What does a claims adjuster do

Everyone does that

- Andreas Zach has just come from a new favorite, as he says. 4,000 tons of sauerkraut and cucumber are buried under a roof that probably collapsed because of a burning photovoltaic system. As he explains, the 48-year-old is happy to constantly meet new people, machines and companies in his job as a claims adjuster at Allianz. His job is to help customers quickly after damage and to determine what they are entitled to. Then the agronomist who actually wanted to become a development worker would enjoy his job. But if black sheep tried to cheat on him, they would get reports. Because insurance fraud is a criminal offense and not a trivial offense, it harms honest policyholders: They pay the crooked sums with higher premiums.

It is important to Zach that this is mentioned. Now that this has been clarified, he can report in good-humored Bavarian language of 17 years as a claims adjuster.

brand eins: If I dropped my television set to buy a new one with the insurance money, would you prove it?

Zach: As a rule, a regulator only inspects damage from 1500 euros. Often it is a question of documentation, i.e. the receipts. The back office does not even allow some damage to be assessed.

When would the office staff prick up the ears because of the television?

There are point catalogs with which we evaluate damage. If several points come together, the clerk takes a closer look. But there is one thing I would like to say quickly, so that we don't just drift into these scam stories: I always assume at first that what I am told is correct. Anything else would be terrible. Then I didn't want to do this job. Most damage reports are correct. Not that you get the impression that we examine each damage to see if it is a scam. But we want to catch those who cheat. Today we have people of our own who only deal with scams.

Which fraud indicators make the office staff prick up their ears?

The clerks become aware, for example, if the start of the contract is relatively close to the time of the damage or if a customer frequently reports damage. Even if someone does not pay premiums and only pays them shortly before the damage. Sometimes there are also inquiries with the respective agent shortly before a claim whether all contracts are still valid. This is where the customer finds out that something might be wrong.

Isn't the awareness of injustice towards insurance companies so pronounced because many customers feel that they are being ripped off by clauses and small print?

On the one hand there is systematic and deliberately planned fraud, on the other hand there is the case in which the insurance company does not want to pay the customer for damage that was not intentionally caused because it is not covered. In this situation, the customer is annoyed about the insurance and the fine print. He may not bear in mind what happens if he tries to make an insured loss out of it. Something like this just happened to me last week. The customer ran out of aquarium. This is usually not included in home insurance unless it has been included. The customer then changed the representation of the damage and wanted 1,800 euros. When the clerk compared receipts and called the seller of the aquarium, he realized that something was wrong. The customer immediately waived his compensation. He still gets an advertisement.

How do such people justify themselves?

A typical argument is: I've been paying in for years and they want to deprive me of my compensation. My piggy bank is now so full that the small print can't be. The premium is understood as a down payment. As an insurance company, we say: We have covered the risk all these years, it costs money. And the conditions are important in order to be able to calculate. We are not a bank with a savings agreement. So some make the damage and reasoning appropriate. This can lead to bitter consequences: from an advertisement to job loss. Recently, a police officer even faked a bicycle theft. The supposed trivial offense of insurance fraud affects all social classes and professional groups.

Hasn't insurance fraud become socially acceptable in the same way as tax evasion, according to the motto: Isn't that what everyone does?

Good point. For example, when you hire a company to do repairs, you will often find yourself asked if you are insured. Now, of course, there are customers who say: That is outrageous, they want to bill generously. But there are also others who ask: "Could you maybe paint the wall over there for me and settle it with the insurance company?" These are constant temptations. We are all exposed to them. You always have to be careful with your moral index finger.

When you catch someone, do you discover awareness of wrongdoing?

In the case of damage that was not caused intentionally, there is. With the systematic fraudsters not really. The other day we had another arsonist in Munich. He is now under psychiatric treatment. For an insurance fraud of ten or fifteen thousand euros, the man had accepted that people would be harmed in apartment buildings.

Why do people cheat insurance?

In this case I would say: The man financed his life with it. He did that every six months. These are people who conclude contracts with the knowledge that they already know what damage they have done. That is calculated coolly. And then there are even more adventurous things where you ask yourself: How could he? I once dealt with a young entrepreneur whose company has grown so quickly that he lost control and thought: How do I get out of there? Shortly before a fire in his company, he asked if his contracts were in order. Then the head office received two messages from the local agency at the same time: There was a fire. And the customer was there a week ago and asked about his contracts.

And was that enough to prove the fraud?

No, that was just the beginning. In this case, the man got a whole truck with deliveries that was supposed to go down in the flames. The truck was actually loaded with scrap. He should burn with the scrap that he would have gilded with us. However, the driver could not enter the hall on the planned day. At the same time, the entrepreneur was in the USA to cover his tracks. From there he reported to us what everything should have broken. But there was nothing in the building. The man was arrested at the airport after landing.

What if the damage is undisputed, the customer wants a new carpet, but the insurer only wants to pay for a cleaning?

Such damage is sometimes blurred. Some damage is so complicated that there are perhaps only five experts who come to different conclusions. There is seldom the ultimate truth. The policyholder wants to shift this area as far as possible in his direction and the insurance in theirs. Usually one agrees. It is my job to reach an agreement as soon as possible.

Allianz is publicly traded and shareholders like to see low claims ratios. Surely there is pressure from above in your company to be strict?

Insurance companies must cover shareholder dividends, the apparatus and the claims expenses with the premiums. If a post gallops away, the premiums must go up. That is why it is also in the interests of honest insured persons that they only pay for what the contracts cover.

In addition to your supraregional tasks, you are responsible for the Munich districts of Gr├╝nwald and Harlaching, where many wealthy people live. What about insurance fraud there?

There are many break-ins there, but I have never found evidence of fraud, for example if expensive jewelry was stolen. Problems with jewelry usually arise when someone has come to a contract that does not suit their circumstances.

Can you be more specific?

For example, if someone has home contents insurance for only 15,000 euros and a watch insures for 25,000 euros. I recently had an accident with a Rolex watch, classic I would like to say. A lady had received jewelry insurance from us through a very good customer. A piece of jewelery was insured for 1,000 euros, one for 2,000 and a Rolex for 25,000 euros. In the first year the first part was lost, then the second, and in the third the watch was due. We had a strange feeling from the start, went to jewelers in Munich and showed them a photo of the woman on whom she was wearing the watch. One seller remembered and said that it was a different Rolex than the one stated by the insurance company. He also testified in court. The woman was convicted of fraud.

But you were lucky.

With Rolex, it's often not that difficult. The company has its own fraud department. The clocks have numbers. If a watch goes missing and is being repaired at a jeweler, Rolex will only issue replacement parts when the watch is sent to headquarters. This is why Rolex watches keep popping up. Sometimes, years later, a watch that has been reported as stolen is repaired by a later owner. Then there are notifications to the public prosecutor's office.

Does all of the deceitful Rolex owners know?

I do not think so. Once, on the last day of his insurance cover, someone allegedly lost his watch during a soccer World Cup match on Leopoldstrasse in the turmoil. But by this point it had not been in his possession for months. We knew that because a new owner had in the meantime sent it to Rolex to have it repaired. -