It’s no secret that average BI severities are rising. While someof this is driven by medical inflation, there are other componentsthat can be controlled.

Let’s take a look at 10 things that can drive results on auto BIclaims.

1. First Notice of Loss

Asking the right questions at the outset of a claim can greatlyreduce transfer friction later in the claim process. By effectivelytriaging potential BIs or claims that are likely to emerge as BIs,insurers can proactively investigate these claims and often pushfor early resolution. Studying data trends can often provide keeninsight into factors that can be proactively used to identifypotential BI claims earlier in the claim process.

2. Auto Physical Damage

If a red car hits a white car, there won’t be green painttransfers. While this seems elementary, there are a number ofsituations in which adjusters are not reviewing the photos ofdamaged vehicles. It is critical to analyze photos, looking formetal deformation, directional force and evidence of priordamage.

In far too many demands, there are allegations that just aren’tpossible. Consider the rear-ender where the attorney alleges thattheir client was thrown “violently forward.” This would defy thelaws of physics, as would many other statements that are oftenpresented.

In other situations, there is little to no damage. If there isno damage to the claimant vehicle, then what is the mechanism forinjury? While it may be possible, it is highly unlikely. Gettingcrisp, clear pictures of vehicles from all angles can be invaluablein pushing these types of claims to an early resolution.

3. Police Report

There is often key information provided to police officersresponding to the scene of an accident. The report will containcitations, witnesses, scene diagrams and any claimed injuries.

4. Comparative Negligence

Did you know that the average insurance carrier assessescomparative negligence on just 3% of all claims? When compared tojurors who assess shared liability in more than half of all casesadjudicated, this becomes a glaring opportunity. Many insurers areturning to tools such as ClaimIQ, resulting in their gaining asignificant competitive advantage.

5. Prior Claims History

Claimants should be indexed at the outset of the claim, as wellas just before any negotiations are to take place. It is notuncommon to find claimants with an accident history, as well asintervening claims that can have a significant impact on your claimevaluation.

It is also important to gather all of the medical recordsassociated with any prior or intervening claims to ensure that whatis being claimed was not caused elsewhere.

6. Claimant Profile

Let’s face it, when it comes to cashing in on an accident, somepeople will be less than virtuous. The airwaves are full of triallawyers promising riches to those who seek to be opportunistic.Herein lies the importance of doing due diligence on anyonepresenting an injury claim. Most certainly people can be hurt incar crashes, but that isn’t always the case. Understanding the claimant and looking for financial motives canprovide keen insight into the veracity of the claimant.

Key items to look for are criminal history, known associates,marital history, professional licensure and assets. Thisinformation can often be invaluable when evaluating and negotiatingclaims. I recall a situation where a claimant was “incapacitated”by an accident. When putting together her profile, there wasa prior criminal history for solicitation and an occupationallicense for exotic dancing. With this information we securedsurveillance that contradicted everything being claimed and theattorney very willingly withdrew his representation.

7. Medical Detail

Upon receipt of a letter of representation, I always made it apoint to advise the attorney up front as to what would be needed toconduct a BI evaluation. The medical bills are only part ofthe equation. Equally as important are all of the provider intakequestionnaires, SOAP notes and a medical history, including allproviders seen. While attorneys generally don’t like toprovide information beyond the particular incident in question, itis important to dig since many claimants have a history ofcomplaints. If there is a refusal to provide the requestedinformation, simply remind them that it is discoverable.

8. Medical Bill Review

Approximately 10% of all claims are outright fraud, and anotherthird involve inflated medical specials. Utilizing a billreview tool, such as Mitchell Decision Point, provides adjusterswith insight into reasonableness and relatedness, as well asidentifying opportunistic fraud, such as upcoding, unbundling andmodifier abuse.

9. Venue

Not all venues are created equally. It is fair to say that thesame claim in the Bronx will be worth far more than if the accidenthappened in Amarillo or Des Moines. That said, it is important tonot use venue as a crutch. Generally speaking, venues fall intothree categories: conservative, moderate or liberal. Of the 3,143counties or county equivalents in the United States, nearly 85%fall into the first two categories. Of the remaining counties, onlya handful would require evaluation consideration beyond liberalconsideration.

I recall a situation in which a supervisor requested authorityto pay our insured’s $10K policy limits. His rationale was that theclaim was in Miami-Dade County. That’s it. Venue was beingused as a crutch. To prove a point, I placed a call to theattorney and reviewed the facts of the case, the claimant’s historyand excessive treatment that clearly wasn’t warranted orrelated. The claim settled for $3,000 dollars.

10. Negotiation Strategy

One of the biggest obstacles to getting an accurate claimsettlement involves poor negotiating skills. It is somewhat counterintuitive to think that this happens, but it is a harsh reality inmany claims organizations. Negotiation, like any skill, requiresconstant honing. Far too often, attorneys gain the upper hand byfocusing on dollars. Savvy negotiators don’t fall this trap andfocus instead of the characteristics of the claim. For example,utilization of the InjuryIQ T-Chart allows adjusters to prioritizenot only their strengths, but those of their adversary. Byunderstanding the other side, they can formulate rebuttals and keepcontrol over the dialogue and direction of the negotiations.

While there may be additional considerations based upon thecharacteristics of individual claims, these 10 items provide asolid foundation to get to the proper outcome.