A Vendor's Role in the Adjuster's Ultimate Objective

In order for an adjuster to handle a claim competently, he or she must be properly trained for the task at hand. Ideally, the adjuster is also experienced or is supervised by someone with the needed experience to ensure appropriate outcomes.

Key areas in which an adjuster's competence is paramount are determining coverage, assessing damages, and scrutinizing liability.

Staff adjusters tend to be strong in interpreting policy terms and coverage. This is because they use company insurance policies that are sold to a familiar demographic and they've read them numerous times. Independent adjusters may be well-versed in coverage and may make recommendations but they'll wisely defer to their clients for a final decision, as different clients have their own interpretations or reasons to take certain positions.

Frequently, when an adjuster is unable to make a coverage determination it is because the details of the actual cause of loss or series of events that resulted in a loss are yet to be determined or understood. Clarification of these loss details (as a result of thorough investigation) allow a decision as to whether the cause of loss is actually covered under the policy.

As a vendor, you must strive to be a resource for adjuster training. Generally, the training insurance companies offer is related to policy language and tort law. You may have knowledge and experience in a specialty that makes your company the best possible resource from which adjusters can learn. In many states, adjusters are required to secure continuing education (CE) credits to maintain their licensing. If this is true, then you can contact your state's Insurance Department to obtain approval as a provider of education leading to continuing education credit for adjusters.

For example, if you specialize in water mitigation, then you could develop a course about how dry-out operations are assessed and performed. If you're a forensic accountant, you might discuss how data is developed to establish a basic or complex earnings loss. If you're a body shop manager, then having adjusters tour the shop to observe the auto damage repair process would serve as an excellent education opportunity as well as enhance the credibility and brand identity of the facility and its staff.

In a case where an adjuster needs more technical data to establish the cause of loss, a forensic engineer could provide the analytical expertise to assist in that coverage decision. Engineers can also be instrumental in clarifying liability when investigating the origin of a fire or the proximate cause of a loss, or failure analysis to name a few areas. Further, forensic engineers can offer adjusters training opportunities that will show adjusters how to identify suspect scenarios that may call for more in depth scientific examination.

There are numerous ways vendors can reinforce adjuster competence. I encourage vendors to be creative in thinking of ways they can be a resource to this end.

Supporting Cost Efficiency

Cost efficiency means resolving the claim with as little operational expense as needed. Managing costs is important to an insurer's loss ratio, and it also impacts premiums billed to insurance consumers, stockholder equity, and the viability of insurance as a solution to society's risk management challenge. To be cost-efficient, an adjuster must have access to the tools needed to adequately execute the task.

Tools can consist not only of software and hardware but might also include a ladder, a flashlight, a camera, a camcorder, a voice recorder, tape measure, psychometric chart, a roofer's pitch card, and finally, a vendor with expertise.

One recurring theme over the last 20 years is that insurer profitability requires more to be accomplished with fewer personnel. The work formerly done by a staff of 20 is now expected to be done by ten or less. This is achieved with tools and vendors who help claim departments do more with less.

My son is a 20-year-old college sophomore. He is a skilled keyboarder and software master. I don't think he has ever touched a typewriter. My grandson, a bright 7-year-old, may never have seen one. There was a time, not too long ago, when you might have filled out a different form (with common data) ten times on a given file. The vendors who create software that require data entry only once to cover the multitude of needs on a given case have saved untold number of claim administrative hours. The value of such innovation has to be in the billions.

On one could argue that IT experts who've developed risk management software and other applications for high-tech hardware have made an immeasurable contribution to claim-handling cost efficiency. However, even the most humble provider of services to the adjustment process (the lower end of the vendor food chain) can make a significant contribution if they help save adjuster time by minimizing the need for adjuster involvement.

Make every effort to convey to the adjuster you're meeting for the first time that you are there to save adjuster time and hassle. As a provider of services to the insurance claim industry, anything you can do to increase adjuster efficiency will be greatly appreciated and rewarded. So, how do you create the proverbial "music" to adjuster ears? Just ask them how you can help them be more productive.

Accelerating Adjuster Expedience

One could loosely define expedience as the time it takes to reasonably investigate a claim to give fair consideration to resolution. You might think that the single greatest factor here is adjuster time management. That's probably true, but you must also consider some important components to that equation. Is the adjuster's caseload reasonable or totally unmanageable? Is the adjuster properly trained in time management skills? Is the adjuster diligent? Does the adjuster have poor work ethic or habits?

Not that you'd ever want to point out an adjuster's deficiencies, but awareness of all components to the time-management equation will help you determine how best to contribute to adjuster expediency.

Promoting adjuster expediency is relatively simple. First, perform your service without delay. Don't do anything that will create a hindrance to resolution of the claim. If there is a snag in the process, then do your best to keep the adjuster informed. If you're working with an adjuster who is hard to reach and seldom answers the phone, then send an email or a handwritten update so that your communications are documented.

If your service involves contact with a claimant or policyholder, then make sure you or a delegate is accessible beyond business hours. This serves to eliminate needless irate phone calls to the adjuster. In fact, make sure you are accessible by email — and that you check your email daily — as well as cell phone, with voice mail. A claimant or insured with a problem won't try very hard to reach you. If you don't make it easy, then the will harass the adjuster, whose time you intended to save.

Not that I recommend this, but some insurers (with a view towards doing "more with less") have arrangements with restoration contractors to photo, measure, and scope a loss before they decide to deploy an adjuster. Thereafter, they may spot check a percentage of the contractor's submissions for accuracy.

You can apply this "assist" type service to almost any vendor. As you are building your contacts with the adjusting community, see if there are ways that your specialty can be used in the assessment process.

Claim Industry Needs

Before a new claim ever gets to an adjuster's desk, a myriad of tasks have been undertaken by software programs using methodology created by visionary IT vendors. Over the last years, streamlining the claim operation has been the mantra of corporate heads championing the cause of "more with less." Nevertheless, IT service providers will tell you that the insurance industry and, particularly claim operations, have been slow to adapt to modern technologies.

There is still much to be done; much more data to be managed; many more dollars to be saved. The successful vendor reaps the rewards by contributing the most to supporting the adjuster's ultimate objective. That vendor is keenly aware of the claim industry needs not being met and constantly strives to be the resource to fill those gaps.