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About the Case

Zoe Merritt, a 40-year-old policyholder from Lansing, Michigan, meets with a claims adjuster to discuss her insurance claim after severe storm damage to her home. As a single mother, Zoe relies on the insurance to cover extensive repairs and hopes for clarity on her policy’s coverage. 

As the claims adjuster, your role is to review Zoe’s policy, explain any coverage limitations, and guide her through the next steps in the claims process. Zoe seeks a clear understanding of her options and a resolution to alleviate her financial burden. 

Learning Objectives:
  • Showing genuine concern for the policyholder’s feelings regarding their claim denial 
  • Clearly explaining the reasons for the denial to prevent misunderstandings 
  • While acknowledging policy holder’s frustration, guiding conversation towards a solution  
  • Maintaining professionalism, even if the policyholder becomes upset 
  • Offering alternative options to help navigate the situation 
Skills Assessed
  • Compassion  
  • Communication 
  • Conflict Resolution 
  • Emotional Intelligence 
  • Problem-Solving 

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