In search of profit, insurers have decimated their professional claims staff. They laid off experienced personnel and replaced them with young, untrained, unprepared people. A virtual clerk replaced the old professional claims handler.
Process and computers replaced hands-on human skill and judgment. Money was saved on the expense side of the business by paying lower salaries. Within three months of firing the experienced claims people gross profit increased. The accountants were happy. The quarterly profits increased. None of the happy people were insurance professionals. None of them understood how a professional claims adjuster saves the insurer by establishing a fair amount of loss, avoiding payment for items not lost or overvalued, and by avoiding losses for which no coverage was provided by the policy.
The promises made by an insurance policy are kept by the professional claims person. Keeping a professional claims staff dedicated to excellence in claims handling is cost-effective over long periods of time. A professional and experienced adjuster will save the insurer millions by resolving disputes, paying claims owed promptly and fairly, and by so doing avoiding litigation and claims of breach of contract and breach of the covenant of good faith and fair dealing.
The professional claims person is an important part of the insurer’s defense against litigation by insureds against insurers for breach of contract and the tort of bad faith. Claims professionals resolve more claims for less money without the need for either party to involve counsel. A happy claimant satisfied with the results of his or her claim will never sue the insurer.
Incompetent or inadequate claims personnel force insureds and claimants to public insurance adjusters and lawyers. Every study performed on claims establishes that claims with an insured or claimant represented by counsel cost the insurer more than those where counsel is not involved.
Prompt, effective, professional claims handling saves money for both the insured and the insurer and fulfills the promises made when the insurer sold the policy.
Insurers who believe they can handle first or third party claims with young, inexpensive, inexperienced and untrained claims handlers should be accosted by angry stockholders whose dividends have plummeted, or will plummet, as a result. When an insurer compromises on claims staff, profits, thin as they may have been previously, will move rapidly into negative territory. Tort and punitive damages will deplete reserves. Insurers will quickly question why they are writing insurance. Those who stay in the business of insurance will either adopt a program requiring excellence in claims handling from every member of their claims staff, or they will fail.
Insurance is a business. It must change — this time for the better — if it is to survive. It must rethink the firing of experienced claims staff and reductions in training to save “expense.” Insurers should, if they wish to succeed, adopt a program to promote excellence in claims handling that can help insurers keep the promises made by the insurance policy and avoid charges of breach of contract and the tort bad faith in both first and third party claims.
Officer Making U-Turn Chasing Criminal May be Immune if Not Done in Reckless Disregard for Safety of Others
Fact Finder Must Establish Basis for Immunity
Post 5236
See the video at https://rumble.com/v72gq5o-governmental-immunity-is-not-absolute.html and at https://youtu.be/CHlEX2ZCc4s and at https://zalma.com/blog plus more than 5200 posts.
In Robert Young v. Officer John Doe et al. No. 2025 CA 0527 (La. App. 1st Cir. November 22, 2025) Robert Young sued Sid J. Gautreaux, III, in his official capacity as Sheriff of East Baton Rouge Parish (the “Sheriff”), and multiple insurance companies. The Sheriff’s Office and an unnamed deputy were not part of the summary-judgment ruling on appeal.
Procedural Posture
The trial court granted Sheriff’s motion for summary judgment, dismissed all claims against the Sheriff with prejudice, holding that La. R.S. 32:24 immunity applied and that Deputy Miller’s conduct did not rise to reckless disregard/gross negligence.
Key Facts
On July 19, 2019, Highway 19 Deputy Kevin ...
ZIFL Volume 29, Issue 23
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Subscribe at https://lnkd.in/gfpn78FM
Read the full article at https://lnkd.in/gczbPSKn and at https://zalma.com/blog plus more than 5200 posts.
Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/
Read the full 21 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/11/ZIFL-12-01-2025.pdf
Roofers, Insurance, Hurricanes and Fraud
Homeowners Defrauded by Roofer Litigate for Years to Get Their Money Back
In Gary v. Hollier’s Specialty Roofing, Inc., 23-260 (La. App. 3 Cir. 12/27/23), 389 So. 3d 109 Ryan Gary and Rebecca Gary (the Garys), homeowners who suffered roof damage from Hurricane Delta sued Hollier’s Specialty Roofing, Inc. (Hollier Roofing), a ...
ZIFL Volume 29, Issue 23
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Subscribe at https://lnkd.in/gfpn78FM
Read the full article at https://lnkd.in/gczbPSKn and at https://zalma.com/blog plus more than 5200 posts.
Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/
Read the full 21 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/11/ZIFL-12-01-2025.pdf
Roofers, Insurance, Hurricanes and Fraud
Homeowners Defrauded by Roofer Litigate for Years to Get Their Money Back
In Gary v. Hollier’s Specialty Roofing, Inc., 23-260 (La. App. 3 Cir. 12/27/23), 389 So. 3d 109 Ryan Gary and Rebecca Gary (the Garys), homeowners who suffered roof damage from Hurricane Delta sued Hollier’s Specialty Roofing, Inc. (Hollier Roofing), a ...
The Professional Claims Handler
Post 5219
Posted on October 31, 2025 by Barry Zalma
An Insurance claims professionals should be a person who:
Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.
How to Create Claims Professionals
To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
