ABC News Anchor Diane Sawyer once said that an investigation maytake six months, a profile a day. The same holds true wheninvestigating p&c insurance claims. Certainly a quick claimprofile can be established, but does it really tell the truestory?

Digging for facts, sometimes even dirty ones, is what sets thegreat adjuster, manager, and executive apart from the typical.During my 20-plus-years tenure in various claims, management, andleadership capacities, I have witnessed the entire spectrum—fromfailure to mediocrity to greatness. At the latter, there are commonbonds of confidence, determination, and an insatiable curiosity todig deep and find answers.

Great adjusters become great because they ask a lot of questionsthroughout the claims process. They ask questions of not onlyparties to a claim but also of management, as well. Often it isthese very people who become great managers and eventuallyexecutives, because they ask the difficult questions.

Digging Deeper

So what exactly sets the great apart from the mediocre? Often itis intuition.

Click on “next” at the bottom right for anexample claims scenario.

Two cars collided in an intersection. The insured readily admitsfault, saying he did not see the stop sign. The occupants of theclaimant vehicle retain the services of an attorney and obtainmedical treatment from a local chiropractor. Now, the ordinaryadjuster may confirm the facts of the accident with both parties,pay estimates on both cars, and move along to the next claim. Theextraordinary adjuster, however, will not only recognize that theremay be more than meets the eye, but also take the requisite stepsto put all of the pieces of the puzzle in place.

Great adjusters take the time to dig deeper. They will not onlyask questions from the parties to the claim, but they will alsolook for discrepancies. Exemplary adjusters will not only inquireabout the medical treatment but also secure physical descriptionsof the clinics and medical providers. They will ask for directionsfrom the claimant's home to the chiropractor's office. They willmeasure the damages and look for metal striations and painttransfers. The list of what the great adjuster typically does goeson and on. At the end of the day, the adjuster's investigative workmay very well show that this seemingly ordinary claim was actuallya staged accident.

Cultivating Exemplary Adjusters

Having spent the formative years of my career adjusting claimsin South Central Los Angeles, an area notorious for insurancefraud, asking the difficult questions become routine. That isbecause my managers were much more than supervisors; they werementors who took the time to develop my intuitive skills. Thistransfer of knowledge became a catalyst for improving my skills andfrom a company perspective, results. It is this type of mentoringthat will make for a great future generation of adjusters.

Wal-Mart founder Sam Walton once said, “Outstanding leaders goout of their way to boost the self-esteem of their personnel. Ifpeople believe in themselves, it's amazing what they canaccomplish.”

It was this intense focus from my superiors that separated themfrom the ordinary. Great managers must know the basics of claimshandling while understanding myriad complexities and nuances.

Of course, this is easier said than done. As I discuss in myforthcoming book, “Game Change,” in order to succeed, organizationsmust employ those with deep knowledge of the industry and thepeople skills necessary to develop future generations. After all,there is a direct correlation between organizational greatness andthe caliber of people within.

As the title suggests, it is people that alter the outcome ofgames. Certainly effective processes and innovative technology areinvaluable assets; however, nothing replaces the core competenciesof “A” players.

Insatiable Curiosity

The key to success is to bring out the insatiable curiosity innot only those who participate in the investigative process, butthroughout the organization. By asking the tough questions, bothinternally and externally, an inquisitive culture is born. Whetherit is “how did this accident really happen” or “why did we fallshort in a particular area,” it forces organizations into the modeof continual process improvement.

It is through this improvement that results improve, and thosewho can adopt this type of transformative mentality will soon gaina significant edge in an increasingly difficult market. This isn'tto say that there isn't success in claims organizations today, butrather to point out that many have deficiencies caused by anynumber of variables. But at the end of the day it does seem thatmany aren't digging deep enough, allowing mediocrity to supplantquality in a never ending quest to meet certainmetrics.

Beyond this, claims staff needs to have the resources todig. Although not every claim warrants a skip trace orforensic analysis, virtually everyone needs an index run or wheninjuries or suspicious circumstances arise, a more detailedprofile.