One of the most complex as- pects of claims adjusting involves bodily injury inves- tigations.
Provided coverage is in line, the immediate task is to determine liability. It is important to remember that a claimant must
prove both liability and damages in order
to be legally entitled to compensation.
Liability is crucial because comparative
negligence is often overlooked. Claims
executives lament that claims are set-
tled at either zero or 100 percent, with
the occasional 50/50 sprinkled in for
good measure. The reality is that rough-
ly three percent of all claims are settled
with a comparative negligence assess-
ment. When compared to the more than
50 percent of all cases adjudicated by
juries where comparative negligence is
assessed, a huge opportunity for organizational improvement emerges.
Consider the sheer number of claims
involving intersections, lane changes,
parking lots, slip and falls, assumption of
risk, or liquor liability and the compara-
tive negligence that should almost always
be evident. While there are numerous
reasons for not assessing comparative
negligence, there are also solutions. A
tremendous upside has been identified
through carriers who have incorpo-
rated proven tools into the end-to-end
A good rule of thumb for all adjusters
is to never underestimate the importance
of liability as a critical element of the
claims investigation. Beyond the potential accuracy improvement in indemnity
payments, there is a dramatic rise in subrogation potential. An estimated 15 percent of all claims are closed with a missed
subrogation opportunity, costing the industry $15 billion annually.
When it comes to the actual bodily injury evaluation, there are key elements
adjusters need to focus on when completing their investigation. First is the relationship between the accident and the
injury. An adjuster may need to ask, “Just
how did the sideswipe accident cause a
disk herniation at L4-5?” or “How did
the $500 bumper ding result in the need
for a spinal fusion?” These may seem like
basic questions, but they are rarely asked
during the course of a claim.
Adjusters should be curious
This aspect of the investigation requires
an insatiable curiosity by all adjusters.
The Art of BI
Curiosity is an adjuster’s
By Chris Tidball