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  #1  
Old 01-18-2020, 05:27 AM
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Afac_8 Afac_8 is offline
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Hi all,
I have a moral/working issue to inquire.
Talking with an old friend of mine, now he know I work for in the company he is dealing with for an insurance claim.
He asked for an help to conclude that claim and be paid.

It seems very wrong doing such a favour for my morality, even I don’t know the internal policies. I didn’t ask in the office or look for the “right” person or read policies.
Moreover , I am also quite new in the company.

Am I too strict and moralist?

I am thinking to help my friend...������

Last edited by Afac_8; 01-18-2020 at 05:30 AM..
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  #2  
Old 01-18-2020, 09:35 AM
Frank45 Frank45 is offline
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Lol what. I seriously doubt there’s anything you could do to influence the disposition of this claim, unless you’re like the CEO or something. And judging by the quality of your post, I seriously doubt you’re the CEO.

You should have laughed in your friend’s face when he asked you this ridiculous question.
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  #3  
Old 01-18-2020, 02:23 PM
Westley Westley is offline
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Quote:
Originally Posted by Frank45 View Post
And judging by the quality of your post...
This is a professional area of the forum, and the tolerance for personal attacks is pretty low. This is uncalled for. Not going to do anything about it this time, but this is unnecessary and rude
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  #4  
Old 01-18-2020, 02:26 PM
Westley Westley is offline
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As to the OP, companies have pretty strict rules about that, unless your company is very small, the claims people aren't even going to talk to you about what they're doing. For example, in health insurance in US, HIPAA rules protect the privacy of people filing claims and the individual information is removed before actuaries even get to see it, for the most part.

I wouldn't worry about the morality of it, but just realistically, there's very little chance you could even find out who the person was that is handling the claim.
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  #5  
Old 01-18-2020, 03:53 PM
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DoctorNo DoctorNo is offline
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Agreed 100% - tell your friend that the actuarial staff doesn't have access to this level of detail due to privacy laws (whether it's actually true in your case or not).
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  #6  
Old 01-18-2020, 03:56 PM
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Lucy Lucy is offline
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At my employer, directly trying to influence a claim for a friend is a violation of policy. I agree, just tell him you can't help.
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  #7  
Old 01-19-2020, 09:41 AM
Frank45 Frank45 is offline
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Quote:
Originally Posted by Westley View Post
This is a professional area of the forum, and the tolerance for personal attacks is pretty low. This is uncalled for. Not going to do anything about it this time, but this is unnecessary and rude
Ok my bad. The OP is new at this company. My guess, which could be totally wrong, is that he’s not very high up in the pecking order there. The idea that he (or she) could find this claim, find the adjuster, and then influence the disposition of the claim ... strikes me as improbable. And yes, I did judge the OP based on his grammar. Again, my bad.

In a prior life, I was Chief Actuary of a small personal lines company. About 300 total employees. If a “friend” asked me to help him push a claim through, it would have been very easy for me to use the claimant’s name to get the claim number, and I’m sure I could have figured out the adjuster based on the coverage form, state, etc.

So what if I called that adjuster and asked to chat about the claim? Odds are high the adjuster would have been a pal of mine, but still would have said “why are you interested in this claim?” At that point, if I say “the claimant is a friend of mine and I want to help him get this settled” — what an awkward position to put the adjuster in. I would hope he’d be professional enough to tell me to go pound sand and stay out of it.

Or I could lie and say “oh this claim just kind of caught my eye when I was pulling some data and I wanted info about our potential liability”. Then as I got the details, I could subtly start telling this adjuster about why I think we should promptly accept liability and make a generous settlement. Even then, there’s a big difference between ceo and chief actuary, and I doubt I could have really influenced this adjuster, or his manager if he took my comments there. Or maybe I could just find some potential holes in our defense, and then told my friend “maybe ask them why blah/blah”.

Is there any reasonable person who would argue that there is no conflict of interest or unethical behavior here?
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  #8  
Old 01-19-2020, 12:20 PM
Westley Westley is offline
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Yes, the grammar is pretty bad. I assume A) He's not very smart and yet for some reason is posting on an actuarial board about his actuarial job (seems very improbable) or B) He's posting in his second, or third language. Unless you can post better in his native language than he can in English, it's poor form imo to get all judge-y on his language skills. Third possibility I guess is that C) he was posting from his phone, which sometimes gets all screwed up.

Agree with the rest of Frank's post, along with the others. This is a ridiculous request, based on a claimant that has no idea how insurance works.

And Frank's comments on conflict and unethical are spot-on. When I said I wouldn't worry about the morality, I mean, you can't even get close enough to the claim that you'll have to worry about those things - but if you could, it's problematic at best.
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  #9  
Old 01-19-2020, 02:41 PM
Frank45 Frank45 is offline
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Quote:
Originally Posted by Westley View Post
Yes, the grammar is pretty bad. I assume A) He's not very smart and yet for some reason is posting on an actuarial board about his actuarial job (seems very improbable) or B) He's posting in his second, or third language. Unless you can post better in his native language than he can in English, it's poor form imo to get all judge-y on his language skills. Third possibility I guess is that C) he was posting from his phone, which sometimes gets all screwed up.

Agree with the rest of Frank's post, along with the others. This is a ridiculous request, based on a claimant that has no idea how insurance works.

And Frank's comments on conflict and unethical are spot-on. When I said I wouldn't worry about the morality, I mean, you can't even get close enough to the claim that you'll have to worry about those things - but if you could, it's problematic at best.
I only speak one language. I can read Spanish fairly well and maybe ask for directions or order a meal, but nowhere near being able to speak it in a business setting. I have huge respect for those who speak multiple languages.

That being said, having poor English language skills is likely going to impede your career growth in the US insurance industry. My main point is that unless you are CEO (or maybe EVP if Claims) you are not going to be able to influence the way the claims department adjusts a particular claim. The comment I made, and you reprimanded me for, was “and judging by the quality of your post, I seriously doubt that you are CEO”.

And judging by the grammar in the OP, I really do doubt that this person is a c-suite type exec. I could, of course, be very wrong. He (or she) might, in fact, be the kind of person who can make a call to the claims department and make them follow his dictates.
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  #10  
Old 01-20-2020, 10:52 AM
mcs84 mcs84 is offline
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Even looking up a claim that you have no business reason to look up is a terrible idea. They may (should?) keep track of every user who accesses a particular claim's internal notes.
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