Ethics for the Street Level Adjuster

1) Course Overview
2) Morality
a) definition
b) examples
i) honesty v. lying
ii) paying v. stealing – hotel
iii) following rules v. cheating – exams
3) Ethics
a) right v. right approach
b) definition of ethics
c) cause of right v. right conflict
4) Examples of right v. right
a) truth v. loyalty
b) short-term or long-term
c) self or community
d) justice or mercy
5) Recap
6) Quiz – Reinforcing Part 1 Materials
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz

1) Introduction
a) reported as ethics
b) in reality, straight forward moral issues
2) Enron – Corporate Conduct
a) Facts
b) Enron’s written ethics code
3) Bernard Ebbers
a) Facts
b) CFO Scott Sullivan
4) AIG and Gen Re
5) Eliot Spitzer
a) facts
b) guidelines issue
6) Analysis of Media Treatment
7) Underwriter and Broker Schemes
a) bid rigging
b) placement service agreements
c) contingent commissions
d) finite reinsurance
8) Recap
9) Quiz – Reinforcing Part 2 materials
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz

1) Intro to Ethics Workshop
2) Approaches to Ethical Decision Making
a) situation-based
b) rule-based
c) people-based
3) Situation-Based Approach
a) best outcome
b) long-term v. short-term
c) do you have enough information
4) Rule Based Approach
a) followed prescribed rules
b) don’t worry about outcome
5) People-Based Approach
a) a.k.a. golden rule approach
b) how would you like to be treated
c) consider the various players and their unique perspectives
6) Inherent Weaknesses in Approaches
a) situation-based: do ends justify means
b) rules-based: are the rules appropriate
c) people-based: dependence on decision maker’s morals
7) Codes of Conduct/Ethics
a) help overcome weaknesses in approaches
b) usually created by:
i) experienced
ii) knowledgeable
iii) somewhat diverse
iv) group effort
8) Organizations with codes
a) examples
b) purpose: credibility
9) Developing a Personal Code of Ethics
a) conflict of interest
b) confidentiality
c) fair dealing
d) honesty
e) integrity
f) leadership
g) legality
h) loyalty
10) Personal Code of ethics
a) example
b) quotes
11) Recap
12) Quiz – Reinforcing Part 3 materials
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz

1) Case Study Intro
2) Case Study Facts
a) you’re the adjuster
b) hail storm claims
c) matching problem encountered
3) Situation-Based Approach
a) consider state laws
b) consider line-of-site
c) consider consistency of application
d) case-by-case approach
e) trial approach
f) problems from over payment
4) Rule-Based Approach
a) policy language
b) company matching rules
c) local regulations/statutes
d) case law
e) practical rules
5) People-Based Approach
a) wood siding – could paint all four sides
b) use of specialty company to match siding
c) pay for all sides
d) consider insurer’s perspective
e) consider agent’s perspective
6) Quiz – Reinforcing Part 4 materials
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz

1) Facts
a) You’re the adjuster
b) old file is dropped in your lap
c) no coverage
d) potential political issues with the agent
2) Rule-Based Approach
a) rules based on agents income
b) business rules related to agent relations
c) waiver and estoppel laws
3) Situation-Based
a) non-waiver assessment
b) repairs that show detrimental reliance
c) more info
d) let another department make business decision
e) anticipation of coverage
f) statutes related to elderly
4) People-Based Approach
a) would the insured understand
b) would the agent understand
c) how would you like to be treated
5) Quiz – Reinforcing Part 5 materials
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz

1) Facts
a) cat storm devastates wide area
b) you set up cat office
c) agent and alleged insureds want instant help
d) no local records available
e) no communications up yet
f) competitor is purportedly giving out checks for $5,000
g) could be some fraud
2) Consider Approaches
a) people-based
b) rule-based
c) situation-based
3) Open Group Discussion/Brain Storming
4) People-Based Approach
a) identify faulty work and excluded items
b) identify ensuing damage/loss
c) identify covered cause for ensuing damage
5) Situation-Based Approach
a) consider methods of verifying identities
i) satellite phone
i          i) agents
b) look for undisputed coverage
c) consider suspending formal requirements
d) arrange for a bank to cash checks
e) consider worthlessness of checks in the first few days
f) consider non-monetary options
g) preplanning
6) Rules-Based Approach
a) make best efforts to verify coverage and ID
b) no payment absent burden of proof being met
c) distinguish insurers from government and aid organizations
7) Quiz – Reinforcing Part 6 materials
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz