Loss Adjusting is a professional activity that relies on a high degree of trust. It is therefore essential to maintain the integrity of the process by ensuring transparency and a complete absence of any financial or other improper influence. As well as being fair and honest, the process must be seen to be fair and honest.
The purpose of this policy is to ensure the work of ANA people is always free of influence and to the highest ethical standards. This is the only way to ensure that we deliver full value for insurers, claimants and society.
2. Areas of risk
The policy applies to all ANA activity in all areas, however the following are identified as higher risk:
- Attempts to influence an assessment outcome, whether in terms of the validity of a claim, what is included in the claim, or the claim value.
- Attempts to influence the allocation and/or pricing of repair work.
- The seeking of confidential information about a claim, which might for example be of commercial; advantage.
Insurers, claimants and suppliers may and are encouraged to supply information to the assessment process. Their intent in supplying such information may in fact be to influence the outcome. This is not corruption per se, as long as they only supply information they legitimately believe to be correct and relevant.
Corruption begins where factors not relevant to a fair decision are introduced. These may include:
- Offering or giving an inducement or benefit. It is not necessary that any link be made between the benefit and a change in outcome; it is corrupt simply to receive a benefit in the context of delivering a professional service.
- Threatening behaviour such as warning of possible consequences or bullying, including to friends or family or to the company.
- Use of potentially embarrassing personal information via threat of disclosure.
A threat to take an action which is not illegal (eg, to lodge a complaint or to go to the media) is not per se corruption, even if it is clearly couched as a threat, but should be documented and reported in accordance with this policy.
Corruption subsists in both the giving/making and in modifying an outcome in response to:
- Offering an inducement, threatening or using personal information to influence an outcome.
- Responding to an inducement or threat or use of personal; information by modifying an outcome.
4. Specific prohibitions
4.1 Payments, gifts and gratuities
ANA staff may not under any circumstances, in relation to a claim or adjustment accept any payment, gift or gratuity, including for example free or sample products.
An exception to this rule is promotional items of no resale value may be accepted from suppliers (eg, branded pens), where that is a normal business interaction.
Where ANA staff avail themselves of this exception, they should keep a note in their records.
4.2 Refreshments, meals, accommodation and entertainment
ANA staff must not under any circumstances accept drinks, food, entertainment or accommodation from anyone involved in an adjustment. They must pay their own way.
There are two exceptions to this rule:
- Non-alcoholic refreshments offered in a home or office (where the refreshments are not purchased) may be accepted.
- Meals and accommodation may be accepted in remote area or catastrophe work where it is a matter of practicality.
Where ANA staff avail themselves of these two exceptions, they should keep a note in their records.
Alcohol may not be accepted in any form.
4.3 Personal relationships
ANA staff may not enter into romantic or sexual relationships with any person they deal with in connection with an ongoing adjustment.
Relationships may be formed after an adjustment is completed.
If an adjustment involves or could involve any ANA staff engaging with a person from outside ANA with whom they are already in a relationship, the ANA person must inform their manager immediately. The manager may consider substituting staff or if the risk is low may seek to discuss the situation with the insurer, if appropriate.
4.4 Confidentiality of information
Information about a claim or a settlement may have commercial or personal value or cause commercial or personal harm in ways that cannot always be anticipated.
In response to any request for information ANA staff should consider whether the person asking has both a right and a legitimate reason to know.
This clause also covers passwords, keys and other access methodologies.
5. Absence of a clear link is no excuse
It may be that no link is drawn between a gift or other act and any outcome relating to an adjustment. For example, a gift may be given or hospitality offered without any indication of an expected reciprocity. A gift may in fact be a genuine act of hospitality made with no expectation or intent to influence an outcome.
However, a gift or act in the context of an adjustment is still banned under this policy, because it may create the appearance or a suspicion of corruption. ANA actions must be both above reproach and be seen to be above reproach.
6. Customer relationship building
In line with normal industry practice for customer relationship building, ANA and its staff may both give and receive appropriate seasonal gifts (eg, Christmas) and accept hospitality such as meals involving clients and suppliers. The defining conditions are:
- The action (giving or receiving) is approved by management.
- The exchange or event is clearly not associated with any particular contract, job or outcome.
7. Obligation to report
All ANA staff are obligated to report to their manager if they believe they have been the subject of an attempt to bribe, coerce or otherwise unfairly influence an outcome.
They should take notes as near as possible to the event and report immediately it is practical.
All ANA staff are also obliged to report any reasonable suspicion of corruption they may have in relation to an adjustment or any aspect of the ANA operation.
Reports should be made to their manager or if unavailable to the national CEO.
ANA will confidentially report to its client any attempted or actual corruption related to work done for that client, promptly and in detail.
8. Advice to others
ANA’s Anti-Corruption and Fraud Policy is a public document. You may decide it is appropriate to send a link to the policy to someone you are working with, for their information (the link is https://ana.net.au/policies/anti-corruption). The best policies are those that prevent bad behaviour, rather than just dealing with its aftermath.
9. Policy violations
ANA takes bribery and corruption very seriously, as a threat to the business, its clients, the industry and the community.
Any more than trivial violation of this policy will be treated with utmost seriousness and may result in summary termination.
10. Checklist of Fraud Indicators
- An inability of the claimant to prove that the property existed
- Unlikely circumstances of loss
- False statements that conflict with other evidence
- Obvious collaborative relationships with others giving evidence
- False documentation that is not consistent with familiar, legitimate documentation
- Vague description of events or patchy accounting of items lost or damaged (quality, quantity and/or cost)
- Aggressive or intimidating behaviour
- Unexpected knowledge of insurance terms and claims practices
- Avoiding recordable contact (claimant insists on meeting and resists writing or telephoning)
- Threatening to engage lawyer at an early stage even when claim is small
- Word-perfect witnesses, using identical phraseology
- History of similar claims, especially if undeclared
- Proof of earnings documentation informal and amateurish
- Injuries that are difficult to quantify (eg back pain, mental anguish)
- Evading or resisting insurer’s contact with witnesses
- Eagerness to quickly agree to a compromise settlement
11. Indicators when arson is suspected
- The business was facing insolvency or bankruptcy
- The proprietors were unable to sell a business
- The inventory level pre-loss does not match the post-loss quantity or type
- The proprietors have already set up another business elsewhere
- Furniture and equipment that was normally stored on the premises was not there at the time of the fire
- There may be a history of other fires
- The premises and business are over-insured
- The business may have recently increased its insurance cover for no apparent reason