ABC News Anchor Diane Sawyer once said that an investigation may take six months, a profile a day. The same holds true when investigating p&c insurance claims. Certainly a quick claim profile can be established, but does it really tell the true story?

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

Great adjusters become great because they ask a lot of questions throughout the claims process. They ask questions of not only parties to a claim but also of management, as well. Often it is these very people who become great managers and eventually executives, because they ask the difficult questions.

Digging Deeper

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

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

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

Great adjusters take the time to dig deeper. They will not only ask questions from the parties to the claim, but they will also look for discrepancies. Exemplary adjusters will not only inquire about the medical treatment but also secure physical descriptions of the clinics and medical providers. They will ask for directions from the claimant's home to the chiropractor's office. They will measure the damages and look for metal striations and paint transfers. The list of what the great adjuster typically does goes on and on. At the end of the day, the adjuster's investigative work may very well show that this seemingly ordinary claim was actually a staged accident.

Cultivating Exemplary Adjusters

Having spent the formative years of my career adjusting claims in South Central Los Angeles, an area notorious for insurance fraud, asking the difficult questions become routine. That is because my managers were much more than supervisors; they were mentors who took the time to develop my intuitive skills. This transfer of knowledge became a catalyst for improving my skills and from a company perspective, results. It is this type of mentoring that will make for a great future generation of adjusters.

Wal-Mart founder Sam Walton once said, “Outstanding leaders go out of their way to boost the self-esteem of their personnel. If people believe in themselves, it's amazing what they can accomplish.”

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

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

As the title suggests, it is people that alter the outcome of games. Certainly effective processes and innovative technology are invaluable assets; however, nothing replaces the core competencies of “A” players.

Insatiable Curiosity

The key to success is to bring out the insatiable curiosity in not only those who participate in the investigative process, but throughout the organization. By asking the tough questions, both internally and externally, an inquisitive culture is born. Whether it is “how did this accident really happen” or “why did we fall short in a particular area,” it forces organizations into the mode of continual process improvement.

It is through this improvement that results improve, and those who can adopt this type of transformative mentality will soon gain a significant edge in an increasingly difficult market. This isn't to say that there isn't success in claims organizations today, but rather to point out that many have deficiencies caused by any number of variables. But at the end of the day it does seem that many aren't digging deep enough, allowing mediocrity to supplant quality in a never ending quest to meet certain metrics.

Beyond this, claims staff needs to have the resources to dig. Although not every claim warrants a skip trace or forensic analysis, virtually everyone needs an index run or when injuries or suspicious circumstances arise, a more detailed profile.

Special Reports /

An Inquisitive Claims Culture

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