ARCHIVED - Brief Case Studies of Exemplary Practices

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Royal & SunAlliance

Objective and Scope of Business Line
Royal & SunAlliance (RSA) is a property and casualty insurance company. Their stated mission is: "To lead the Canadian insurance industry through expertise, innovation and outstanding service to our customers and business partners."

Type of Service Provided
RSA has approximately 1 million policyholders in Canada with premiums generating revenue of approximately $1.2 billion per annum. Personal policyholders include those insuring their automobiles and/or their residences (home owners, renters, condominiums). RSA also has commercial policyholders, providing coverage for retail premises and financial liabilities.

RSA processes approximately 200,000 claims per year and makes coverage payments of approximately $14 million each week.

Delivery Processes
RSA policies are sold through a network of approximately 1,500 independent insurance brokers across Canada. The primary focus of RSA's service delivery is the handling and processing of insurance claims.

Of RSA's staff of about 3,500, there are 700 whose functions are solely dedicated to the claims process. The claims staff includes telephone response representatives, adjusters and automobile appraisers, among others.

RSA claims staff provide 24-hours a day, 365 days a year response through a nationally accessible 1-800 toll-free telephone line.

Service Standards in Use

Service Pledge
The following "promises" are featured prominently on all RSA promotional material, the RSA web-site and on all documentation that is sent out to customers:

Claims Promise To meet - and exceed - our customers' service expectations by handling all claims fairly, efficiently and sensitively. Delivering on our Promise Contacting customers promptly & courteously. Dealing with customers sympathetically. Investigating claims efficiently. Arranging appraisals and repairs quickly. Settling claims reasonably, responsibly and promptly. Pursuing all avenues of recovery conscientiously. Resisting fraudulent and exaggerated claims.

Service Standards
RSA has developed a set of service standards designed to help them meet their pledge commitment. The standards were developed internally, without the use of external consultants. The standards were developed by a task force of employees from various areas within the company. The standards were developed using input from a variety of sources, including:

• Claims representatives
• Insurance brokers
• Call centre personnel
• Findings from customer satisfaction surveys

These standards are published internally and are not available to customers or the general public. The objective of the standards is to meet the pledge that is made to customers. These standards are used to monitor, modify and evaluate employee and company performance. A copy of these standards is included on the following page.

R&SA Claims Service Standards

1. Initial contact with Insured is within 2 hours of receiving telephone notification of loss and within 4 hours of receiving faxed notification of loss from broker.
2. Initial contact with Claimant is within 24 hours of receiving loss report.
3. We appraise vehicle damage within 1 working day of claim being reported in urban areas, and 3 working days of claim being reported in rural areas.
4. A total loss from an auto accident is negotiated and paid within 10 working days of the motor vehicle accident. A total loss theft is negotiated and paid within 21 - 30 days of the theft.
5. We assess property damage within 2 working days of claim being reported.
6. We issue a cheque within 2 working days of the settlement.
7. Invoices are processed within 5 working days of being received on all claims except Ontario Accident Benefit claims. We follow the Ontario auto legislation and pay approved medical invoices within 30 days and all other approved AB payments within 14 days of receipt of the invoice.
8. All telephone calls are answered and/or returned immediately when possible; at the latest within 24 hours.
9. Correspondence is answered or acknowledged within 5 working days of receipt except in the case of Ontario Accident Benefit claims. We follow the Ontario Auto Legislation and respond to Accident Benefit claims correspondence within 14 days of receipt.
10. Use of a pro-active diary system, in the initial stages of the claim, ensures that every claim is reviewed every 30 days by the Claims Representative.

Service Standard Monitoring
A variety of methods are used to monitor service standards.

For the claims representatives and appraisers, five of their claim files are randomly selected each month. These files are reviewed to ensure that all 10 of the service standards (where applicable) have been met. Where service standards are not being met, a more thorough review of that representative's files is undertaken.

For telephone call centre personnel, supervisory staff listen in on calls on a random basis. Where shortcomings are identified with respect to standards for a particular individual, the calls will be recorded and the supervisor and call centre representative will listen to the calls together and identify areas for improvement.

All claims personnel who are monitored are provided with a one-page report card identifying strengths and areas for improvement. These report cards are also used as part of each individual's annual performance appraisal.

After each automobile claim has been settled, the policyholder is sent a post-repair from to complete. The information collected through these forms is also used to monitor the service provided by both the claims department and the repair service provider. This enables RSA to monitor both its own service levels as well as those of their selected external providers.

RSA participates in the annual Customer Satisfaction Survey that is mandated by the Financial Services Commission of Ontario (FSCO) for Ontario automobile claimants. This survey comprises three questions designed to measure overall customer satisfaction. RSA has expanded its questionnaire to 15 questions, measuring the various specific aspects of customer satisfaction and identifying potential areas for improvement.

As well, RSA not only surveys Ontario automobile claimants, but has expanded its survey sample to include both property and automobile claimants across Canada. The findings from the survey are compared with results for other insurance companies as well as with results from previous years. As previously mentioned, the survey findings are included in the development of service standards.

Exemplary Practices

Telephone Communication

• All claims staff receive training in telephone communication. Including ongoing, on the job training, the process takes 12 months to ensure that all standards will be met.
• All staff, if they cannot answer their telephones leave a message that indicates when the caller should expect to be called back. If they are unavailable for an extended time, they indicate where the call should be re-directed to.
• "Live" telephone communication is available 24-hours per day, 7-days per week. This enables somebody who has just undergone a loss to confirm their coverage immediately.

Appraisal Service

• The RSA appraisers are provided with up-to-date technology, in the form of video-imaging equipment. This allows for faster and more accurate assessment of damages and it speeds up the repair process. In addition, appraisers re-inspect at least 10% of repaired vehicles to ensure that the work and parts meet the set standards.

Empowered Adjusters

• Adjusters are equipped with field cheques. This allows them to provide immediate payments to policy holders. The intent of this service is not to make full payment on the claim, but rather to provide the policyholder with enough money to see them through until the claim is settled. There are always adjusters available on a 24-hour stand-by basis.

Lessons Learned

Modifying Standards in Unusual Circumstances

1. During a major, natural disaster (i.e. ice storm) there was an unusually high number of claims coming in, all at one time. Rather than recognize the unusual circumstances, an attempt was made to maintain service standards in the face of overwhelming call volume. The results were frustrated customers and overworked, demotivated employees.
2. In post-disaster analysis, it was found that customers understood the gravity of the situation and generally did not expect to be called back within two hours. A better understanding was developed for this kind of situation as well as a willingness to understand that the service standards that are in place primarily apply to business as usual.
3. Rather than sticking to the aforementioned standards, it is alright to say: "In view of the current emergency, we will try to get back to you within 72 hours instead of 24 hours." This type of approach of managing customer expectations decreases customer frustration and at the same time improves employee morale.

   Keeping Customers Informed

4. Customer satisfaction surveys demonstrated that the greatest frustration faced by customers did not involve the fairness or timelines of their claim settlement. Rather the most common complaints revolved around being kept informed regarding the progress and coverage that applied to their claim.
5. Much of the focus of the claims process now includes providing customers with expected timing on such items as adjustment and appraisal, deductible amounts and eligible coverage, time to settlement, temporary automobile or residence rental limitations, etc..
6. It was discovered that the bulk of reasons for customer dissatisfaction did not involve the claims process, but rather the communication process. Consequently, a large part of the service standards are linked to the establishment and maintenance of a communications process.

Contact

Karen Lock
Manager, Claims Department
416-366-7511
Karen_Lock@royalsunalliance.ca

 

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