When diving into the world of claims, just what should the adjuster be focusing on? Here are five key areas where adjuster focus is essential:

Coverage — This is critical to the outcome of any claim. Oftentimes coverage can seem pretty routine. Was the policy in force on the date of loss? Does the driver meet the definition of an insured? What about the scenarios that take an inordinate amount of time to resolve: Non-permissive use, implied versus explicit permission, unlisted drivers, vehicle usage that falls outside of the scope of the policy? The list goes on, and it is critical that the adjuster makes the right decision for every file hitting his desk.

Investigation — Having run quality assurance for a large multi-national insurer, this is an area where there is tremendous opportunity for improvement. It seems that with all the competing priorities, the investigation often takes a back seat. There is a reason why adjusters assess comparative negligence on only 3% of claims, while juries assess it more than half of the time.

Evaluation — Perhaps the most fundamental aspects of the claims process, yet one that can be quite time consuming. Just what is an adjuster to do when a 500-page time-limit demand lands on the desk but he or she needs to attend an HR mandated training course on workplace civility?

Negotiation — Driving to the right outcome takes both knowledge of the claim and wisdom. When one loses focus on establishing liability and damages due to noise external of the claims process, how can one reach an optimal settlement? The answer is they can't. Sometimes it is just easier to look at the medical bills and apply a multiplier. After all, we have to close claims to chase a disposition number, right? That is a topic for another day.

Recovery — There is a direct correlation between not focusing on claims-related tasks results and missed recovery opportunities. Whether it is a delay in moving a totaled vehicle, evidence spoliation, overlooked risk transfers or missed subrogation, the result is the same. Money is left on the table. Industrywide, these misses equate to billions of dollars annually.

Special Reports /

Keys to improving the claims adjusting process