Curl begins by defining ethics, morality, and values and establishing the continuum along which moral and ethical dilemmas lie. He explores from where our ethical principles come and the values that have been embraced by our society. He stresses the importance of developing an ethical compass. He lists the core values for business and commerce. In describing the ethical conduct of the claims professional, he evaluates scenarios of good and bad ethical practices by adjusters. He also reviews the Fair Claims Practices Act. Finally, case studies are provided in Part 5 (first- party property claims) and Part 6 (casualty claims).

After completing the course, the attendee will be able to define ethics, morality, and values; identify from where our ethical principles come; outline the values embraced by our society; discuss the theories of ethical behavior; understand the importance of developing an ethical compass; list the core values for business and commerce; summarize the sources of obligation that drive the ethical conduct of the claims professional; outline the matrix of duties that surround the claims professional; describe the continuum of ethics and good customer service; and have a better understanding of how to apply ethical principles to claims scenarios.

The course is designed for practitioners and insurance professionals working in the area of coverage analysis. Professionals in both the property and casualty coverage arenas will find this module beneficial.

What CE Credit is available?

Note: To qualify for credit, you must submit completion (including a passed final exam if required) within five days of completing the last quiz. No partial credits will be awarded.

State:
Adjuster General CE Hours:
Adjuster Ethics CE Hours:
Attorney General CLE Hours:
State's Course ID:
NH 2.0 Ethics 485560
TX (classroom equivalent) 2.0 Ethics 138531
NC 2.0 Ethics C99687
FL * ( Provider Number: 364169 ) 2.0 Ethics (Not Approved for 5-Hour Requirement) 1179567
IL 2.0 431956
WY 2.0 Ethics 36530
OK 2.0 Ethics 1026253

* This course has been approved by the Florida Department of Financial Services for insurance continuing education credit.

Course Content

Lesson Content

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

Lesson Content

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

Lesson Content

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

Lesson Content

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

Lesson Content

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

Lesson Content

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

Submit within 5 days to get CE Credit or Certificate of Completion.

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