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Improve bottom-line outcomes on claims by thinking outside-the-box!

Claim handling is just as much an art as it is a science. Synthesizing facts and investigating losses requires, not only following process and procedures, but also the ability to look at new ways of solving established problems.

Following best practices is of course an effective way to achieve consistently good claims results. Regardless, the best claim handlers always look at different ways to examine even the most ordinary file. Thinking outside the box is an essential element to innovative claims handling. This type of thinking can lead to lower indemnity payments and reduced expenses.

Below are two examples of situations where the claims adjuster’s innovative approaches lowered the overall exposure.

Using Chinese numerology allowed for earlier resolution in a wrongful death claim

In a case involving a Chinese immigrant, the decedent’s family sought damages for wrongful death as a result of a construction accident. Prior to the mediation, the Claims Adjuster had heard that certain numbers in the Chinese culture were considered bad luck and superstitious. In fact the number four, and certain combinations of numbers, are particularly insulting (see Artcile on Chinese Numerology).

As a method to resolve the case at the best possible value, the adjuster made the first offer to claimants utilizing a series of numbers that were considered prosperous in Chinese culture. The plaintiff’s responded in kind with similar combinations of numbers that made it clear that the gesture did not go unnoticed. With this measure of good faith presented to the other party, the case was resolved sooner than anticipated saving the carrier additional legal and investigative costs.

Using excel to graph heart rate changes in a Malpractice suit helped to reduce the ultimate settlement

In a medical malpractice case involving a brain damaged infant, the liability turned on the baby’s heart rate changes during the delivery period. The plaintiff alleged that the doctor should have performed a cesarean section earlier than had occurred. The allegations against the nursing staff were that they failed to appreciate a significant drop in the baby’s heart rate, and should have then alerted the doctor sooner.

The adjuster used excel to graph the heart rates of the mother and the infant over the critical period. With the graph, they were able to show that fetal heart monitoring strips were actually recording the mother’s heart rate rather than the infants (maternal heart rates are significantly lower than fetal heart rates).  The information helped the defense to surmise that the mother’s monitoring belt had slipped out of position. The period of time where the mother’s heart rate was being recorded coincided with the alleged decrease in the fetal heart beat, thus providing an explanation for the precipitous drop. Using this argument, the claims handler was able to mitigate the settlement at trial below the original value.

Think differently and try new approaches when looking at that same old claim file

The above examples are situations where the adjuster’s thinking “outside-the-box” produced better results. It’s not always about proving an absolute defense, but can be about mitigating an already significant loss. Claim handlers should make an effort to look at the normal in a different way. Even using common available tools differently can result in large savings in indemnity or expense dollars. Some other examples of existing tools that can be used to help think outside-the-box would be:

  • Get SIU involved earlier. Sometimes, even though there may not be fraud present, your SIU investigator can help explore different approaches to finding new information about the claimant  or the events at issue. Even minor issues can lead to information that can be used to reduce the loss exposure.
  • Social media is free so use it. Twitter, Facebook and other social media outlets can be a valuable source of information about a claim or claimant.
  • Use reconstruction animations. In the right case animations are a valuable tool that can create a new understanding of the claim. The sophistication of these short videos allow the claims handler to look at events from different perspectives and open new avenues to the defense not previously seen (i.e. ability to look at a crash from different angles and different drivers viewpoints).

Have you saved money by looking at a claim file outside-the-box? Tell me your story and spread the word to help others save significant money on indemnity and expense payouts.

Posted in Best Practices, SPOT on Issues.

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