Adjuster Consistency Seen Needing Help

By Daniel Hays

NU Online News Service, May 27, 2:34 p.m. EDT?There is no consistency in the damage figures that different adjusters come up with for the same bodily injuries, according to field tests by a claims management system company.

When groups of adjusters are asked to evaluate the same case file any two adjusters were found to have 60 percent or greater chance of being 100 percent apart in their evaluation, said Lee Fogle, vice president of ISO Claim Services in Columbia, S.C.

ISO Claim Services, a division of Insurance Services Office in Jersey City, markets the Claims Outcome Advisor system. In analyzing how different adjusters rate the same closed case, he said, "We find them to be all over the board."

Mr. Fogle said ISO Claim Services has run such tests at more than a dozen companies to demonstrate a problem, which the Claims Outcome Advisor is designed to fix.

He said at one company a check of 10 adjusters found them to range from $15,000 to $200,000 for the same claim.

Frank Marx, the president of the National Association of Independent Insurance Adjusters in Geneva Ill. said the current problems with adjusters at large companies is that their firm's fail to give them enough training.

"Thirty years ago adjusters were trained as multiple lien adjusters. Today, people are pigeonholed. You're trained as just a PIP adjuster," he said.

Adjusters assessing the value of a claim "should be within the same ballpark. That's not happening because of a lack of training.

Mr. Marx's firm, The Curley Adjustment Bureau in Philadelphia, does work for a lot of insurers and he said "they are all in the same boat with cutbacks in budgets. The training provided 20 years ago isn't there today."

Mr. Marx said his firm's adjusters do not use software like Claims Outcome Advisor or COLOSSUS, licensed by El Segundo, Calif.-based Computer Sciences Corporation, but more and more large insurers do.

Mr. Fogle said the Claims Outcome Advisor as part of its system allows adjusters to point and click on a model of the human body to get an assessment. The system's mathematical model has programmed into it 14,000 injuries, and treatments and prognosis including information that factors in pre-existing conditions, he said.

Testing of adjusters who are schooled in the ISO system, he said, reveals they rate claims with a high degree of consistency.

Mr. Fogle said the ISO system also provides for tracking of claims to see if certain geographic or medical provider trends emerge. Hypothetically, he said, it could find a company was encountering more head injuries in a certain location or that doctors were continually diagnosing the same malady.

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Adjuster Consistency Seen Needing Help

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