Where should adjusters focus?
When diving into the world of claims,
just what should the adjuster be focusing
on? Here are five key areas where adjuster
focus is essential:
Coverage — This is critical to the outcome of any claim. Oftentimes coverage
can seem pretty routine. Was the policy
in force on the date of loss? Does the
driver meet the definition of an insured?
What about the scenarios that take a
longer time to resolve: Non-permissive
use, implied versus explicit permission,
unlisted drivers, vehicle usage that falls
outside of the scope of the policy? The list
goes on, and it is critical that the adjuster
makes the right decision for every file hitting his desk.
Investigation — Having run quality
assurance for a large multi-national insurer, this is an area where there is tremendous opportunity for improvement.
It seems that with all the competing
priorities, the investigation often takes a
back seat. There is a reason why adjusters
assess comparative negligence on only
3% of claims, while juries assess it more
than half of the time.
Evaluation — Perhaps the most fundamental aspects of the claims process, yet
one that can be quite time consuming. Just
what is an adjuster to do when a 500-page
time-limit demand lands on the desk but
he or she needs to attend an HR mandated
training course on workplace civility?
Negotiation — Driving to the right
outcome takes both knowledge of the
claim and wisdom. When one loses focus
on establishing liability and damages due
to noise external of the claims process,
how can one reach an optimal settlement?
The answer is they can’t. Sometimes it is
just easier to look at the medical bills and
apply a multiplier. After all, we have to
close claims to chase a disposition number, right? That is a topic for another day.
Recovery — There is a direct correla-
Improving outcomes for all
tion between not focusing on claims-
related tasks results and missed recovery
opportunities. Whether it is a delay
in moving a totaled vehicle, evidence
spoliation, overlooked risk transfers
or missed subrogation, the result is the
same. Money is left on the table. Indus-
trywide, these misses equate to billions
of dollars annually.
So how can we improve quality and outcomes? Simply put, let adjusters focus
on the basic blocking and tackling of the
claims process. Don’t throw unnecessary
tasks their way. Leverage this age of digitization to make adjusters more efficient,
effective and happy. This approach might
even have a positive benefit on staffing
models while lowering turnover.
Consider the facets of the life of a
claim. How can a robust first notice of loss
(FNOL) strategy help improve the claims
process? Can we leverage analytics to
identify recovery opportunities? Can we
use big data to assign and triage claims? If
we get the right claim to the right adjuster
immediately, there is a reduction in trans-
fer friction and a decrease in cycle time.
As adjusters conduct their investigations, are there tools that can make them
more efficient? Does it really make sense
to have an adjuster spend three hours
sorting, organizing and indexing a demand when technology could be used to
free up their time to focus on investigations, evaluations and negotiations?
In this age of digitization, there should
be a demarcation between where the adjuster’s touch is needed, and where technology can be leveraged to improve processes. The implications of being more
efficient in this regard drive everything
from staffing models to outcomes to customer retention.
However, this can be a challenge. After
all, the insurance industry is often rooted
in the status quo, but we can’t afford to be.
Innovation is going to leave those with
that mindset at a significant competitive
I once had a boss tell me that to be effective leaders we must always be thinking five years into the future. Technology
is changing rapidly. Think about it this
way. From the days of Double Indemnity to the early 1990s, a period of about
50 years, the typical adjuster was out on
the streets, Polaroid in hand, handwriting
estimates and documenting their Face
Then came the emergence of claim
management systems, where claims, underwriting and policy information went
online. Adjusters were armed with cellp-hones, often contained in an oversized
bag. Phones got smaller, systems got
better, estimatics moved online and the
world of the internet engulfed us.
In the mid-2000s came the emergence
of iPhones, changing the entire world of
connectivity. Facebook and other social
SIMPLY PUT, LET
ON THE BASIC
TACKLING OF THE
TASKS THEIR WAY.