5 Fatal Flaws in Litigation Management: Why Immediate Change is Crucial

With over 25 years of experience in the insurance industry, I’ve had the unique opportunity to see both sides of the litigation management equation—first as a defense attorney representing carriers, and later as a claims professional hiring counsel to protect insureds. Despite decades of advancements in technology and claims practices, one critical aspect has stubbornly remained unchanged: the strained dynamic between insurers and their legal counsel. The pervasive “us versus them” mentality continues to undermine collaboration, inflate costs, and prolong claim resolutions. Instead of fostering a true partnership, the focus has often shifted to controlling defense costs, leading to rigid oversight rather than meaningful teamwork. Yet, I firmly believe this doesn’t have to be the case. True collaboration—where counsel and claims professionals align around shared outcomes—isn’t just a lofty goal; it’s a necessity. The question is, are we ready to move beyond surface-level cooperation and embrace a partnership that truly delivers value?

Over the next few articles, I will delve into the persistent challenges plaguing litigation management and introduce practical solutions to bridge the gap. While these insights may seem straightforward, the fact that these issues persist underscores their complexity. This article serves as the starting point, outlining the problems.

I will be exploring solutions to this problem and present the Decision+™ approach—a framework designed to accelerate decisions and reduce payouts, which fosters genuine collaboration, leverages innovative strategies, and embraces technology to transform litigation. Together, we can break free from outdated practices and create a more efficient, collaborative future. Stay tuned for the solutions ahead.

Problem 1 – The Carrier-Counsel Divide

A key issue in litigation management is the lack of alignment between carriers and counsel. Many industry guidelines emphasize the importance of adjusters maintaining control of claims during litigation:

“Adjusters should proactively handle the claim in litigation and not abandon the claim to defense counsel just because the claim is in litigation.”

Despite these guidelines, adjusters often relinquish control once litigation begins, treating attorneys more as external agents than as integral members of the claims team. This hands-off approach results in a leadership vacuum, leaving attorneys to manage cases without the benefit of a cohesive claims perspective or strategic guidance. The outcome is a reactive process with limited opportunities for meaningful collaboration, hindering both efficiency and effective resolution.

Left to navigate cases independently, attorneys often make decisions that are technically sound but disconnected from the carrier’s broader objectives. The lack of alignment can lead to:

  • A focus on litigation tactics over settlement strategies increases filings, prolonging cases and driving up costs.
  • Overuse of depositions and document requests without clear plans inflates expenses.
  • Without guidance, attorneys may prioritize billable hours over efficient resolutions, conflicting with cost-containment goals.

The carrier-counsel divide highlights a critical need for stronger integration and alignment. Without a unified approach, inefficiencies persist, and opportunities for timely and effective case resolution are missed. Building a true partnership based on shared goals and open communication is essential to overcoming these challenges and ensuring better outcomes for all stakeholders, especially the insured.

Problem 2 – Costs and Outcomes

The disconnect between carriers and counsel has significant financial and operational consequences, driving inefficiencies that disrupt the claims process. Ineffective collaboration exacerbates three critical issues:

  • Delayed Resolutions: Without streamlined decision-making, claims linger in litigation for extended periods, escalating frustration and costs.
  • Escalating Costs: Poor coordination often results in prolonged lawsuits that inflate expenses without delivering meaningful value.
  • Erosion of Trust: Lengthy litigation leaves policyholders feeling overlooked, undermining trust and damaging the carrier’s reputation.

Efforts to address these challenges through communication mandates and litigation plans have had limited impact, largely due to the entrenched adversarial mindset between carriers and counsel. The ongoing emphasis on cost control rather than collaboration continues to perpetuate inefficiencies and dissatisfaction for both sides.

Problem 3 – Culture and Billing

At the core of the carrier-counsel division lies a systemic issue: the culture of litigation management within the insurance industry. The dominant focus on cost containment often overshadows the need for collaborative, outcome-driven relationships. Industry guidelines frequently emphasize the importance of aligning legal strategy with claims objectives:

“Attorneys must align with the overall claim strategy and obtain adjuster approval for significant decisions such as filing motions, hiring experts, or pursuing depositions.”

However, in pursuit of cost control, the industry has swung to extremes, implementing stringent billing guidelines and complex coding requirements. While these measures aim to rein in expenses, they often have unintended and counterproductive consequences:

  • Administrative Overload: Attorneys spend an increasing amount of time ensuring bills meet approval standards rather than focusing on meaningful casework. This adds layers of bureaucracy, detracting from substantive progress on cases.
  • Micro-Management of Tasks: Carriers frequently require pre-approval for even routine tasks as a cost-control measure. Instead of fostering open dialogue about case strategies, these conversations often occur indirectly through billing systems, reducing opportunities for collaboration.
  • Frustration and Distrust: Restrictive guidelines leave counsel feeling stymied and claims perceiving attorneys as billing-focused, eroding trust and hindering teamwork. Attorneys may feel undervalued or constrained, leading to a transactional relationship where both parties operate defensively. This dynamic discourages proactive problem-solving and reinforces a mindset of minimal compliance rather than genuine partnership.

The cultural divide stems from viewing attorneys as cost centers rather than strategic partners, limiting their ability to craft solutions and drive effective resolutions. This compliance-focused relationship stifles innovation and collaboration, leaving carriers with higher costs and delays, and attorneys constrained by rigid controls. Breaking this cycle requires shifting from cost-control to a value-driven approach.

Long-standing issues—misalignment, cultural divides, and inefficiencies—have persisted throughout my three decades in the industry. Change is a necessity.

Problem 4 – Misaligned Priorities and Increased Documentation Demands

A critical issue in litigation management arises from a lack of understanding between claims professionals and legal counsel regarding their distinct roles, responsibilities, and external pressures. While both aim to achieve favorable outcomes for the insured and the carrier, their differing methods, priorities, and incentives often clash, undermining collaboration and amplifying inefficiencies.

Legal counsel, incentivized by billable hours, dedicate significant time to documenting their work—efforts that may not always align with the carrier’s broader goals. Meanwhile, claims professionals focus on efficiency, striving to resolve cases swiftly and cost-effectively while also managing mounting scrutiny from internal auditors, regulators, and compliance teams. This dual burden of efficiency and oversight has increased demands for meticulous documentation at every step, creating friction between the two groups.

The disconnect manifests in several ways:

  • Documentation Overload: Attorneys feel encumbered by frequent requests for detailed reports, while adjusters grapple with the pressure to justify their decisions to superiors, auditors, and regulators, often in real time.
  • Strategic Misalignment: Attorneys, concentrating on legal nuances and litigation risks, may lose sight of broader claims strategies. Conversely, adjusters, preoccupied with timelines and audit compliance, may overlook critical legal considerations.

The lack of alignment between claims professionals and legal counsel creates a cycle of inefficiency, with each side constrained by competing demands and priorities. This misalignment not only hampers collaboration but also detracts from achieving timely, effective outcomes for all stakeholders. Bridging this gap requires a shared understanding of roles and a commitment to aligning strategies with overarching goals.

Problem 5 – The Impact of COVID-19 on Staffing and Collaboration

The COVID-19 pandemic further intensified these challenges by introducing new pressures on both claims departments and legal counsel. Remote work, staff shortages, and increased caseloads have forced both sides to “do more with less,” often under strained circumstances. The demands for enhanced documentation and compliance have only grown in this environment.

For claims professionals, staffing reductions and remote operations have disrupted workflows, resulting in delays in decision-making and reduced capacity for active oversight of litigation. Attorneys, meanwhile, have faced similar staffing challenges, coupled with court backlogs, increases in nuclear verdicts and procedural changes that demand additional effort to navigate. The combined effect has heightened existing tensions, as both parties feel overburdened and under-supported.

Key impacts of the post-COVID environment include:

  • Increased Scrutiny: Carriers face higher demands from regulators and auditors, requiring extensive documentation and justification for claims handling and litigation decisions.
  • Reduced Collaboration: Remote work and virtual communication tools have made it harder for claims professionals and attorneys to engage in the face-to-face discussions necessary for building trust and aligning strategies.
  • Burnout and Attrition: Both claims and legal teams are experiencing high turnover rates, leading to a loss of institutional knowledge and continuity, further complicating the alignment of goals and strategies.

As noted, the COVID-19 pandemic has intensified challenges in litigation management, with remote work, staffing shortages, and increased caseloads disrupting workflows and straining resources. These pressures highlight the urgent need for a more adaptable, collaborative approach. Prioritizing clear communication and shared strategies is essential to building a resilient framework for effective litigation management.

Looking Ahead

The problems outlined in this article underscore the urgent need for a fundamental transformation in litigation management. These long-standing issues—misalignment, cultural divides, and inefficiencies—have persisted throughout my three decades in the industry, now intensified by post-COVID pressures. While these challenges are significant, they are not insurmountable. Addressing them requires a deliberate shift in mindset, where carriers and counsel move beyond entrenched adversarial dynamics to foster trust, mutual respect, and alignment around shared goals.

At its core, this transformation is about reframing the carrier-counsel relationship as a partnership, one where both parties are aligned around a common purpose: achieving fair, efficient, and value-driven claim resolutions. It is only through collaboration and open communication that the full potential of this partnership can be realized, benefiting insureds, carriers, and counsel alike.

Future articles will explore actionable solutions, innovative strategies, and frameworks like my Decision+™ approach. Together, we can break free from outdated practices and transform litigation management into a strategic advantage. Stay tuned for the next steps toward meaningful change.

5 Actionable Strategies for Emerging Trends and Challenges for Claims Departments in 2025

It’s been an interesting year and 2025 is shaping up to be another exciting year for the insurance industry.  As 2024 ended we saw some interesting market trend reports from leading consulting and industry firms.  As the insurance landscape evolves, claims departments face a range of new trends and challenges. Drawing insights from recent industry reports and past discussions on best practices, we will explore the key dynamics expected to shape claims handling in 2025, along with 5 actionable strategies for adaptation.

Rising Costs and Litigation Severity

Claims departments are grappling with the escalating costs of litigation, driven by trends such as social inflation and nuclear verdicts. The Marsh McLennan MMA Q3 2024 Market Trends Report highlights how litigation funding abuse contributes to rising claim costs, particularly in casualty markets:

“Nuclear verdicts, driven in large part by litigation funding abuse, are a significant factor in the pace of change in the casualty market”​.

The McKinsey Global Insurance Report further emphasizes how inflation and rising costs are straining claims operations:

Corporate legal defense spending on class action lawsuits in the United States increased by 8 percent in 2022 and by 5 percent in 2021. This leads to higher claims costs and ultimately has a negative impact on affordability across the industry “​.

Digital Transformation and AI Integration

The integration of AI and digital tools into claims operations has become essential for enhancing efficiency. As noted in the PwC Insurance 2025 Report:

Insurers still lack speed and agility due to inherent complexities such as legacy systems and traditionally siloed operations. A fresh approach to digital is needed to drive a competitive advantage that can be sustained. “

Similarly, the Global Insurance Report highlights the potential of AI to transform claims processes:

“Generative AI will enable carriers to rethink and innovate the end-to-end value chain”​.

Climate Risks and Natural Disasters

The insurance sector faces increasing pressure from climate-related risks, with severe weather events becoming more frequent. According to the MMA Q3 2024 Report:

The flood protection gap is widening. Since the 1990s, the cost of flood damage has roughly doubled each decade. The federal government issued two disaster declarations for floods in 2000. As of October 22, 2024, it has issued 66. “​.

The PwC Insurance 2025 Report reinforces this trend by underscoring the criticality of sustainability in claims management:

The growing threat of climate change poses systemic physical and transition risks, with direct implications for the insurance industry “​.

Customer-Centric Claims Models

With customer expectations shifting, transparency and efficiency in claims handling are more important than ever. The PwC Insurance 2025 Report highlights the rising trust gap in the insurance industry:

“In a world in which trust in businesses and governments is declining, trust in financial

institutions is near an all-time low….Trust is fundamental for insurance, and insurers clearly have a much bigger role to play in our society and economy than just protecting risks. ​.

Incorporating customer-focused technologies into claims processes can address these challenges:

Continued rapid advancements in digital and analytics capabilities, from inside and outside the industry, have put many players under pressure. We’ve seen a sharp increase in digital efforts and adoption in areas like distribution, operations, and claims. However, insurers still lack speed and agility due to inherent complexities such as legacy systems and traditionally siloed operations. A fresh approach to digital is needed to drive a competitive advantage that can be sustained. “​.

Operational Efficiency Amid Economic Pressures

Economic uncertainties, including inflation and volatile interest rates, demand innovative approaches to operational efficiency. As stated in the Global Insurance Report:

Profitability challenges were acute across markets as inflation increased. Net combined ratios grew between 2021 and 2023, most notably in the United Kingdom (where combined ratios and inflation increased by 16 percentage points and 17 percent, respectively), the United States (five percentage points and 12 percent, respectively), and Australia (three percentage points and 13 percent, respectively)”​.

5 Actionable Ways to Future-Proofing Claims Departments

As the insurance industry navigates 2025, claims departments must evolve to address emerging challenges while seizing opportunities for innovation. From managing climate risks to adopting AI and digital transformation, success lies in adaptability and forward-thinking strategies.

By investing in technology, fostering customer-centric models, and leveraging data-driven insights, insurers can stay ahead in a competitive market.  Building on themes explored in previous Claims Spot articles, the following suggestions aim to address 2025’s challenges while enhancing operational efficiency, customer satisfaction, and resilience in claims departments.

1. Prioritizing Accurate Reserving and Trend Analysis

In The Critical Role of Timely and Accurate Practices in Claims Management, the importance of consistent reserving and trend analysis is emphasized as foundational to claims operations. This remains critical as we approach 2025, where accurate reserves will play a pivotal role in navigating increasing claims severity and unpredictability.

“Think of reserves as the financial shock absorbers of the insurance world. When set correctly, they help cushion the impact of claim payouts, ensuring stability and solvency”​.

2025 Actionable Strategies:

  • Establish adaptive reserving frameworks that account for emerging risks like climate-related disasters and inflation-driven costs.
  • Invest in advanced analytics tools to monitor and predict reserve adequacy trends.
  • Conduct regular reviews of reserve practices to ensure alignment with real-time market changes.

2. Enhancing Litigation Management with Data

As detailed in Taming the Claims Severity Beast: A Data-Driven Approach to Litigation Management, rising legal costs and the threat of nuclear verdicts call for more robust, data-driven litigation management. Proactively identifying high-risk cases early will help claims departments mitigate the financial and operational impacts of social inflation.

“Leveraging data and AI can significantly improve outcomes, with predictive models offering a roadmap for managing high-severity claims more effectively”​.

2025 Actionable Strategies:

  • Deploy early case assessment protocols, integrating AI to prioritize and streamline resource allocation.
  • Build predictive analytics models that identify litigation-prone cases, helping departments prepare defense strategies or negotiate early settlements.
  • Invest in training claims professionals to interpret and apply data insights effectively.

3. Streamlining FNOL with Advanced Technology

The FNOL process, discussed in Streamlining the First Notice of Loss (FNOL) Process: Best Practices and Technologies, sets the tone for the entire claims journey. By incorporating customer portals and AI, insurers can enhance efficiency while maintaining a strong human touch for complex claims.

“A robust customer portal that serves as a one-stop-shop for FNOL and claim management is a game-changer, offering ease of reporting and reducing input errors”​.

2025 Actionable Strategies:

  • Introduce or enhance 24/7 FNOL customer portals, incorporating features like real-time updates, photo uploads, and automated triage.
  • Combine natural language processing (NLP) with AI to extract critical information from FNOL reports, reducing the need for manual intervention.
  • Train FNOL staff to blend empathetic communication with efficient problem-solving for distressed customers.

4. Balancing Innovation with Implementation Challenges

In Navigating the Choppy Waters of Claims Technology Implementation, the focus is on integrating new technology without disrupting existing processes. As 2025 approaches, adopting a measured, collaborative approach to technological transformation is essential.

“Think of it as a tech tango—new and old dancing in perfect sync. The goal is to enhance processes without sacrificing familiarity or efficiency”​.

2025 Actionable Strategies:

  • Map current claims processes to identify areas where technology can seamlessly enhance efficiency.
  • Foster collaboration between claims, underwriting, and actuarial teams to ensure holistic solutions.
  • Invest in phased rollouts with iterative improvements to balance technological advances and operational stability.

5. Tackling Social Inflation with Proactive Measures

In Social Inflation Has Commercial Casualty Losses Up 11% Over the Last 5 Years, strategies like predictive analytics and advanced technology are suggested to combat the rising costs of claims driven by litigation and societal factors.

“Predictive models can help claims departments anticipate high-severity cases, allowing for proactive strategy adjustments in reserving, settlements, and litigation decisions”​.

2025 Actionable Strategies:

  • Expand data analytics capabilities to monitor and adapt to societal trends influencing claims costs.
  • Develop jurisdiction-specific strategies for high-litigation areas, ensuring preparedness for nuclear verdicts.
  • Build strong legal partnerships and networks to negotiate favorable outcomes in complex cases.

Incorporating These Changes

By integrating these suggestions, claims departments can adapt to the multifaceted challenges expected in 2025. Whether through accurate reserving, innovative FNOL processes, or data-driven litigation management, these changes will ensure claims operations remain agile, efficient, and customer-focused.

What steps is your organization taking to implement these strategies in 2025? Share your plans and insights below!

Thinking About 2025: Driving Innovation in Insurance Claims Technology

The U.S. insurance industry continues to exhibit its remarkable resilience, as underscored by its impressive financial turnaround in recent years. However, sustaining this momentum and preparing for future challenges demand more than just traditional strategies. As highlighted by the exceptional leaders featured in Insurance Business America’s Hot 100 2025, the road ahead involves fostering technological innovation in claims processing and ensuring the right expertise is on board to drive these initiatives.

The Call for Claims Technology Innovation

The modern insurance landscape necessitates a profound shift in how claims are managed. From the First Notice of Loss (FNOL) process to complex litigation management, the integration of advanced claims technology has proven to enhance efficiency, reduce costs, and improve customer satisfaction.

For example, AI-driven tools like predictive analytics and natural language processing are now being used to:

  • Identify high-risk claims early: This enables insurers to allocate resources effectively, mitigating costs and risks associated with prolonged claims.
  • Enhance fraud detection: Machine learning models can analyze patterns in data to detect anomalies that may indicate fraudulent activity.
  • Automate routine processes: By automating document reviews and data entry, insurers can free up human resources for more strategic tasks.

These advancements align with the pressing need for seamless systems integration. As noted in the industry, the “tech tango”—the harmony of old and new systems—enables companies to maximize the benefits of their investments without disrupting ongoing operations.

Hiring the Right Consultants for Success

Innovation in claims technology is a complex journey that involves navigating challenges such as system integration, stakeholder buy-in, and operational disruptions. This is where the role of specialized consultants becomes invaluable. It is critically important to recognize the gaps and seek complementary expertise to bridge them effectively.

Hiring the right consultants can ensure:

  • Objective assessments: Independent experts provide unbiased evaluations of existing systems and processes.
  • Tailored strategies: Consultants bring a wealth of experience across different industries, enabling the customization of solutions that align with an organization’s unique needs.
  • Streamlined implementation: With dedicated project management expertise, consultants help mitigate scope creep and ensure timely execution of technological initiatives.

Furthermore, consultants facilitate cultural change within organizations by aligning technology goals with broader business strategies. They act as catalysts for innovation, ensuring that both technological tools and the people using them are set up for success.

Balancing Technology with Human Expertise

The future of claims innovation lies in striking the perfect balance between automation and human oversight. As seen with solutions like  AI-driven FNOL process, technology can handle simple claims efficiently, but complex cases still require human judgment and empathy.

Investing in robust training programs ensures that staff can harness the full potential of new technologies. It’s equally critical to maintain transparency in AI-driven decisions, fostering trust among both employees and customers.

Charting the Path Forward

As the U.S. insurance market is poised to reach $4.50 trillion by 2029, the stakes for staying competitive are higher than ever. Embracing claims technology innovation and enlisting the right experts to guide this transformation are no longer optional—they are essential strategies for thriving in a rapidly evolving industry.

The journey to modernization requires bold leadership, strategic investments, and a commitment to enhancing both technological capabilities and human expertise. By addressing these areas, insurers can transform claims management from a cost center into a driver of customer satisfaction and operational excellence.

What steps is your organization taking to innovate in claims technology? Share your insights and experiences in the comments below!

13 Key Areas to Review: The Case for an Annual Claim Department Operational Review

In today’s ever-evolving insurance landscape, the need for claims departments to stay agile, compliant, and customer-focused has never been more critical. As we near the end of yet another year, an annual review of operations is not just a best practice—it’s a cornerstone of maintaining excellence in claims management. 

By systematically evaluating key areas, claims departments can ensure efficiency, compliance, and satisfaction across the board. Let’s explore the vital components of this review and why they are indispensable.

1. Best Practices and Leakage Quality Audits

Best practices ensure claims are processed effectively, while leakage quality audits identify areas where financial inefficiencies might be lurking. A thorough annual assessment can:

  • Uncover process bottlenecks.
  • Detect overpayments or missed subrogation opportunities.
  • Benchmark performance against industry standards.

This proactive approach safeguards the bottom line and enhances operational credibility.

2. Review of Staffing Model

The claims landscape is dynamic, and staffing models must adapt to workload fluctuations, claim complexity, and organizational goals. An annual review ensures:

  • Adequate adjuster-to-claim ratios.
  • Optimization of roles for efficiency.
  • Preparedness for peak claim seasons or emerging risks.

3. Adjuster Licensing and Compliance

Staying compliant with state and federal regulations is non-negotiable. Claims departments should annually:

  • Verify adjuster licensing across jurisdictions.
  • Audit compliance with regulatory updates.
  • Address gaps to avoid penalties.

4. Privacy and Security

With increasing cyber threats, protecting sensitive claim information is paramount. Annual reviews should focus on:

  • Compliance with data privacy regulations like GDPR or CCPA.
  • Strengthening cybersecurity protocols.
  • Training employees on data security best practices.

5. Data Quality

Accurate data fuels every decision in claims management. Reviewing data quality ensures:

  • Elimination of duplicate or outdated records.
  • Enhanced data integration across systems.
  • Reliable reporting for trend analysis and forecasting.

6. Aggregate Tracking

Tracking aggregate claim data helps in identifying trends and managing reserves effectively. Annual evaluations ensure:

  • Monitoring loss patterns.
  • Adjusting reserves based on historical trends.
  • Informing underwriting and pricing strategies.

7. Adjuster Authority

Adjuster authority levels should be calibrated to reflect experience, risk, and claim complexity. A review includes:

  • Reassessing monetary thresholds.
  • Balancing empowerment with oversight.
  • Reducing escalation bottlenecks.

8. Litigation Management Updates and Review

Litigation is costly and time-consuming. Annual reviews can:

  • Analyze case outcomes for patterns.
  • Update litigation guidelines and adjust counsel partnerships.
  • Incorporate predictive analytics for case management.

9. Training and Development

Continuous learning is vital for keeping adjusters and managers sharp. Annual training plans should address:

  • Emerging trends like social inflation and AI in claims.
  • Regulatory updates and compliance.
  • Enhancing negotiation and communication skills.

10. Customer Satisfaction

Customer experience is a key differentiator. To measure and improve it:

  • Implement surveys post-claim resolution.
  • Analyze feedback for actionable insights.
  • Develop initiatives to enhance claimant interactions.

11. Technology Enhancements

Technology evolves rapidly, and claims departments must keep pace. Annual reviews should:

  • Assess current technology for gaps.
  • Explore automation opportunities.
  • Plan upgrades to align with strategic goals.

12. Reporting Adequacy and Updates

Effective reporting is essential for transparency and decision-making. Review reports for:

  • Completeness and accuracy.
  • Alignment with organizational KPIs.
  • Inclusion of insights for all stakeholders.

13. Manager Reviews

Finally, evaluating management effectiveness is crucial for organizational health. Annual manager reviews should:

  • Assess leadership in driving claims outcomes.
  • Provide constructive feedback for growth.
  • Align individual goals with departmental objectives.

The Path Forward: Building a Resilient Claims Department

Annual operational reviews are not just checklists; they are opportunities to elevate the claims department to new heights. By addressing these areas comprehensively, claims leaders can foster a department that is efficient, compliant, and customer-centric. The result? Enhanced trust, reduced costs, and a strong foundation for future success.

Is your claims department ready for its annual operational review? What areas are you focusing on? Share your thoughts and best practices in the comments below!

Why Engaging an Independent Claims Expert is so Critical to Successful Technology Implementation


Yes, I am biased. I am an independent consultant, but I have also worked at a large consulting firm.  The current insurance environment is in a rapid state of change, where claims departments are struggling to be competitive and efficient due to increased claims volumes and complexities. Technology could transform every step of the claims process, from intake through resolution—but successful implementation requires more than just technological know-how. But to make that a reality, subtle understanding is needed from the claims landscape itself.


To bridge this chasm, what insurance leaders require is not some standard-issue consulting firm but a professional claims expert well-versed in the deeper nuances of the claims process. For large implementations that span multiple years the large consulting firm can be an invaluable resource.  However, when the implementation is small or your company is smaller,  hiring an independent claims consultant can make all the difference in realizing a technology implementation that not only transforms the operations but does so with efficiency and precision.

1. Process-Driven Technology Integration: Understanding Claims from the Inside Out


The processing of claims with high levels of accuracy and efficiency, but with empathy nonetheless, constitutes the core mission of the claims department. Without an implementation approach which places the process of the claim at the forefront, technology can quickly turn into a disruptive force rather than a supporting tool. Unlike larger consulting firms, independent claims consultants focus on bringing in technology to meet the unique workflows and departmental business objectives. This ensures that the process of claims drives the technology, not the other way around.

2. Solutions Customized with Flexibility for Real-World Claims Challenges

Independent claims consultants bring an unprecedented level of agility and customization that larger firms simply cannot match. Because they are not bound by rigid frameworks, they can move more nimbly to meet the particular needs of each department, from property to casualty claims, without unnecessary layers of oversight. This will introduce flexibility for active consultants to tailor solutions within the existing ecosystem, including claims data analytics, fraud detection, and maintaining the human touch necessary in ensuring customer satisfaction.

The scalability of the solution will also be catered for by a focused consultant to enable your department to evolve with the technology over time. They have practical experience in how to spend each working day projecting the daily challenges an adjuster and manager face so that the technologies implemented will be as pragmatic as they are innovative.

3. Cost-Effectiveness: Maximize ROI without the Big-Firm Overhead

One of the values in retaining an independent consultant over a large consulting firm often has to do with bottom-line economics. Independent claims experts are unencumbered by all of the trappings and demands of higher overhead-greater office space, for example, more administrative personnel, an extensive marketing program-and maintain a lean approach focused exclusively on delivering results. That is to say, more of your budget is directly invested in the project, yielding a larger return on investment for your claims department.

Another major factor: essentially, independent consultants have a stake in the success of every case. They will work hand-in-hand with internal teams, offering hands-on guidance throughout the process. This kind of processing will typically result in faster project turnarounds and faster adoption, which means a faster return on investment.

4. Proven Process: How a Claims Consultant Drives Successful Implementation

New technology implemented within a claims department requires a clear, structured approach beyond generic project plans. Here is one specific way an independent claims expert would drive a successful implementation, step by step:

  • Assess and Plan: First, take a deep dive into where current claims workflows enhance pain points, resource needs, and department goals. The result is that the technology solution will focus on the particular needs of the claims department, not just industry standard needs.
  • Solution Design: Having worked in close cooperation with the department heads, the consultant now designs the solution to be adapted for smooth integration into the workings of the department. The focus is then on nuances of the claims process, so that one may target areas where technology will add value without disrupting processes.
  • Pilot Testing and Iteration: Before the rollout, pilot testing paves the way for live insights and iterations. A claims-focused consultant can quickly identify and rectify any issues to make technology work right in the life conditions of claims.
  • Training and Adoption Support: The successful implementation of technology requires user adoption. More often, independent consultants provide hands-on training, tailored for different roles within the department. They help each member of the team understand how the new technology makes their workflow easier and more intuitive to perform their tasks.
  • Ongoing Review and Adjustment: The true claims expert knows that after implementation, the work is not over. They remain involved with performance monitoring, suggesting adjustments, and ensuring the technology meets their changing needs.

5. Partnership, Not Just Completion of the Project

Probably one of the most valued elements in working with an independent claims consultant is the relationship they will build with your team. Unlike larger consulting firms that might simply focus on delivering the project and moving on, independent experts truly invest in a partnership. They work side-by-side with internal teams, understand their challenges, and adjust in real time to feedback for long-term success. This harmony makes for trust and confidence in the new technology as team members learn to fully welcome the change. Over time, the partnership offers consistent ways it assists departments in not just attaining immediate implementation goals but also in fostering a culture of continuous process improvement and innovation.

The Strategic Advantage of Partnering with a Claims Expert


The challenges of claims implementation require much more than a one-size-fits-all solution. In engaging an independent claims expert, C-suite executives and claims leaders receive a partner focused on expert-level talent, flexibility, and hands-on involvement their large consulting firm counterparts often cannot match. Using their specific knowledge, they make sure that new technology underpins the claims process for tangible gains in greater efficiencies, customer satisfaction, and financial performance, amongst other benefits. The right consultant will be the difference between ‘disruptive change’ and a ‘transformative solution’ in today’s competitive insurance landscape. Embrace expertise that puts your claims process first, and watch technology become an enabler of growth rather than just another operational hurdle.

Navigating the Choppy Waters of Claims Technology Implementation

Let’s face it, implementing a new technology into existing processes and systems is no easy task. But in today’s fast-paced insurance world, it’s not just about upgrading tech—it’s about transforming your entire claims ecosystem. So, how do we ensure that this shiny new penny enhances rather than disrupts our current processes? Buckle up, folks, because we’re about to dive into the deep end.

1. Map It Out and Take Your Time Doing It

Before you jump headfirst into this tech tornado, you need to know where you’re standing. As I like to say, “knowing where you are is just as crucial as knowing where you want to go.” So, roll up your sleeves and get mapping of your existing processes and how the new technology will fit into that process. Assess your current processes, systems, and challenges. Trust me, this homework will pay off when you’re not lost in the implementation wilderness later.

2. It’s Not Just About Claims, People

In some instances, the impact of a new system initiative goes way beyond the claims department. Don’t adopt new technology in a vacuum. This isn’t just a claims thing—it’s a business thing. Drag your underwriters and actuaries into the mix when needed. Their input will help create an enterprise-wide solution that improves overall business outcomes, not just makes claims handling easier. Remember, we’re all in this together.

3. Executive Champion: Your New Best Friend

A project needs an executive champion who can move mountains (or at least meetings). This isn’t a part-time gig—you need someone who’s all in. Yes, it’s a big ask, but the payoff in streamlined decision-making will be worth every executive hair that turns grey in the process.  It’s also important for change management to ensure executive buy in and not just in approving the project but being involved in the process.

4. Passion: Not Just for Romance Novels

Your project team needs to live and breathe this implementation. They should be more excited about this project than a kid on Christmas morning. We like to ensure that there is a focus on minimizing disruption and maximizing ROI. That’s the kind of passion we’re talking about and such passion will be infectious to help with adoption.

5. Scope Creep: The Silent Killer

It’s tempting to keep adding bells and whistles, but remember—every change needs to bring value. Before you add that shiny new feature, do a cost-benefit analysis. Some enhancements might take time to show their worth, so be patient. Measure the impact over time, and don’t be afraid to admit if something isn’t working out. No system or technology will be perfect right out of the box.  Teams need to use and learn how best the system integrates in the process.  Get it working and look at future enhancements as part of an iterative development project.

6. Integration: The Name of the Game

It is so important to try and seamlessly weave cutting-edge technology into your existing claims ecosystem. This isn’t about out with the old, in with the new. It’s about creating a beautiful harmony of efficiency and familiarity. Think of it as a tech tango—new and old, dancing in perfect sync.

7. Customize, But Don’t Go Crazy

Yes, tailor those workflows to match your unique claims processes. But don’t go overboard—you’re implementing a new and modern approach, not building a spaceship. Find that sweet spot between customization and out-of-the-box functionality. Your future self will thank you when it’s time for system updates. Scope creep can be put in check and adoption rates will go up.

8. Remember the Humans

At the end of the day, your fancy new system is only as good as the people using it. Invest in training and make sure that interface is more intuitive than your smartphone. I like to stress that a user-centric approach is key. After all, a technology that no one can use is about as useful as a chocolate teapot.

9. Measure, Tweak, Repeat

Once your system is up and running, don’t just sit back and admire your handiwork. Keep fine-tuning for optimal performance. Use those data analytics to spot areas for improvement. Remember, in the world of claims technology, standing still is the same as moving backward.

Implementing a new system might feel like trying to change a tire while driving, but with the right approach, it can transform your operations faster than you can say “subrogation.” The goal isn’t just new tech—it’s creating a claims process so smooth, it helps claims professionals do their job better.  We all love the idiom of work smarter not harder!

So, claims leaders, what’s your secret sauce for successful system implementations? Share your wisdom in the comments below—let’s learn from each other and keep this industry moving forward!

Social Inflation has Commercial Casualty Losses up 11% Over the Last 5 Years: 3 Claims Department Strategies That Will Help You Navigate The Problem

Swiss Re’s latest report on social inflation is a must-read for claims professionals. Their sigma No 4/2024 study, “Litigation costs drive claims inflation: indexing liability loss trends,” offers a comprehensive look at this growing challenge. The findings are sobering: the U.S. liability risk pool is expanding rapidly, with commercial casualty insurance sector losses growing at an average annual rate of 11% over the last five years. Importantly, this isn’t just a U.S. phenomenon anymore. The UK, Australia, and Canada are also experiencing similar trends, albeit to a lesser degree. As claims leaders, it’s crucial we understand and adapt to this changing landscape. With that in mind, let’s explore three essential strategies that can help your claims department navigate the complexities of social inflation.

1. Embrace Your Inner Data Nerd

In today’s claims environment, data should be at the forefront of your decision-making process. Modern claims departments need to utilize their data effectively, not just for reporting, but for predicting future trends. Predictive analytics can help you identify potential high severity claims before they escalate. 

By analyzing historical data, court rulings, and social trends, you can spot patterns that may indicate where social inflation is likely to impact your claims. This foresight allows you to proactively adjust your strategies, whether in reserving, settlement approaches, or litigation decisions.

If you’re not using your claims data to anticipate future challenges, you’re missing a crucial tool in managing social inflation. The ability to predict which claims are likely to result in larger-than-expected payouts can be a game-changer for your department.

Predictive does not always mean some hi-tech analytics model. Predictive can also be developing, using and analyzing the correct trends within your existing data. 

2. Early Case Assessment: Your New Best Friend

In the age of social inflation, early case assessment has become more critical than ever. The sooner you can identify high-risk claims, the better positioned you’ll be to make informed decisions about how to handle them.

Your early case assessment process should be comprehensive and efficient. It should help you quickly identify claims that have the potential to result in large verdicts or settlements. This might include cases in jurisdictions known for high awards, claims involving severe injuries, or those that touch on hot-button social issues.

By identifying these high-risk claims early, you can develop appropriate strategies – whether that means early settlement negotiations, allocating additional resources for defense, or preparing for potential litigation. Early case assessment is your first line of defense against the impacts of social inflation.

3. Invest in Advanced Technology

If your claims department isn’t leveraging advanced technology, you’re at a significant disadvantage in today’s environment. Advanced data analytics tools and AI can process vast amounts of claims data quickly and accurately, identifying patterns and predicting outcomes that might not be apparent to human analysts.

These technologies can help you process claims more efficiently, spot potential fraud, and assist claims professionals in making more accurate reserve estimates. They can also assist in identifying trends in jury awards and settlement amounts, helping you stay ahead of the curve in your claims handling strategies.

However, it’s not enough to simply have these technologies – you need to use the insights they provide to inform your strategies. Use this data to adjust your reserves, refine your pricing models, and guide your overall claims handling approach.

Adapting to the New Normal

Social inflation is reshaping the claims landscape, and it’s clear that this trend isn’t going away anytime soon. By embracing data analytics, prioritizing early case assessment, and leveraging advanced technology, your claims department will be better equipped to navigate these challenges.

Remember, the goal isn’t just to react to social inflation, but to anticipate and mitigate its effects. With these strategies in place, you’ll be well-positioned to manage claims effectively in this new environment.

What strategies is your claims department using to address social inflation? Share your thoughts in the comments below – let’s learn from each other and develop best practices for this ongoing challenge.

Book Review: The Global Directors and Officers Handbook by Granof & Nicholls

214627_Def_LGlobal Reach, Global Need

In today’s ever expanding global marketplace, the need for executives to be aware of potential liability exposure is greater than ever. To assist in understanding that exposure, the Global Directors and Officer Handbook, published the ABA (get your copy here) and Edited by Perry Granof and Henry Nichols, will be a tremendous resource. This paperback handbook is truly a great overall global guide to Directors and Officers Liability. As the editors point out, the “book is intended to provide an overview of the directors and officers landscape within and outside the United States, with a particular emphasis on those jurisdiction where the majority of business interests are non-U.S. based.”

The book covers 28 countries, including the U.S. and Canada,  in five global regions and is authored by local specialists in every country. Interestingly, unlike in the US and the UK, most countries are statutory law jurisdictions and those differences can have dramatic impacts when trying to understand D&O issues in foreign lands. The editors make an attempt to maintain the framework for each country in each chapter making it easier to conduct comparisons. Each chapter covers the following topics:

  • Statutory and Regulatory Framework
  • Indemnification
  • Regulatory Proceedings
  • Shareholder Representative Actions
  • Insolvencies
  • Arbitration and Alternative Dispute Resolutions
  • Insurance Issues

Interestingly, since English was not the first language of many of the individual authors, certain cultural differences can be gleaned as well as influences those difference have on the substantive law approaches.

The breath of the international coverage, as well as the fact that it has a comprehensive US Chapter makes this book unique.  The work succeeds in its intent to be a reference guide and to give the reader a survey of the topic at issue with furhter references as needed.

For a further review, please see the D&O Diary by Kevin LaCroix.

The book is well laid out and easy to manage and will certainly come in handy when needing to address various key D&O issues on a global scale.

 

 

15 Excuses For Not Changing And 5 Reasons To Change The Way We Make Change

96005727Going Along With How It’s Been Done Is Not The Best Way To Go Through Business

I have a client that is so entrenched in its way of doing things that a significant part of my job has been to manage change. Change is hard for everyone and how and when to change has been debated and discussed in companies since the first company was formed.  What is never debated are some of the excuses used for not changing. People are resistant to change and despite the need to move forward people generally prefer to live with what they have. Fast Company put out a list of Reasons Why We Cannot Change and these are my favorite 15:

  1. We’ve never done it before
  2. We’ve been doing it this way for 25 years
  3. It won’t work in our company
  4. Why change — it’s working OK
  5. It needs further investigation
  6. It’s too much trouble to change
  7. Our company is different
  8. We don’t have the money
  9. We don’t have the personnel
  10. You can’t teach old dog new tricks
  11. It’s too radical a change
  12. I don’t like it
  13. You’re right, but….
  14. We’re not ready for it
  15. We’re doing all right as it is

“Men Plan, God Laughs”

This list was originally complied in 1959!!! by E.F. Borish a product manager for a Milwaukee company.  Amazingly these excuses are as true today as they were over 50 year ago. So we plan to make change and address the list of excuses to help achieve a positive result. Regardless, in addressing these excuses it is important to accept that change is difficult and also understand that great strategic plans may still not yield desired results. Management must acknowledge during any change process that “culture eats strategy for breakfast” (a quote attributed to management guru Peter Drucker).

5 Changes To The Way We Change

To help address the culture and achieve success, Harvard Business Review’s Bill Taylor suggests changing the way to approach change in his article The More Things Change, the More Our Objections to Change Stay the Same.

Mr. Taylor continues asks –  “so what have we learned in the twenty years since Fast Company was created, or the 54 years since E.F. Borisch compiled his list?”  He suggests 5 possible principles to consider to change the way we make change:

  1. OriginalityFor leaders to see their organization and its problems as if they’ve never seen them before, and, with new eyes, they need to develop a distinctive point of view on how to solve them
  2. Break from the past without disavowing it – The most effective leaders…don’t turn their back on the past. They reinterpret what’s come before to develop a line of sight into what comes next.
  3. Encourage a sense of dissatisfaction with the status quo – persuade colleagues that business as usual is the ultimate risk, not a safe harbor from the storms of disruption
  4. Requires a sense of “humbition” (humility and ambition) among leaders – enough ambition to address big problems, enough humility to know you don’t have the answers. When it comes to change, nobody alone is as smart as everybody together.
  5. Be consistent in the approach – If, as a leader, you want to make deep-seated change, then your priorities and practices have to stay consistent in good times and bad times.

Change does not have to be a bad thing but managing the change process must be addressed. Strateigic plans must have an approach to dealing with change to achieve a measured success.

How Do You Address Cultural Issues During the Change Processs?

Part 3 on Leadership: Challenges and Assistance in Leading Change

The mechanismCollaborating Can Make The Successful Difference

In Leadership: The Change Process In Claims Requires A Different Approach, I put forth the position that changing a claims organization needs a new brand of leadership skill that does not usually exist in the traditional claims organization. In Part 2 on Leadership: Developing a Strategic Transformation Team, I addressed how to break from existing management process to achieve effective strategic results. In the final installment, I discuss how challenges around leading change make it beneficial to bring in strategic support to help achieve the desired success.

Additional Challenges in Leading Transformational Change

Oftentimes, managers are too close to individual problems to have the necessary perspective to see what needs to be done to benefit the whole organization. As a result, many fail to achieve true Strategic Transformation.

There are three main reasons why building Strategic Transformation can be such a challenge:

  • Lack of Independence – Management has political ties and history within an organization and are not always free to ask the sometimes difficult questions and make recommendations that are truly in the best interests of the organization.
  • No Objectivity – Often companies are attached to their existing organizational and procedural structure. Despite very good intentions, it is human nature for individuals to get emotionally connected to a particular method of doing things. Management can be entrenched with emotional or political agendas as to how things are being done. Change requires an objective, fresh viewpoint–without worrying about what people in the organization might think about the results and how they are achieved.
  • Limited Experience –Strategic Transformation requires a set of skills that combines project management with a strategic sense of determination. Managers have experience and skills on how to execute what has been done but lack the depth of knowledge to execute change that transforms their organization. Most claim managers come from a purely technical claims handling role and may lack experience addressing organizational problems, thus failing to grasp all the process concerns of their own operations.

Facilitated Strategic Transformation to Achieve Success

Bringing in an expert from outside the organization is one way to jump-start the Strategic Transformation process. Independent, objective experts can help facilitate the building of teams and focus the organization on successful, rapid implementations. In addition, the best facilitators will have specific capabilities in managing large scale project management, and insurance industry specific knowledge with proven methodologies in management. Such facilitators can:

  • Identify Problems – Sometimes employees are too close to a problem inside an organization to identify them. Facilitated sessions can help draw out what many in the company already know but could not see.
  • Supplement The Staff and Minimize Disruptions – Getting staff to focus on problems is difficult when the call of everyday business comes. Having a dedicated independent resource helps to balance those situations and ensure projects move forward on time and on budget. Delays can have disastrous effects down the chain and across other projects. Supplementing staff can help avoid these pit falls.
  • Objectivity Allows 3rd Parties to Act as a Catalyst- Most employees resist change. Regardless, change is needed, and an independent may be brought in to “get the ball rolling.” In other words, the facilitator can do things without worrying about the corporate culture, employee morale or other issues that get in the way when an organization is trying to institute change. They can also be there as the independent voice to validate how the change will help improve the organization.
  • Inject New Ideas – A fresh set of eyes can bring experiences from other transformation projects to inject new change ideas. At one time or another, most businesses need someone to administer “first aid” to get things rolling again.

The Time to Change is Now

In today’s market it is harder for insurance companies to distinguish themselves from competitors. For companies to gain an advantage, carriers must adapt to changing market conditions, embrace technology and further expand their use of data analytics. Moving rapidly to manage change requires new ways to manage multiple initiatives. Strategic Transformation is a method for meeting these challenges and ensuring that projects are rapidly deployed on time and on budget.

How Have You Tried to Move Your Organization Through the Change Proccess?