Insurance claims departments are where insurance becomes real. This is the central message I took from Chantal Roberts’ recent white paper, The ROI of Claims Staffing and Education: How Skilled Adjusters Make Carriers More Profitable. 1 The paper deserves serious attention from insurance executives, regulators, claims trainers, and anybody who still believes the insurance product is supposed to mean something after the premium is paid.
Roberts’ core point is that claims departments are not back-office expense centers. They are the place where the insurer’s promise is either fulfilled, delayed, diminished, or denied. The insurance policy may be sold by agents, priced by underwriters, modeled by actuaries, and protected by reinsurers. But the promise becomes real only when a claims adjuster investigates, communicates, evaluates coverage, sets reserves, and promptly pays what is owed.
Chantal Roberts has the background to be listened to. She presents herself as a claims consultant, educator, author, former front-line adjuster, team leader, claims manager, and CPCU expert witness with more than two decades of property and casualty claims experience. Her background spans auto, property, catastrophe claims, inland marine, homeowners, commercial property, and general liability. She also teaches risk management and insurance and states that she has no financial interest in staffing vendors, training companies, or claims technology platforms.
Her paper does not read like it was written by somebody reverse-engineering claims philosophy from a spreadsheet. It reads like it was written by someone who has seen claim files deteriorate in real time. It reads like someone who has watched overwhelmed adjusters forced into triage, supervisors turned into file handlers, and claims executives celebrate short-term expense savings while long-term claim costs and lost quality quietly ferment in the basement.
Roberts is plainly pro-professional adjuster. She believes claims work has often been wrongly measured, undertrained, and squeezed by executives chasing short-term financial optics. She is also appropriately skeptical of claims automation when it is sold as a substitute for professional judgment rather than a tool to support it. Significantly, her views are expressed as an insurance industry insider.
The paper’s biggest strength is its moral clarity. Roberts understands that an insurer cannot ethically sell peace of mind and then run a claims operation so thin that adjusters are forced into superficial investigations, scripted communications, rotating file assignments, and delayed decisions. Understaffed, undertrained, over-automated, and poorly supervised claims operations do not merely create inconvenience. They create ethical failure, financial volatility, regulatory exposure, litigation, employee burnout, and policyholder distrust. Her conclusion should be placed on the wall of every insurance claims executive’s office.
Roberts also does a fine job translating claims professionalism into financial language. People have said for decades that training, experience, supervision, and manageable caseloads matter. Roberts explains why those issues belong in the insurance company boardroom. They affect financial stability, loss adjustment expense, litigation rates, adverse development, reopen rates, supplemental payments, turnover, and capital volatility. Insurance executives may nod politely when claims professionals talk about quality. They pay closer attention when those issues impact a company’s financials.
Regulators should read this paper because it articulates a problem they often see after catastrophes. Delayed communication, rotating adjusters, poor documentation, inconsistent estimates, and superficial file review are often treated as isolated claim-handling mistakes. Roberts suggests they are frequently symptoms of operational design. A market conduct examination often finds the smoke. This paper points to the fire.
Claims trainers should read it because Roberts makes the case that education is not a perk. It is loss control. The best claims education does not simply make adjusters better employees. It prevents mistakes, improves communication, reduces unnecessary litigation, and helps policyholders receive accurate payment sooner.
My colleagues should read this paper because it provides an insurer-side explanation for many recurring claim problems. Not every underpayment is intentional. Sometimes the claims machine is simply built to fail the human being inside it.
The paper is also timely because of artificial intelligence. Roberts correctly warns that AI can be a work multiplier, but not a replacement for professional judgment. AI can organize documents, summarize notes, identify deadlines, and assist with workflow. But it cannot ethically make coverage decisions, evaluate causation, apply policy language, assess matching, determine actual cash value, explain a denial, or exercise the good faith judgment required of a licensed claims professional.
A human signature on a coverage letter is not the same thing as meaningful human review. This is a point every insurance regulator should remember as insurers increasingly promote automation as the future of claims handling. The question is not whether AI can make claims faster. The question is whether it makes claims more accurate, more transparent, and more faithful to the promise sold to the policyholder.
The paper is not perfect. Many of the charts are illustrative rather than empirical. The carrier comparisons are useful, but sophisticated readers will want a more formal methodology explaining why those examples were selected and what contrary evidence was considered.
I suggest that “profitability through claims excellence” means accurate payment, not artificial claim suppression or severity control. The ethical goal of a claims department is not to pay less. It is to pay correctly. Sometimes, better training reduces overpayment. Sometimes, better training increases payment because the adjuster finally recognizes covered damage, additional benefits, code requirements, business interruption, matching issues, or policyholder duties that were poorly explained. Accuracy cuts both ways.
Overpayment affects insurer capital and rate adequacy. Underpayment affects policyholder rights, regulatory exposure, bad faith risk, and public trust. A truly ethical claims operation must be disciplined against both.
I also suggest that the claims industry needs claim-type staffing ranges by complexity and type of loss. A low-severity auto physical damage claim is not the same as a represented bodily injury claim, a wildfire total loss, a commercial property loss, a construction defect claim, or an excess liability file. Caseload standards should be discussed by line of business, severity band, jurisdiction, representation status, and litigation risk. There is no magic universal number.
Vendor incentives deserve a deeper discussion. Independent adjusters, engineers, building consultants, medical reviewers, defense counsel, third-party administrators, managed repair networks, and estimating platforms can all improve claim quality or degrade it. The difference often lies in how they are selected, motivated, paid, supervised, audited, and pressured. Vendor management is not just a procurement issue alone. It is a claims ethics issue.
Despite those limitations, this paper should be read because it asks the right questions. Are insurers measuring claims activity or claims quality? Are supervisors actually supervising, or are they merely following severity control directives? Are claims managers using AI to support judgment, or to disguise the absence of it? Are staffing reductions saving money, or simply moving loss costs into the future? Are policyholders getting the benefit of the bargain, or just being processed through a system designed for speed over truth?
The insurance industry needs more internal self-reflective work like this. It needs more serious discussion about claims ethics, staffing, training, supervision, automation, and vendor incentives. It needs fewer slogans about customer service and more honest and transparent examination of whether claims departments are built to honor the promise of insurance.
Insurance does not become real when the policy is printed. It becomes real when the claim is handled properly. If the claims department is undertrained, understaffed, over-automated, or poorly supervised, the promise of insurance is not merely weakened. It is betrayed.
Thought For The Day
“A policyholder’s experience with the claims organization is a strategic asset because the handling and payment of covered claims fulfill the policy’s promise. For the insured, this is the moment the product proves its value.”
—Chantal Roberts
1 Chantal M. Roberts. The ROI of Claims Staffing and Education: How Skilled Adjusters Make Carriers More Profitable.