信頼の貯蔵庫を満たす：保険会社が顧客体験を再構築する方法

A few weeks ago the insurance industry received an unusually large amount of attention from the press. A well-known insurance startup came under fire for its allegedly unethical use of AI. The New York-based insurer had tweeted about a unique aspect of their claims process, noting that when policyholders submit claims, they are asked to create a video explaining the circumstances that led up to their claim. The recording is then evaluated for fraud when the AI picks up “…non-verbal cues that traditional insurers can’t since they don’t use a digital claims method.”

And that's when the floodgates broke loose. An outpouring of tweets accused the company of discriminatory practices based on a variety of potentially prejudicial identifiable facts such as race, gender or disability. In response, the insurer immediately deleted the post and published a blog saying it was a “poorly worded tweet” and that “AI that uses harmful concepts like phrenology and physiognomy has never, and will never, be used at [this company].” They also noted that no claim is automatically rejected. If a suspicious claims story is detected it is forwarded to a human reviewer.

While tensions between the insurer and the “Twitter mob” seem to have abated, it made me wonder if this incident was symptomatic of a larger problem: an industry-wide fundamental lack of trust. Insurers constantly have to grapple with the notion of equity and fairness. Part of their business model is ensuring customers they can easily get paid in the event of any sort of accident. On the other hand they have to ensure they are taking necessary steps to protect themselves against fraud.

In the above instance, the public’s inability to “see” this new AI addition inside the insurer’s ‘black box’ or code led to some concern about this extra level of potential bias when claims are filed. While there may be some implicit human bias in any claims processing whether it is embedded within the AI code or stems from evaluations made by traditional industry professionals, this new development caused some members of the public to suspect the worst.

There are several other possible reasons why insurers may not always inspire trust, but I believe the root lies in a mismatch of expectations.

Making the Customer Whole vs Just Getting the Claim Paid

Many insurers believe their responsibility to policyholders is to ensure they are paid for a loss. While this is important for customers, many of them “want more.” Many customers have never filed a claim before and have no idea what to do in the event of an accident. If they were to get into an auto accident: who is going to tow their car, what auto body shop should they go to, and how are they going to get a rental car to go to take their kid to soccer practice the next day? Cutting a check simply isn’t enough. What they want is to be ‘made whole again’ and for customers that requires making them feel there is a more holistic element included in how they are taken care of in a time of crisis.

Other contributing factors to a negative perception of insurance companies:

Monthly Premium Burden

In the most basic terms an insurance policy is a guarantee to indemnify a loss in a time of need. By collecting a small premium from many, insurance companies then pay a large sum to a small few. Relatively few individuals in that pool ever incur a loss and many feel their premium only goes to paying for claims made by other customers. Thus, for the many that simply pay a monthly premium and never file a claim, they often see their policy as an annoying expense.

Lack of Policy Education

Few policyholders actually take the time to read their policy and really see what it covers. As a result, many policyholders are not educated on the exclusions, or specific definitions of what is, and is not, covered. They may be frustrated and/or confused when they file a claim. Even once a policy is sold it’s also true that some agents may not have taken the time to educate or re-educate themselves with what coverage is provided in the current agreement. All of this may lead to confusion and further mistrust.

Payment Misunderstanding

The principle of indemnity states that the role of the insurer is to put the customer in the same position he was before the claim was filed; not better and certainly not worse. While this makes sense, valuation clauses such as Actual Cash Value (applying depreciation) or Replacement Cost Reimbursement make this concept harder to understand.

Let’s say I am a manufacturer and think I’ve purchased replacement cost coverage on my equipment as the dec page says I have replacement cost. But buried in the fine print, which I’ve never read, is a clause that says that the insurer will reimburse me the replacement cost, only after I have replaced the equipment. Until such time that the property has been replaced, they’ll only pay the actual cash value – applying depreciation factors to the amount of payment. A fire breaks out and the business is destroyed. I’m now on the hook to come up with the difference between the cost to replace the equipment and the ACV payment. If the equipment is relatively new, that may not be a big burden. But if it’s older equipment or high-valued equipment, I may have difficulty coming up with the funds.I may need to take out a loan – which is problematic if I have no collateral (because it burned) and I have no income (because the business was destroyed). This can seem frustrating to the customer as they may feel they are not “being made whole” again when they actually have to reach into their own pocket to return life to normal.

‘Grass is Greener’ Effect

Insurers constantly have to grapple with the notion of equity and fairness. Part of any business model is ensuring customers can easily get paid in the event of any sort of accident. On the other hand they have to ensure they are taking necessary steps to protect themselves against fraud.

It's understandable that some legitimate customers resent the safeguards they encounter when they actually do file a claim. Any new protections may lead them to believe that their particular insurance company is adding undue friction to the process. They may think that other insurance companies out there would provide a much easier experience. Consequently, any sort of checks or extra validations in the claims process may erode customer satisfaction and contribute to the overall picture of slightly untrustworthy and less than helpful service providers.

The Future: Filling the Reservoir of Trust

While there is no panacea that can instantly cure society’s negative perception of the insurance industry, the industry's recognition of this problem is creating an environment where insurers are already making modest strides towards initiating change. At the heart of this effort is the move to ensure that their organizations take a customer-backed approach. It is paramount they do all they can to make sure the customer feels they are covered (and not just monetarily) in a time of need. Practical customer-based services such as providing information on replacement cars when a customer’s vehicle is in repair can make all the difference to getting life back to normal for the policyholder and not coincidentally enforcing good will towards the helpful insurance company providing even small but crucial information or services when a claim is filed. On the very simplest level, this can, in part, be achieved by making sure, from the very beginning, that the policyholder has a clear understanding of the insurance company’s role and what their coverage entails. In addition, the policyholder should be aware of new definitions of the services an insurance company can provide when a claim is initiated.

Sure, there will continue to be skepticism about the insurance industry especially when instances similar to the one that just occurred come to the public’s attention. However if insurers act in good faith and take more steps to ensure customers are an ally then maybe, just maybe the public will meet them halfway.