Every P&C insurer has to deal with them (and occasionally life insurers, toosee Private Eyes Watch for Corpses that Blink, in the March 15, 1999, National Underwriter). Theyre what Mark Burnam, claims systems and operations manager for Kemper Insurances Individual and Family Group (IFG), calls opportunistic claimants.

Theyre the ones whose first reaction to a fender-bender is to grab their necks and shout Whiplash! hoping to get five-figure checks from Kemper IFG or some other insurer for soft tissue injuriesthe kind that cant easily be detected, or disproved, by a physician. Like every carrier, Kemper realizes some of these injuries are real and deserving of payment. Our job is to pay people what they are entitled to, Burnam said. But we dont want to pay what is not legitimately owed.

Differentiating between the two has never been easy and has often been expensive. Insurers have to bring in experts to examine the physical evidence from an accident and issue an opinion on the severity of the injury. That can be a costly proposition and often leads to acrimony between the claimant and the insurer, which in turn leads to a court date. This goes against the basic principle of claims settlement: You want to get in early and not let a $500 claim turn into a $10,000 claim, Burnam said.

We need a way to address opportunistic claimants, Burnam said. It is tough to decipher these accidents without experts, but having experts engaged on every claim can be cost prohibitive.

Enter WrExpert, software designed by Injury Sciences to enable claims adjusters to determine the possible severity of minimal-impact injuries. Kemper IFG was familiar with Injury Sciences, but it wasnt until the 1999 ISOTech conference that Burnam first saw WrExpert. After the management team sat through a demo, it was sold on the program. For one thing, unlike other kinds of software, there wasnt anything else in the market to compare with WrExpert. They were really the only game in town, he said of the Injury Sciences team.

Kemper IFG and Injury Sciences negotiated a deal in the Spring of 2000. They began a pilot program for the southeast states in July and another for the northeast in September, tracking the results carefully, according to Burnam. Satisfied with the results, the company began a full rollout this spring, and Kemper IFG adjusters throughout the nation now have access to the system.

Burnam estimates that Kemper has 10,000 bodily injury claims a year involving people who dont hold Kemper personal lines policies. Of those claims, approximately 25 percent involve soft tissue injuries. Those are now being run through the WrExpert program.

It is hard to judge success in the new areas, but in the [Southeast and Northeast], where theyve been using the system for a while, weve had some success in deterring opportunistic claims or intervening in a case to make a settlement, Burnam said.

WrExpert has not reduced the need for accident investigation experts, especially when such cases reach courtrooms. We would never go to trial with WrExpert as our sole expert, Burnam said. What the software does, though, is identify cases up front that we should look at more closely. WrExpert has also reduced the turnaround time for claims.

Because its only been a year since Kemper started using WrExpert, Burnam said its too soon to say how the still-open WrExpert cases will be resolved. Weve brought in accident reconstruction experts, he said, and after theyve looked at the cases, they feel that WrExpert has been more conservativein favor of the claimants, he said.

While most of Kempers claims reps have endorsed the software, there are still some that resist. Our challenge is to have our claims reps continually use this as a tool, but still judge each claim on its own merits, Burnam said. Its a huge culture change for many of our people. Weve had to learn new phraseology. We used to refer to these accidents as minimal impactnow we call them low velocity. ROBERT REGIS HYLE

THE COMPANY: KEMPER INSURANCEINDIVIDUAL AND FAMILY GROUP

NET WRITTEN PREMIUM (PERSONAL LINES): $955 MILLION

WEB SITE: www.kemperinsurance.com

THE PRODUCT: WREXPERT FROM INJURY SCIENCES

WEB SITE: www.injurysciences.com

Special Reports /

Kemper Insurance/Injury Sciences

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