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Category Archives: SPOT on Issues

  1. Why Extending More Claims Authority Means Extending More Responsibility September 10, 2010

    Posted in Best Practices, SPOT on Issues.

    Extending additional authority to a number of claim handlers can have a dramatic affect on the department’s total incurred. Make sure claim handlers understand the impact, both good and bad, to the company. Deciding when, and how much authority to extend will always depend on the line of business, and experience of the claims professional. Giving more authority also means extending more responsibility to the junior claims professional to make greater financial decisions for the company.

    In today’s post we discuss the authority-responsibility correlation and the importance of ensuring claims authority is extended only when responsibilities associated with that authority are understood.

    No comments
  2. 3 Ways To Help Defense Counsel Help You Make Claims Management More Efficient September 3, 2010

    Posted in Best Practices, Litigation Management, SPOT on Ops.

    We all talk about collaboration with counsel as a means to get better results at a lower costs. But getting what you want is not so easy. How about trying to get what you truly need to get your job done. In our latest post, we discuss three suggestions for helping counsel help you get better results. No attorney is going to say that they don’t want to make a claims professional’s job easier, so help them to help you. Start by telling them what you do, ask for what you want, and then make sure they do it. Take a look at the latest – from the Claims SPOT.

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  3. AMA Study Finds Almost 1 Malpractice Claim Is Filed For Every Physician – Not Really Shocking August 23, 2010

    Posted in Medical Malpractice, SPOT on Issues.

    A study from the American Medical Association (AMA) reports that an average of 95 medical liability claims are filed for every 100 physicians, almost one per physician. The AMA study looked at 42 specialties and was from a sample size of over 5,800 physicians. The number of medical liability claims is not an indication of the frequency of medical error, as the physician prevails 90 percent of the time in cases that go to trial. While 65 percent of claims are dropped or dismissed, they are not cost-free.

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  4. Promote Creative Thinking To Get The Most Out Of Your Claims Staff August 16, 2010

    Posted in Best Practices, SPOT on Issues.

    Good workers are sometimes all that claims departments look for and, given the nature of claims these days, it is not a bad thing. There is so much to do and so little time to do it and good workers, however you define them, are great to have. But how often are creative thinkers looked for? In a video lecture from, Sir Ken Robinson, he asks why don’t we get the best out of people? He argues that it’s because we’ve been educated to become good workers, rather than creative thinkers. Do you recognize that employee in your organization? How should we promote creative thinking in the claims world – read more in today’s post at the Claims SPOT.

    2 comments
  5. What Paul Revere Can Teach Claims Professionals About The Benefits Of Building A Strong Professional Network August 12, 2010

    Posted in Best Practices, SPOT on Issues.

    Is professional networking (so-called social networking) relevant for claims professionals? Does it make them more effective, help them to identify resources they need to do their job better, find the right attorney, be creative, identify emerging technologies, spark their imagination, and set industry trends? Or are they a waste of time, an invasion of privacy, or just not part of your world?

    To look at that, this article examines the effectiveness of Paul Revere and the analytical work done in several publications, including the Harvard Business Review, Tipping Point and Connected. It examines the potential of social and professional networks, what makes them successful and effective, and the applicability of technology platforms liked LinkedIn to the claims management profession.

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  6. 3 Suggestions To Beat The Summer Slow Down In Claims (If You Do Slow Down) August 3, 2010

    Posted in Best Practices, SPOT on Issues.

    It’s summer time and the living is easy!

    Take advantage of the summer slow down and make changes, clean things up and improve your operation. In the latest post from the Claims SPOT see three suggestions for ways to use your summer effectively. One for the manager, one for the claims handler and one for the claims executive, suggestions to use the slow down to improve your operation. Take a look and suggest others – we would love to hear from you.

    2 comments
  7. Why Can’t We All Get Along? Making The Agent A Partner In The Claims Process July 27, 2010

    Posted in Customer Service, SPOT on Issues, SPOT on Ops.

    Creating a strategic advantage through improved agent carrier relations

    The relationship between claim adjusters and agents can be an adversarial one. Each side often finds itself correcting issues created by the other side. Agents may set the wrong coverage expectation for a customer, leaving the adjuster to deliver the bad news. Adjusters may get overloaded and not return phone calls in a timely manner, resulting in a complaint to the agent’s office. In the worst case scenario, adjusters and agents may badmouth each other to customers, putting customers in the middle. Clearly, agencies have a role to play in the claim process. Enabling agents and their staff to perform their role efficiently with empathy and professionalism can benefit customers, agents, and the claims department. Read more this week from Melissa Loew.

    2 comments
  8. Encounters of the Best Kind Can Create The Strongest Claims Organizations July 20, 2010

    Posted in Best Practices, Customer Service, SPOT on Issues, SPOT on Ops.

    Companies cannot define their core “brand” through brute marketing and advertising. Rather, customers define what that brand is in their individual interactions with the company. Those interactions can either be transactions or encounters. Encounters make the relationship stronger while transactions result in a worse relationship or one that stays the same. This is no different in the claims professional’s world. How can claims professionals create encounters, and avoid transactions, in their interactions with their customers?

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  9. In Claims Don’t Let The Process “Thing” Get In The Way Of Doing The “Right” Thing July 19, 2010

    Posted in Best Practices, SPOT on Issues.

    Making a check in the process won’t ensure the matter is done right. I have written, and am a big proponent of, the importance of good process as a way to ensure good results. Putting a proper process in place is a road-map to help move claims to a prompt fair resolution. Nonetheless, doing and focusing on the process without making sure the outcome is sound is doing things right without doing the right thing. It’s so easy in claims to focus on the process and not use the process as a means to the end

    2 comments
  10. The Importance Of The Pre Bind Claims Review In The Reinsurance Context June 29, 2010

    Posted in Claims Auditing, Due Diligence, SPOT on Ops.

    Reinsurance companies faced with a new submission often review loss runs and other financial data to determine the effectiveness of an account. However, numbers only tell half the story and in order to get a complete picture of a cedent’s submission, it is important to have an understanding of the claims department. What is the company’s reserve philosophy? What kind of systems do they have in place? How are claims staff measured? Conducting a comprehensive pre-bind review is an important step to help minimize the risk.

    In this post, the Claims SPOT explores the importance of the Pre-Bind review in the Reinsurance context.

    2 comments
  11. Social Media And Claims Investigation: Do You Know About Foursquare? June 28, 2010

    Posted in Best Practices, SPOT on Issues.

    Undoubtedly, you’ve read plenty of articles or have been to numerous presentations regarding the use of social media to investigate claimants. At this point, the novelty of Facebook and MySpace has worn off. The same can be said about Twitter. Everyone knows at this point to take a look at those platforms when searching a claimant’s background. Enough said. However, seemingly with every new day comes a new social media application. One relatively new application that you should also take a look at during your claims investigation is Foursquare.

    Learn more from out latest contributor, Christian Stegmaier, JD and look for more articles from Christian in the weeks to come.

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  12. 6 Steps To Reduce Expenses For Medical Experts As Suggested By The Expert June 17, 2010

    Posted in Medical Malpractice, SPOT on Costs, SPOT on Issues.

    The traditional method for preparing an expert is to send them the entire record and let them review for possible issues. Dr. Philip Lanzkowsky, a medical expert providing opinions and testimony on cases for both plaintiff’s and the defense, raises some practical questions and provides a series of suggestions as to how those expert costs can be reduced.

    Read more in this interesting post of expense reduction of medical expert costs as suggested by the expert.

    2 comments
  13. How To Understand Capturing Lost Hotel Profits Due To The Gulf Oil Spill June 16, 2010

    Posted in SPOT on Issues.

    Knowing how to capture lost profits is critical when seeking reimbursement from the responsible party With uncertainty and concern surrounding the impact of the Gulf oil spill to the coastline from Florida to Texas, many companies are asking what needs to be done to quantify and document lost income for future claims.  Many businesses are [...]

    2 comments
  14. The Need For Claim Auditing In Catastrophe Loss Situations Such As The Gulf Tragedy June 15, 2010

    Posted in Best Practices, Claims Auditing, Rick Woollams (Chartis Chief Claims Officer), SPOT on Issues.

    The tragedy of the Deepwater Horizon and the aftermath seem to be a topic of constant conversation. From an insurance perspective there is a large amount of criticism being brought to bear on the claims process. The massive administrative organization that has been established to handle what are already tens of thousands of claims is an undertaking that could be fraught with problems. In today’s post from The Claims SPOT we discuss how auditing in the Catastrophe situation is an important part of the process to ensure claims are paid quickly and appropriately while at the same time preventing fraud.

    Take a look and join the conversation.

    Like what you read? Pass it along to a friend and suggest they subscribe.

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  15. Change Hats With Someone And Free Your Mind To Make Your Claims Operation Better June 9, 2010

    Posted in Best Practices, SPOT on Issues.

    Don’t limit what you can imagine by what you know – look to others to help improve your claims department.

    In Trading Places: A Smart Way to Change Your Mind, Harvard Business Review contributor, Bill Taylor discusses the “power of a whole new mindset about innovation.” The article goes into what happened when two CEO’s switched companies for a day and the learning that came from the new perspectives they had. The Claims SPOT discusses how having claims adjusters switch roles with different disciplines can be a new way to expand their skills. Having managers sit with other business divisions, such as underwriting or actuarial, can be a great way to get a better understanding of the entire insurance process outside of claims. And lastly, looking outside of claims and insurance altogether to change hats and free your mind to new ways to make your operation better.

    2 comments
  16. The Claims Writing Workshop: Write How You Speak! Just Leave Out The Color Commentary June 1, 2010

    Posted in Claims Writing Workshop, SPOT on Issues.

    From our new contributor Dr. Gary Blake, we learn about writing and claims. Dr. Blake is a Port Washington, NY-based writing consultant who presents claims writing webinars and seminars throughout the United States. In his first post on The Claims SPOT, Dr. Blake discusses writing the way you speak without the color commentary. As he states, “write using the model of speech’s simplicity, directness, and warmth. Just don’t mirror speech’s unplanned distraction and tendency to ramble. “

    1 comment
  17. 3 Settlement Techniques That Will Help Move A Case To Resolution May 25, 2010

    Posted in Negotiation, SPOT on Issues.

    As a claims professional, you know you have cases that will ultimately settle, and can settle, but for some reason or another you just can’t get there. Recently I came across a great blog dedicated to providing different ideas and solutions surrounding the settlement process. Settlement Perspectives, written by John DeGroote, provides insights and “thoughts on how to resolve disputes and get your deal done.”

    In today’s post I comment on three techniques suggested by John – Managing Expectations, Decision Trees and Offers of Judgment – and show how more out-of the-box approaches can be a useful way to move a case to resolution and settle claims faster and cheaper.

    4 comments
  18. How Do You Effectively Manage A TPA? Speak Up And Be Active! May 20, 2010

    Posted in Best Practices.

    Become The Squeaky Wheel To Actively Manage TPA Outcomes As claim practitioners, most of us are familiar with what to look for when we shop for a third-party claim administrator (“TPA”).  One recent discussion on this blog cited such elements as claims systems, data reporting capabilities, and quality control (6 Essential Elements When To Explore [...]

    3 comments
  19. 2 Chores that should not be neglected to become a stronger claims organization May 18, 2010

    Posted in Best Practices, Claims Auditing.

    Lets face it – no one really likes to do mundane things. Nonetheless, it’s those very chores that have to be done regularly to ensure a strong organization. Like cutting grass, the longer you let it go the worse it is for your grass, and the harder it will be to fix the mess that has been created. There are certainly enough chores that need to be done in the world of claims that no one likes to do. You know what they are – those things that you would prefer to not have to get to. They can include writing notes on files, keeping a diary and paying bills. But as any good claims handler knows, if you fail to do those tasks regularly not only won’t your grass grow, but you will have quite a clean-up.

    Two chores that can really help claim departments grow nice healthy grass are in the areas of training and managerial assessments. Learn a few chores that have to be done but will help grow your organization.

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  20. 4 Key Areas For Claims Handlers To Review When Dealing With Follow Form Policies April 15, 2010

    Posted in Coverage.

    A follow form excess or umbrella policies is a type of policy were the terms and conditions of an underlying layer of coverage are adopted and incorporated into the “following” layer. While these policies may still have independent provisions and exclusions, they will nonetheless relate back to the underlying, “followed” policy, for most of the terms. In many situations this way of handling excess coverage prevents inconsistencies and ensures there are no gaps in coverage. However, in complex matters involving multiple layers of coverage, or when the language conflicts with the underlying layer, many problems can occur. In claims involving these types of policies, claims handlers must fully analyze all the terms and conditions of all the policy provisions to truly understand the coverage applicable. This weeks post give 4 key areas for claims handlers to consider when dealing with follow form policies.

    1 comment
  21. Saying “I’m Sorry” Can Reduce Exposure to New Claims March 5, 2010

    Posted in Commentary, Medical Malpractice, My SPOT, SPOT on Costs.

    It may seem counter intuitive, but with the right technique a heartfelt apology can help lower claims costs and exposures There is a wave of civility sweeping through the world of risk management as a way to lower exposure and reduce costs: Apologize. Maybe mom was right when she stood there and said “now say you’re sorry.” In fact, there are some very impressive statistics in the area of medical malpractice around the simple use of an apology. Regardless, there is a proper way to apologize while protecting rights and some policy considerations to consider.

    3 comments
  22. 7 Considerations When Drafting Claims Guidelines March 1, 2010

    Posted in Best Practices, Compliance, SPOT on Issues, SPOT on Ops.

    Claims departments employ professionals that want to do a good job for policy holders as well as the company, and claims guidelines should help foster those goals. Before drafting guidelines there are a few things that should be considered and we, along with our fellow blogger Phil Loree, suggest 7 things a company should consider when drafting claims guidelines.

    5 comments
  23. Important Update: Medicare Secondary Payer changes production date to January 1, 2011 February 18, 2010

    Posted in Medicare Secondary Payer, SPOT on Issues, SPOT on Ops.

    The Centers for Medicare/Medicaid Services (CMS) have announced the following: CMS advises all NGHP RREs that the date for first production NGHP Input Files is changed from April 1, 2010 to January 1, 2011, effective immediately. Read the complete announcement at the CMS website in “What’s New.” This is clearly a welcome change and one [...]

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  24. Absence of procedures to notify reinsurance is a basis for bad faith February 17, 2010

    Posted in Bad Faith, Best Practices, SPOT on Issues.

    Recently I was discussing bad faith and notice procedures with attorney Phil Loree Jr., an expert on reinsurance and arbitration issues and author of the the Loree Reinsurance and Arbitration Forum blog.  I thought this was a timely conversation as it reinforced the concepts regarding procedures and the potential risks when they are not in [...]

    6 comments
  25. 5 Claims issues cited for non-compliance on market conduct exams & 3 tools to avoid them February 15, 2010

    Posted in Best Practices, Compliance, SPOT on Issues, SPOT on Ops.

    Insurance Market Conduct examinations are a regular part of the insurance business. Besides the stress of the exam itself, being cited for violations can result in costly fines. Regardless, many citations can be avoided. Every year, insurance compliance solutions provider Walters Kluwer releases its annual study of top ten reasons insurance companies are found to [...]

    2 comments