Dilemma: Right vs. Right
Honor Confidentiality or Protect a Child? An Insurance Adjuster's Dilemma
Don Riles, insurance claims adjuster, had the day off. He was playing with his 4-year-old daughter Erica when the telephone rang. At the other end of the line, Don's supervisor apologized for interrupting his time away from the office, and pleaded for his help. Would Don please visit a woman in his neighborhood who had made claims for bodily and mental injury resulting from a car crash with a person insured by Don's company? The woman had consented to a visit from their adjuster to assess the injuries to her nose and her mental state. (Apparently the crash had caused her to relapse into a condition of paranoia and manic depression, previously stabilized.)
The claims adjuster in charge of the case had called in sick, and scheduling the appointment had been difficult. Would Don please fill in? Don agreed readily, but asked if he could bring his daughter--it was their day together while his wife worked. Don's supervisor gratefully assured him that bringing the little girl along was no problem.
When Don arrived at the woman's house, he discovered no one at home, so he and his daughter waited in the car. Eventually, the woman arrived, parked, and emerged from her car, at which point Erica cried happily, "It's Miss Anderson!"
"Who is Miss Anderson?" asked her father with surprise. Miss Anderson turned out to be Erica's day-care teacher. Don conducted a short interview with the woman on the front steps of her home, satisfying himself that she did indeed have some facial injuries and that she was taking prescription medicine for her mental problems.
Insurance ethics mandates that claims investigations are completely confidential. An insurance professional with knowledge of a claims case is expected to keep silent and to refrain from using the knowledge for personal benefit.
Don had a real dilemma. On one hand, to uphold his industry's code of ethics, he was not to discuss or act on the information he had received about Miss Anderson's situation. On the other hand, he did not want his daughter under the care of a person who was undergoing treatment for mental illness and who might be dangerous. Don's wife was an insurance claims adjuster for another company. Even if Don told her, she was bound by the same code of ethics.
As a last resort, Don called Miss Anderson's lawyer and asked if she would leave her job until she became stabilized. Her lawyer said that it was out of the question.
What should Don do?
Note: This and other dilemmas on this site come to you without their real-life resolutions. We encourage you to think for yourself about how you might resolve them, since the nature of each dilemma is highly individualistic. In sharing these dilemmas, we do not endorse them in any way, but rather offer them for your consideration.
