Our Ethics Series
As part of our mandate, the CIP Society engages our members and the industry in a discussion about ethics in p&c insurance. Through our ongoing columns in Canadian Underwriter, we highlight the importance of being able to identify ethical dilemmas, present different perspectives, and propose various resources and strategies available to resolve them.
Our past columns have covered a wide array of topics including how to deal with confidential information, the importance of data integrity, and how to help clients understand the responsibility of all parties to the insurance contract.
We are continually expanding our library of columns and hope to engage you on a number of emerging issues in the future.
Here's our latest. Click on the title below to read the full column and two responses from the industry.
After further review…. (PDF)
An insured is owed more money than they claimed. Do you disclose the oversight?
An insurance adjuster is assigned a series of claims files for different policyholders related to a common incident that occurred at a construction site.
The adjuster familiarizes herself with each file as well as the incident that gave rise to the claims. Everything seems reasonable and straightforward when she interviews the insureds and visits the construction site.
When the files are almost complete and ready for approval, one of the insureds mentions something related to the claim that pertains to her policy. If true, the additional detail would result in a larger payout as per the terms of the policy. Upon further investigation, the adjuster discovers that the policyholder is correct and advises her of this.
Although each of the other policyholders is satisfied with the amount already communicated, the adjuster reviews the contents of their policies to see if they contain a similar additional benefit. As it turns out, the remaining policyholders all have this similar entitlement under their contracts.
The adjuster feels somewhat conflicted by this discovery. Should she reveal to each of them that they would be entitled to a larger payout? Or, since they did not bring this matter forward themselves (as the one client did), should the adjuster say nothing and save the insurance company a lot of money?