Regardless of the coverage involved, those analyzing claims files can take two different approaches—either quantitative or qualitative auditing. The best audit involves both, whereas inferior audits involve only one.
Too often, auditors, especially those who do not come from an adjusting background, may tend to look at claims files only quantitatively, and may therefore declare an excellently adjusted file "inferior," simply based on quantitative factors. Let's look at both types of analyses to determine what an auditor must consider when reviewing a claims file.
Of Vital Importance
Undoubtedly, many claims adjusters have been the victims of auditors who looked solely at quantitative factors. In one of the early Iconoclast columns, I cited the case of Jack. An adjuster for well over 10 years, Jack had expert knowledge of coverage, liability, and damage issues. Even so, he was somewhat lazy and often relied upon this ample knowledge to take shortcuts that often did not appear in his file notes.
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