Claims Advisor Winter 2009

winter 2009

claims

www.claimsadvisor.com

advisor Information for today’s claims professionals

No Fear...

They’re Just Best Practices Start off 2009 with the tools to be more effective.

Creating Competitive Advantage

Using Unstructured Settlements Concerns That Can Arise from Water Induced Losses

Estimates Unveiled

Inside: Temporary Housing Special Section

Investigating Negligent Hiring Claims

Best Practices for Mobile Machinery Claims

Contents in this issue winter 2009

26 52

20

32

8

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The Customer is King Creating Competitive Advantage in the Claims/Customer Relationship

By Michael Kelly fineos corporation

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The Happy Adjuster How to Thrive in the Midst of Today’s Stress By dr. Steven Carter, Psyd, LP Expert advantage

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Making the Most of Your CE Dollars & Hours Develop your plan to make the most of your investment in 2009.

By donna j. Popow, J.D., CPCU, AIC American Institute for CPCU and the insurance institute of America

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Special Focus

Using Structured Settlements

Temporary Housing Special Section

Reduce Costs While Meeting Claimant’s Needs

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By dennis drexler

cambridge galaher settlements and Insurance services

32 Concerns That Can Arise from Water Induced Losses

By Richard Byrd & Jon Schatz EFI Global

CLAIMS ADVISOR | WINTER 2009

Forensic Analysis Services

EFI Global employs a large team of trained professionals who routinely conduct forensic investigations to determine the sequence of events resulting in an accident or failure.

Whether the project requires failure analysis, forensic engineering, event reconstruction, or other analysis, EFI Global provides quality analyses and defendable loss evaluations involving mechanical, electrical, civil, structural, automotive, metallurgical, and chemical engineering, as well as other disciplines and services.

Our experts provide forensic evaluations resulting from a variety of issues including:

• Product Design Defects • Fire Inspection and Plan Review • Building Component Failure • Construction Defects • Roadway and Pavement Damage • Vehicle Damage Consistency Analysis

• Electrical Wiring Failure • Petroleum and Gas Pipeline Failure • Roof Collapse • Storm Surge and Flood Damage • Metallurgy Failure Analysis • Load Bearing Analysis

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Forensic Engineering • Fire Investigations • Environmental Consulting • Specialty and Consulting Services

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Contents in this issue, cont’d... winter 2009 46

36

56

Estimates Unveiled

An Insurance Policy for Enterprise Data

Their Differences, Secret Meanings and the Devil in the Details

By Bradley D. Sharp, BA, AIC Guideone insurance

Becoming Irreplaceable

60

frstEAM

46

42

Outsourcing to a SaaS or Hosted Backup Site Supports Disaster Recovery Strategies

By Jason King

By jim nicholas

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36

40 Fabric Restoration Providers Adapt to Needs of Insurers

48

60

Hyland software, Inc.

Best Practices for Mobile Machinery Claims

By David Shillingford

National Equipment Register

in every issue winter 2009

Investigating Negligent Hiring Claims

Edit: Letter from the Editor/Publisher

An Investigation of the Investigation By kyle roehler, esq.

foland, wickens, eisfelder, roper & hofer, PC

Pulse: Your Responses to Our Online Polls

72

Cool Linx

72

~The Commish

~NEW

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6

73

Interview: What Makes You Tick?

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Write: Tips for Better Writing

75

Why Insurers Need Alternatives in Today’s Market

Event: Calendar of Industry Meetings

76

Source: Advertiser Directory

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By ian cunningham

Story: Claims Adjuster Musings

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Direct Repair Programs

Scene Genesis

CLAIMS ADVISOR | WINTER 2009

Edit Practice Makes Perfect Growing up in a musical family, I’ve played my fair share of instruments. I finally settled on the French Horn and began years of study and practice. In high school band, you always knew which students did their time at home as well as in the practice rooms at school—they simply sounded excellent.

In the world of band geeks, first chair is where the best are seated, and I wanted to be the best. However, I knew it would require one thing to get there— practice, practice, practice.

Now, the horn is not the most quiet instrument and practicing it caused some ear-peircing sounds to come from my bedroom at night. It must have been tough for my family to endure, but it was the only way to improve.

As an adult in the business world, how does practice play into your daily life and your future? Is it as critical for success today as when you were a kid in school?

You bet. But now, “practice” becomes best practices.

To better understand a sometimes overused term, best practices can be defined as techniques or methodologies that, through experience and research, have proven to reliably lead to desired results. They are considered the most efficient and effective way of accomplishing a task.

A Google search on “Claims Adjusting Best Practices” gets you over 323,000 results. Obviously, this is a subject of

Don’t miss an issue!

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great interest and attention.

Claims executives seek to give every claim the right skills, attention and time.

By continually seeking the best and most efficient ways to handle each claim, that goal can be accomplished. But, it requires tenacity and education.

In order to help you attain the best possible results for your company and your clients, in this issue we look at best practices for handling a number of issues faced by claims professional each day.

I did get first chair eventually and my hard work and pursuit paid off. As you strive to provide quality service for your customers, best practices can be your best friend. And, in the words of my mother, “practice makes perfect.”

Information for today’s claims professionals

Winter 2009 VOLUME 3. NUMBER 1

Publisher & Editor Bevrlee J. Lips/blips@claimsadvisor.com Editorial Advisory Board Steven Carter Expert Advantage Glenn T. Gibson

Crawford & Company International

Patrick Harmon

IMACC

Patrick Jeremy

Hartford Steam Boiler Inspection and Insurance Company

James R. Jones

Katie School of Insurance and Financial Services, Illinois State University

Robert Kelso Thomas W. Mallin John McHale

Renew Today Be sure to log on to www.claimsadvisor. com/subscribe today and renew your subscription for another year. Claims Advisor is free to claims professionals and provides you with the expert information critical to your success. In addition to receiving your print magazine, there are online benefits as well. Check out “My Claims Advisor” where you can update information and set up your viewing preferences. Log on and renew today!

Until next time...

Bevrlee J. Lips Publisher/Editor editor@claimsadvisor.com

Donna J. Popow

Kightlinger and Gray Property Loss Research Bureau Erie Insurance American Institute for CPCU/ Insurance Institute of America

Claims Advisor Staff VP Finance/Michael Marsh VP Information Technology/Michael Kay Web Site Associate/Chris Walters Project Associate/Amanda Pierce Warren Editorial Assistant/Paige Kay Database Associate/Sheila Hoyer Database Associate/Teresa Baran-Carlson Design Assistant/Ashley Jones Design Assistant/Richard Shivers Human Resources/Shannon White Advertising Sales Vice President/National Sales Phil Imbrenda/pimbrenda@claimsadvisor.com For advertising information, call 866.276.7970 or email advertise@claimsadvisor.com

Volume 3, Number 1, Claims Advisor (ISSN 1940-0993) is published four times a year in January, April, July and October by Claims Advisor, 537 Deltona Boulevard, Deltona, FL 32725. Printed in the U.S. Copyright © 2009 by Claims Advisor. All rights reserved. Reproduction in whole or in part without permission is strictly prohibited.

No charge for subscriptions to qualified claims adjusters and managers. Annual rate for subscriptions to nonqualified individuals is $46 USD. Canadian $70 (in U.S. funds). For individual issues, $12 USD. For reprints, e-mail the editor at editor@claimsadvisor.com POSTMASTER: Send address changes to Claims Advisor, 537 Deltona Blvd., Deltona, FL 32725.

Founder/D. Scott Plakon

Claims Advisor

537 Deltona Boulevard, Deltona, FL 32725 office 866.276.7970 | fax 866.276.7972

WINTER 2009

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Property Loss Research Bureau Liability Insurance Research Bureau

Educational Opportunities

Claims Conference March 22 - 25, 2009 Seattle, WA Join the industry's largest educational conference and expo, hosted this year in the "Emerald City" of the great Northwest.

With more than 110 sessions and over 300 exhibiting companies, you'll connect with the major issues, resources, and players of the claims industry.

www.claimsconf.org

2009

Large Loss Conference November 2 - 4 Tampa, FL

Regional Adjusters Conferences Eastern: June 24 - 25 Providence, RI Central: September 9 - 10 Lombard, IL Western: October 20 - 21 Austin, TX These Conferences are geared for front-line adjusters, supervisors, and managers and are held in three parts of the country (Eastern, Central, Western) each year.

Twenty-eight sessions are offered for property and casualty claims professionals.

www.plrb-lirbregionals.com

This Conference explores claims issues associated with the largest property and casualty losses. The audience includes general adjusters, EGAs, large loss claims managers, and service providers who work with them to effectively adjust these claims of $100,000 or more.

Workshops include personal lines / property, commercial lines / property, and casualty claims.

www.plrblargeloss.com For more information and to register, please visit www.plrb.org, or call 630-724-2200.

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CLAIMS ADVISOR | WINTER 2009

The Custom Creating Competitive Advantage in the Claims/ Customer Relationship

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mer is King

By Michael Kelly

For years, insurers have been consumed with the high cost of doing business and rising claims costs.

Organizational initiatives, wholesale transformation efforts, and IT investments have focused on improving processes intended to minimize leakage and drive expense out of the system.

This is no surprise in an industry that pays out 65 to 75 cents of every premium dollar in order to meet its contractual requirements (not counting associated operating expenses).

However, as failures among financial institutions are at an all time high and every

day brings new doom and gloom headlines, insurers are facing leaner margins and decreased investment incomes. The reality is that there simply are fewer places left to make cost savings.

So while the emphasis on driving out costs has been necessary and well founded, a noticeable shift is now occurring. The customer, often seen as a necessary participant or by-product of the claims process, will need to become the center of the claims universe. Successful insurers will be those that can deliver best-in-class claim service to their customers. One way of doing

this is through the intelligent use of technology.

The Customer-The New Priority To be truly healthy in a financial sense, companies strive to achieve a balance of profit and growth. The profit side of the equation has been addressed by focusing on the loss and expense ratios as mentioned above. Additionally, many cost cutting measures, restructuring efforts, and layoffs have occurred. It is questionable how much more expense benefit these traditional practices can add without jeopardizing loss

CLAIMS ADVISOR | WINTER 2009

payments and service.

Growth (much less profitable growth) is particularly challenging in a mature market like the U.S. The potential pool of customers is not increasing, particularly for certain lines of business, such as automobile, where insurance is mandatory and everyone who needs to be insured may be insured already.

The result of this saturation is that, in order to grow, an insurer must take a customer from its competitors. Price has always been one way of doing this and remains an important part of the equation but, in this market, price isn’t always significantly different from one carrier to another.

This suggests that the primary competitive differentiator for the future is claims service. Customer retention is a critical element in (profitable) growth as many customers are likely to jump ship after a less than satisfying claims experience, and acquiring new business may be seven times more expensive than keeping current policyholders.

The changing attributes and preferences of the insurance customer will be a challenge to manage.

Studies suggest that customers increasingly are likely to change insurance providers because of negative experiences, price, product choice, the availability of information, or changing demographics.

The insurance industry traditionally is slow to respond to the environment, but changes in customer demographics are becoming noticeable now. The Gen Xers, and now the Millennials, comprise a greater

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percentage of the customer base compared to the Baby Boomers. These younger customers demonstrate some different preferences from more traditional customers. Because of the heavy reliance on the Internet, convenience is paramount. Service must be seamless and information must be readily accessible.

How Carriers are Responding Today All of this does not imply that insurers have turned a blind eye to customer service in the past even though the industry currently does not enjoy an overall positive reputation with consumers. In differing degrees, many companies have taken steps to create a customer centric culture, develop feedback mechanisms, make their processes less cumbersome, and to create enhanced service features. Most carriers sincerely intend to provide competitive service, and many have expended a great deal of effort to improve processes and company culture to provide customer service.

However, the reality is that those carriers who will weather the storm effectively will find ways to raise the customer service bar by improving their response to the increased demands for customer convenience, choice, information, and access (while not underestimating the human element).

In the world of auto claims, the evolution of repair networks and associated programs, such as concierge services, is making the process ever more seamless for claimants. Some

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carriers are experimenting with Web portals to allow agents and customers to check on the status of their claims. They may be able to monitor the status of their car repairs from the comfort of their living rooms and see regular digital picture updates of the progress of the repair work.

Companies also have grasped the significance of loss exposure and the opportunity for positive (and negative) publicity due to catastrophic events. Rapid mobilization, high touch service, and operational efficiency are emphasized when catastrophes occur.

Leveraging Technology to Respond to Customer Needs While the development of effective customer strategy, a customer centric claims culture, meaningful service metrics, useful surveys, and enhanced claims services and networks are prerequisite, technology is a powerful tool for creating competitive advantage.

Carriers that remain in a legacy and paper-bound environment will find it virtually impossible to respond to customer needs.

A modern claims platform allows for file visibility by various insurance company personnel so that customer

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The Katie School attracts the best and the brightest students who are pursuing careers in the insurance and financial services industry.

To learn more about what the Katie School has to offer, contact: Deborah A. Babcock, Associate Director (309) 438-3368 Debbie.Babcock@ilstu.edu

Fact or Fiction was it really lightning?

From January 1, 2008 through July 22, 2008 Vaisala’s North American Lightning Detection Network (NALDN®) recorded more than 67 million lightning strokes and lightning season was only half over!

• One-third of all lightning claims can be falsely attributed to lightning.

• Vaisala STRIKEnet® offers the fastest access to the most comprehensive lightning detection database in North America.

• Since 1995,Vaisala’s lightning investigation tool STRIKEnet® and NALDN® data have provided companies with the most scientific and objective solution available to verify the presence or absence of lightning.

• Be confident with the knowledge that lightning was active near a specific property address.

To order a STRIKEnet® report, log on to https://thunderstorm.vaisala.com Vaisala Inc.

Tucson Operations Tel: 520 806 7300 Fax: 520 741 2848 claims@vaisala.com

questions can be answered quickly, even when the handling adjuster can’t be reached.

In the traditional legacy environment, the view of the customer has been claim by claim. Technologies such as Customer Relationship Management (CRM) or Single View of the Customer allow a company to have a total customer view instead of viewing within the context of one claim only. CRM is a third generation customer management solution specifically designed for the insurance industry, and understands the complexities and nuances of the business. CRM technology not only allows for better information between various systems within the insurance company (claims, underwriting, policy

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administration, billing), but can provide valuable insights into a customer’s preferences if more than one policy or claim exists.

The use of data, rules, and analytics also can have a significant impact on efficiencies and claims loss payments. Tremendous benefits can be achieved by using historical claims data to help understand customer behaviours and preferences, and to design processes to more effectively meet their needs while reducing cycle times. The appropriate use of rules reduces delays and errors associated with the human touch. The effective use of data and analytics also can lead to a new and improved segmentation model which enables claimant self service and auto adjudication for certain types of claims.

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Processes like this can go a long way toward driving costs out of the system.

Predictive analytics are also an important way to impact financial outcomes on a claim by claim basis.

As older workers retire, will there be enough trained and experienced claims professionals to handle complex and high potential claims effectively? Through the use of analytics, immediate insight can be provided into fraud, recovery, reserves, injury potential, and effective adjudication strategies. Predictive analytics has been around for a while now, and is slowly but steadily being adopted by more and more claims organizations.

Other technology tools also can add potential value to the claims process.

Mobile technology can

enhance the effectiveness of the adjusting staff in the field by providing the information and tools necessary to further the adjudication of a claim on the spot. Web portals can help satisfy the policyholders’ demand for point and click convenience by allowing claim self-enrollment and inquiry capability. There also is the potential to capitalize on the popularity of social networking tools to enhance policyholder experience and improve perception of the insurance company.

The rapid deployment of new technology also has a profound impact in the claims workplace. Legacy systems, paper-bound environments and many other traditional manifestations associated with the claims department are disappearing and new skills

are required. Not only is it critical to possess the disposition and training to adopt more highly developed customer advocacy skills, but changes in jobs brought about by technology will create stresses on the workforce. Change management and employee training become critical initiatives for the successful claims departments of the future, particularly since many claims professionals currently may not be technology savvy. There is, however, a real upside

to automation as it relates to the claims workforce.

Younger and more computer literate workers will gravitate towards those employers who are more advanced from a technology perspective.

Today’s insurance companies face a formidable challenge in maintaining and improving their competitive positions. As always, sound financial management is critical, especially in this volatile economic time. But, more than ever, it is becom-

ing evident that insurance companies need to focus on the customer by accepting the new �customer is king� paradigm, developing an aligned strategy and culture, and wisely adapting key technology enablers such as a fully optimized modern claims platform supplemented with robust CRM capabilities. Making these changes in the way a claims department functions will have an impact on the claims workforce, so training and effective change management are

essential. Those companies who can retain their customers through best-inclass claim service will be in the best position to achieve long term success. cA Michael Kelly is the CEO for FINEOS Corporation. For further information, please visit www.FINEOS.com or email us at info@FINEOS.com.

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The

Happy Adjuster How to Thrive in the Midst of Today’s Stress

By Dr. Steven Carter, PsyD, LP

The 2008 Stress in America survey by the American Psychological Association (APA) found that nearly half of Americans report that their stress level has increased over the past year.

Thirty percent of the respondents rated their average stress levels as extreme (8, 9, or 10 on a 10-point scale). Most of the respondents believed that they were managing their stress effectively (81%), but the facts indicated otherwise.

Most were experiencing negative effects of stress on their physical health, emotional health, relationships, and work productivity. This suggests that the sedentary activities most people

reported using to manage their stress are not effective.

Insurance adjusters might be doing even worse.

Times are Tough There is every indication that the days ahead will prove to be just as tough, if not tougher. Employment as a property and casualty claims adjuster provides a steady supply of stressproducing situations under the best of times. Working and living at the site of a large loss claim following hurricanes, floods, and large fires multiplies the stress level. That is especially true if one’s own family has been affected by the disaster.

The worldwide economic

Resilience: The ability to recover from or adjust easily to misfortune or change.

recession ensures greater stress, too, as employees demand more production from fewer employers and customers are desperate for quick settlements.

Build Your Resilience Most adjusters can stay happy, healthy, and produc-

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tive even while living at the site of a major disaster.

Whether you will be one of those fortunate ones will be decided by the choices you make today. Resilience in a high stress environment results from a healthy lifestyle over days, weeks, and months, not implementing a list of quick-fix tips the day after one is deployed to the field to handle a large loss claim. Key steps are recognizing your stress signals, avoiding quick fixes that cause long-term pain, thinking right, eating right, aerobic exercise, frequent breaks, and healthy relationships.

Recognize Your Stress Signals People experience stress in different ways. Thriving in a high stress environment requires rapidly recognizing and responding to your personal signs of stress. If you can’t listen to your own body, you’ll be in no shape to listen to the complaints of angry, agitated claimants.

Men in particular have difficulty recognizing and accepting signs of stress in themselves. Ask for help.

Chances are your coworkers, spouse, children, and friends already know how

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you experience stress. Ask them what they see. Listen to their answers. You probably won’t like what you hear, but it will help you succeed in being the tough guy that you thought you were all along.

Common Signs of Stress • Headaches • Muscle tension • Neck pain • Back pain • Upset stomach • Dry mouth • Chest pains • Rapid heartbeat • Difficulty falling or staying asleep • Fatigue • Loss of appetite • Overeating “comfort foods” • Increased frequency of colds • Lack of concentration • Forgetfulness • Jitters • Irritability • Short temper • Anxiety Short Term Gain, Long Term Pain The 2008 APA survey found that almost half of Americans (48%) report overeating or eating unhealthy foods to manage stress. Women were more likely than men to report

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unhealthy behaviors to manage stress, like eating poorly (56% versus 40%), shopping (25% versus 11%), or napping (43% versus 32%). Almost onefifth of the respondents reported drinking alcohol to manage their stress (18%). These activities are quick, easy, affordable, and available, and they are effective—but only briefly.

They do not provide the relief that your mind and body require to sustain lasting employment as an adjuster in a high stress environment.

Think Right Change your beliefs and you will change how you feel. Your feelings are involuntary responses that are largely outside of your control, but you can change the thoughts that produce your unpleasant feelings.

4 Common Classes of Cognitive Distortions • Dogmatic Demands— I, they, the world, must, have to, ought, can’t be a certain way • Low Frustration Tolerance—I can’t stand it!

• Awfulizing—This is terrible, horrible, unbearable

•

Self/Other Ratings—I am worthless or he/she/they are worthless

Change your feelings by changing how you think about things. For example, the Dogmatic Demand “I must complete every claim file correctly” becomes “The fewer mistakes I make, the easier my day will go.”

Beliefs about working in a disaster zone can change from “I can’t stand another week in this hell hole!” to “This place is hot, damp, and filthy, but I’ve endured it for two weeks and can make it another week even if I hate it.” The new belief increases your frustration tolerance while recognizing your misery. Most importantly, rate the effectiveness of your actions and the actions of others rather than rating yourself. For example, “I keep forgetting to ask about XYZ” suggests a solvable problem, whereas “I’m a hopeless failure” will lead only to despair.

Of the four common classes of cognitive distortions, dogmatic demands are the most common, but self/ other ratings are the most destructive. Many times, an inspirational quote can help keep your thinking on track.

See if any of the following are helpful for you: Quotes to Help You Avoid Self/Other Ratings • “Only the mediocre are always at their best.” — Jean Giraudoux • "The truth is that there is nothing noble in being superior to somebody else. The only real nobility is in being superior to your former self." — Whitney Young • “It’s a good thing when you're being criticized. It means what you are doing matters and someone cares how well you do. Be worried when you're doing poorly and no one cares because they have given up on you.” — source unknown The key to thinking right is not simply to think positively. Adjusters commonly confront situations in which a positive outlook would be irrational. The key is to convert inflexible demands into preferences and probabilities. It means recognizing that, usually, when we tell ourselves that we can’t stand a situation, we are in fact standing it at that moment and simply strongly dislike it. It means that calling unpleasant circumstances awful actually worsens our experience of them. It means recognizing that the inherent and unchangeable worth in yourself and every other person cannot be changed by actions or inactions.

Frequent Small Breaks Develop the habit of taking frequent small breaks throughout your workday. These can keep stress from building to an overwhelming level and can increase your endurance greatly. The simplest strategy is to pause and count four deep breaths in and four deep breaths out. This works well upon getting into your car and upon arriving at a destination before interacting with an insured. It’s free, easy, always available, and surprisingly effective.

The effectiveness of deep breathing can be enhanced by a few minutes of stretching. While standing, reach as high as you can above your head. Next, pull your shoulders up towards your ears then behind you while arching your back as if you’re being suspended

;a^\]i G^h`#

Your best hope for your company’s future could be ready to bail on you right now, and you don’t even know it. Unless you do something about it right now.

Ad\ dc id lll#V^XeXj#dg\$'^ckZhi#]ib and download our free brochure that will help you rethink the importance of professional development.

The American Institute for CPCU and the Insurance Institute of America have a wide variety of professional development solutions. Contact us, and we’ll help you develop a comprehensive plan to help you invest in your younger employees.

Don’t let him get away. Visit www.aicpcu.org today!

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CLAIMS ADVISOR | WINTER 2009

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by your shoulder blades.

Lower your chin to your chest, then rotate it up and as far left and right as is comfortable. If you can, remove your shoes, arch your toes up, then rotate your foot around your ankle.

Repeat these stretches and the deep breathing multiple times throughout the day.

Exercise If you do only one thing to help yourself cope with stress, make it aerobic exercise. Aerobic exercise includes things like brisk walking, running, dancing, swimming, and playing basketball. Changing your lifestyle to increase your resilience to stress also requires activities to strengthen your muscles, like push-ups and lifting weights.

Stress affects the immune system in ways that

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lead to aging conditions such as frailty, functional decline, cardiovascular disease, osteoporosis, inflammatory arthritis, type 2 diabetes, and certain cancers. Exercise reduces the physical impact of stress by reducing cortisol production, and it causes the release of endorphins which relieve pain and produce a natural high.

In the 2008 APA stress study, less than half of the respondents (47 %) said they exercise or walk to manage stress, yet no other single step is more effective.

The federal government has issued its first-ever Physical Activity Guidelines for Americans. The guidelines describe the types and amounts of physical activity that offer substantial health benefits. You can obtain your copy at www.health. gov/paguidelines. The Web

Tra n Ser scrip vic tio es

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Contents Evaluations

Policy Holder Portal

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Dr. Steven Carter, PsyD, LP is CEO of Expert Advantage® (www.Expert—Advantage.com), which provides medical evidence analysis, independent examinations and testimony nationwide. He can be reached at 218.749.3107 or stevencarter@mchsi.com.

Co

R a e l p n d Fu ac lf

Infectious Happiness A study this month in the online version of the British Medical Journal was the first to demonstrate that emotion is contagious. Researchers analyzed data compiled from nearly 5,000 interconnected people over a 20-year period.

They concluded that happiness is about as contagious as the flu and can spread to people three degrees away from the original mood shifter. A happy person not only makes his or her associates happier, but also the associates’ friends.

“Catching” an emotion requires more physical proximity than adopting a behavioral norm. The research indicated that we are more likely to adopt the happiness of people with whom we have frequent face-to-face contact, not merely those who live nearby or under similar circumstances.

Where do you meet these happy people so you can pick up these happy “germs”? Probably not at the hotel bar. Look for happy people wherever people are exercising. This can include fitness trails, gyms, and community dances. Attending religious services is another option.

r

waitresses, hotel staff, etc.). Try to see the opportunity in every difficulty and share your vision with others. These steps will increase your happiness and that of those around you. cA

n

Eat Right Simple dietary changes can increase your resilience to stress greatly. Reduce your intake of simple carbohydrates (e.g., soda, fruit juice, alcohol, white bread, etc.). Increase your intake of complex carbohydrates (e.g., whole grains, whole fruits, and vegetables).

Maintain healthy eating habits. For example, always eat from a plate rather than straight from the can, bag, or box of food. Make eating your primary focus (e.g., no TV, no reading). When in a disaster area with few nutritional options, you likely will benefit from using nutritional supplements. A key nutrient for a stressed adjuster is omega-3 fatty acids, which you can obtain easily from fish oil capsules or flax seed oil capsules. Vitamins D, B6, and B12 along with folic acid also are helpful and are easily and inexpensively obtained from over-the-counter multivitamins.

You can create happy people yourself. Become genuinely interested in other people and ask them to tell you about themselves. Memorize and share a few clean jokes. Smile. Act as if you already are happy and it will tend to make you happy. At a disaster site, invite colleagues to join you in watching a comedy movie on your laptop.

Be liberal with your encouragement.

Provide frequent, specific, genuine praise. Express honest appreciation to those who help you (e.g., colleagues,

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Making the

Most of

Your CE Dollar & H 20

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Donna J. Popow J.D., CPCU, AIC

Your business card may look like a ScrabbleTM game because of all the letters after your name, but there are two important letters that don’t appear there—CE. Our industry and the environment in which we work are constantly changing, which is why many states require continuing education (CE) for their claims adjusters.

Some employees view CE as a burden, as something they must do to keep their jobs. Others recognize the value of professional development and embrace the opportunity to enhance their skills. Regardless of whether you loathe or love CE, you need to develop a CE plan to make the most of your investment.

CE requirements vary by state, as indicated by the State Insurance CE Requirements chart (figure 1). States along the Atlantic and Gulf coasts require that adjusters who handle flood insurance claims comply with the minimum training requirements established by the Federal Emergency Management Agency (FEMA) and

rs Hours

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Continuing Education Requirements State

CE Requirement

CE Proof Sent By:

Nonresident Compliance

Alaska

24 hours biennially

Adjuster

Exempt

Delaware

Adjuster & public adjuster 12 hours biennially, must include 4 hours of ethics

Adjuster

Adjuster & public adjusters are exempt

Florida

Workers compensation adjuster: 24 hours biennially, must include 10 hours of workers comp. law, 12 hours workers comp., 2 hours ethics. Effective 1/06 reporting, all adjusters must have completed 24 hours, including 10 hours of law, 10 hours optional related topic and 2 hours ethics.

Provider

Meet CE requirement from a reciprocal state where license is held or meet Florida’s requirement

Georgia

Independent & public adjusters: licensed less than 20 years 15 hours annually; licensed 20 years or more 10 hours annually. Professional designation such as CLU or CPCU 6 hours annually. All CE must include 3 hours of ethics.

Provider

Meet home state requirement, if none, exempt from GA requirement

Louisiana

24 hours biennially

Adjuster

Meet requirement of home state or meet this state’s requirement

Massachusetts

15 hours triennially

Provider

Meet requirement of home state or any state where active license is held

Mississippi

12 hours annually after first renewal date

Adjuster

Meet home state requirement, if none, must complete Mississippi requirement

Montana

24 hours biennially, including 1 hour on Montana law

Adjuster

Meet home state requirement, if none, must complete Montana requirement

Nebraska

Public adjusters are licensed as consultants in Nebraska.

24 hours biennially (21 general; 3 hours ethics).

Adjuster

Meet home state requirement, if none, exempt from Nebraska requirement

New Hampshire

Workers compensation & multiline claims adjusters: 20 hours biennially. Workers comp. adjusters must take 10 hours multiline and 10 hours workers comp. courses.

Public adjusters: 15 hours biennially. Must take only public adjuster courses.

Provider

Multiline or workers compensation adjuster: home state requirement or meet New Hampshire requirement.

Public adjuster: meet New Hampshire requirement.

New York

Public adjusters are licensed as a general consultant; 15 hours biennially. Independent adjusters do not complete CE.

Adjuster

Meet home state requirement, if none, must complete New York requirement

North Carolina

12 hours annually (property & liability lines).

Requirement must include 3 hours of flood taken within 2 years of 1/1/08 and every 4 years thereafter.

Provider

Meet home state requirement, if none, complete 12 hours of property casualty courses approved by home state or meet North Carolina requirement

Oklahoma

12 hours biennially, courses must cover the lines of insurance for which the adjuster is licensed

Provider

Meet CE requirement from any state where license is held

Tennessee

24 hours biennially

Provider

Meet CE requirement from any state where license is held

Texas

30 hours biennially, including 2 hours of consumer protection or ethics. 15 hours must be classroom or classroom equivalent, i.e., online course with security measures.

Adjuster, if requested

Adjuster licensed with LOC and no exam - complete CE from any state where a license is held. Adjuster licensed after Texas exam - complete Texas requirement.

Utah

24 hours biennially, including 3 hours ethics

Adjuster

Meet home state requirement, if none, complete Utah requirement

Vermont

Workers compensation adjuster (WC) attend 1 Insurance Department WC seminar per renewal cycle.

No CE requirement for property casualty adjusters.

Adjuster

Complete Vermont requirement

Wyoming

Public adjusters licensed as consultants in Wyoming.

All adjusters must complete 24 hours biennially including 3 hours of ethics.

Adjuster

Meet home state requirement. If licensed in a state that does not require CE, Wyoming will accept CE completed in any state where the adjuster is licensed but the hours must match the Wyoming requirement of 24 hours including 3 hours of ethics.

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the National Flood Insurance Program.

Conflict of interest is one of the most common ethical dilemmas adjusters face. According to Dan Kerr’s “Insurance Claims Adjuster—Adjuster Ethics,” a hotel manager in Beaumont, Texas was arrested for offering his adjuster $20,000 cash in exchange for a $125,000 insurance claim check on a loss of only $18,000 after Hurricane Humberto in 2007. In this situation, the claims adjuster did not accept the bribe and reported the incident to police; however, not all such situations are resolved this way. The New York State Insurance Department issued a news release on May 11, 2004, announcing the arrest of three claims adjusters who were indicted on insurance

fraud and related charges.

The individuals were unlawfully receiving illicit payments in exchange for enhancing vehicle damages and repair estimates totaling nearly $24,000. These situations are not uncommon, so it is no surprise that many states require CE courses in ethics.

Government officials also are realizing the benefits of continuing education. On September 25, 2008, Governor Arnold Schwarzenegger signed legislation addressing the new California Insurance Code section that establishes continuing education requirements for licensed adjusters. Effective January 1, 2009, the new law reads as follows: 14090.1. (a) An individual who holds an insurance adjuster license and who is not

exempt under subdivision (b) of this section shall satisfactorily complete a minimum of 24 hours, including ethics, of continuing education courses pertinent to the duties and responsibilities of an insurance adjuster license reported to the insurance commissioner on a biennial basis in conjunction with his or her license renewal cycle. (b) This section does not apply to either of the following: (1) A licensee not licensed for one full year prior to the end of the applicable continuing education biennium. (2) A licensee holding a nonresident insurance adjuster license who has met the continuing education requirements of his or her designated resident state.

Continuing education provides advantages to both the

claims adjuster and the consumer. CE designations often lead to career advancement, as many employers consider these designations when deciding to hire or promote individuals. CE also allows adjusters to be exposed to new ideas and helps to prevent burnout.

Consumers benefit from CE by receiving better service from knowledgeable claims adjusters who are upto-date with current industry trends and case law. CE certifications allow consumers to validate the expertise of their adjusters.

Continuing education is an essential building block—the cornerstone—of professionalism. To remain an expert in your field, you must maintain the skill sets necessary to meet the changing needs of the industry.

CLAIMS ADVISOR | WINTER 2009

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According to H.G. Kaufman in his book entitled Obsolescence and Professional Career Development, “Obsolescence is the degree to which professionals lack up-to-date knowledge or skills neces-

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sary to maintain effective performance in either their current or future work roles.” Because it is difficult to stay current on every aspect of your job at once, you run the risk that pro-

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fessional obsolescence may affect you at some point in your career. You owe it to your customers to maintain high levels of professional competence. Through careful planning, you will make

the most of every CE dollar and every CE hour and keep professional obsolescence at bay.

In addition to our professional obligation to remain knowledgeable so we can better serve our customers, we also have an ethical responsibility. A claims adjuster must have a variety of skills and be knowledgeable in many subject areas to be able to provide the best possible service to the insured.

Both the Society of Registered Professional Adjusters (RPA) Code of Ethics and the CPCU Code of Professional Ethics require that we maintain and improve our professional knowledge, skills, and competence continually.

CE is one way to fulfill that obligation.

Remember that some view CE as a burden, while others see it as an opportunity for growth. If you put off CE until the last possible minute, you are short-changing yourself.

Sure, you are getting CE out of the way, but what are you getting out of CE?

Take the time to examine your areas of competence and develop a plan for formal and informal professional education. Sit down with your supervisor or a mentor and take a hard, critical, and honest look at your skills, your company’s needs, and your career goals. Make sure that you do the following: • Begin by viewing CE as your own personal research and development • Focus on what will benefit your career • Link your learning objectives to your business objectives • Conduct a self-assessment of the skills your

clients or customers will need you to have in the next three years Use this information to develop your plan and then commit to that plan. If you do not plan your continuing education carefully, you will lose valuable time and money on top of not gaining the essential knowledge you need to stay competitive.

Document your plan in writing and keep it with your business plan or in your personal file. Focus the investment of your CE dollars and hours on those skills you will need to move forward with your career goals. Each time you participate in CE, put a copy of the course curriculum in the file.

Review the file at the end of the year and ask yourself if you’ve met your CE objectives. Also, ask yourself if you need to reassess your objectives based on changes in your life or changes in the marketplace.

Before signing up for a single CE course, you should determine your learning style. A learning style indicates the preferences you have for perceiving, conceptualizing, organizing, and recalling information. You can find tests online to help you determine your style, including this one at http://agelesslearner.com/assess/learningstyle.html. Once you have some insight into your learning style, use this information to make better choices when it comes to investing your CE dollars and hours.

Another aspect of adult learning is that we learn best when we can place information into a framework, preferably one connected to personal experience. When you place information into a familiar context (e.g., your work), that information takes on a greater degree of relevance and you can retain it more readily. Depending upon your CE objectives, you may want to seek out courses and workshops that teach material from a claims perspective.

There are, of course, costs associated with continuing education—but don’t let those costs deter you. Many companies provide financial support and incentives for continuing education. By carefully planning your CE

goals and aligning them with your company’s needs, you will be making a sound investment. When CE supports business objectives, companies are more likely to provide financial support in return.

Make the most of your CE dollars and hours by taking courses that support your objectives and match your style. Don’t just get CE out of the way—get something out of it. Remember, in today’s turbulent economy, continuing education is not a luxury; it is a necessity. cA

Donna Popow (popow@cpcuiia.org) is senior director of knowledge resources and ethics counsel for the American Institute for CPCU/Insurance Institute of America (the Institutes). She has responsibility for all aspects of claims education including the Associate in Claims designation program and the Introduction to Claims certificate program.

Wi n n i n g re s u l t s a n y w h e re , anytime...

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CLAIMS ADVISOR | WINTER 2009

25

Using

Struct Settle Reduce Costs While Meeting Claimants’ Needs

By Dennis Drexler

When resolving personal injury and workers’ compensation claims, structured settlements offer claimants a sense of financial security through the use of a customized benefit plan tailored to meet their individual needs. But beyond providing claimants

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with peace of mind, structured settlements also act as a valuable tool for claim professionals. By employing a structured settlement service to resolve personal injury and non-injury cases, claim professionals can reduce administrative and legal costs, cut the time

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it takes to settle claims, and avoid the risks associated with going to trial.

Structured settlements are an important tool claim professionals can use to enhance the negotiation process. For example, the use of a structured settlement can help bridge the

gap between a settlement offer and demand, create an opportunity in a deadlocked negotiation, and shift settlement discussions from cash to providing for a claimant’s financial needs on a long-term basis. Such settlements also expedite the removal of liability and

tured ements

CLAIMS ADVISOR | WINTER 2009

27

legal obligations from a defendant’s corporate books and transfers liability for future payments.

Using Structured Settlements Structured settlements involve the payment of damages to an injured party over time. Some settlements can result from voluntary arrangements, as in the case of a pretrial settlement or, when they involve a minor, they may be court ordered. Other structured settlements involve no litigation at all, although at least part of the settlement must be promised for payment at some future point.

The payments may be scheduled for any length of time, even over the claimant’s lifetime. Payments can be made according to

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the claimant’s needs, using a fixed schedule of periodic or life-time payments, installments (e.g. monthly, quarterly, semi-annual, annual or bi-annual), future lump sum payments, or any combination of installment and/or lump sum payments.

Structured settlements typically are used to resolve “qualified” cases, or those involving physical injuries that are exempt from taxation based on IRS law. Such cases can include claimants who are temporarily or permanently disabled, the guardianship of minors or persons with diminished mental capacity, claimants with limited financial management skills, severely injured claimants who may or may not have a shortened life expectancy, as well as wrongful death lawsuits.

Structured settlements

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Regardless of the type of claim, the age of an individual does not have a bearing on whether or not a structured settlement is offered. Many senior citizens find that structured settlements protect them from individuals who may prey upon them.

Children, grandchildren and great

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increasingly are being used to resolve “nonqualified� or taxable cases that do not involve a physical injury. Such cases can include nonphysical injury claims, employment disputes, wrongful termination, sexual harassment, discrimination cases, construction defect, attorney fees, punitive damages, environmental claims, property damages, and lottery winnings.

When considering both qualified and nonqualified cases, claim professionals should use the following guidelines to determine whether or not a structured settlement is appropriate:  • The loss amount is greater than $10,000 and there is an opportunity to defer some of the payments for three or more years • Anytime a minor is involved and the loss is greater than $5,000 • The claimant has concerns with security and would like to receive a steady stream of payments over a period of time • The claimant has concerns with managing a large sum of money • The claimant would like to shelter the settlement proceeds from future taxation on the earnings

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grandchildren also can be left a legacy for use in education, wedding planning, a down payment on a home, etcetera. Moreover, structured settlements are not subject to the volatility of the markets and payments are fixed regardless of market fluctuation.

Partnering with the Structured Settlement Specialist Structured settlement proposals require a team effort between the claim professional and the structured settlement specialist. The sooner the structured settlement specialist is brought into the claim, the better.

By forming a partnership early in the process, the claim professional and structured settlement specialist can begin to gather information and make an informed decision on whether or not the claim is a candidate for a structured settlement.

A meaningful structured settlement meets as many of the claimant’s needs as possible within the settlement range established by the claim professional. It is the claim professional’s knowledge of the claimant that allows the proposal to be designed to fit the needs of the claimant and his or her family. As such, the claim professional is responsible for defining each party’s role during the initial strategy sessions. Once those roles are clearly defined, the struc-

tured settlement specialist attends all settlement conferences, mediations and meetings the claim professional deems appropriate.

It’s important to note that structured settlement specialists are paid by the life insurance company upon the purchase of an annuity.

That means all services offered by the structured settlement specialist are free of charge, which can present claim professionals with an important source of cost savings.

One such service includes the securing of age ratings, a technique designed to maximize annuity payments for the claimant. The process involves submitting medical records to insurance carriers to determine a “rated-age� for the prospective claimant. Take, for example, an injury victim with a biological age of 12.

Upon review of the victim’s medical records, actuaries at the insurance company may feel that due to the severity of the sustained injuries, the child’s life expectancy is no longer that of someone who is age 12 but rather of someone who is age 30. As a result, the company offers to issue the annuity based on that “age-rated age,� which translates into increased monthly payments to the annuitant since the insurer has based the payments upon a shorter life expectancy.

Other valuable services offered

CLAIMS ADVISOR | WINTER 2009

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free of charge by structured settlement specialists include providing structured settlement proposals with periodic updates and changes, providing quotes from multiple life insurance companies to maximize the annuity payments and security for the claimant, analyzing economist reports for future damages, providing present value figures, and testifying as an annuitist at trial.

Workers’ Compensation Claims Qualified workers’ compensation claims also can be resolved using structured settlements. These cases include Medicare Set Asides (MSAs), total permanent disability cases involving wage differential, partial permanent disability cases with a value of $50,000 or greater, occupational disease cases, and permanent total cases, as well as disputed cases such as those involving stress or heart attacks.

The administration of workers’ compensation claims over the years has become increasingly more difficult and challenging to the claim professional. Even with jurisdictional changes within the statutes, the compensation laws still favor the injured worker.

Sympathetic arbitrators and administrative law judges continue to rule in favor of the injured worker.

Issues such as modified duty programs, medical treatment, rehabilitation, healthcare costs, ongoing temporary total disability payments, Medicare (CMS) involvement, and spiraling settle-

ments all are driving up the cost of workers’ compensation claims.

By utilizing a structured settlement, the claim professional and the structured settlement specialist can team up to produce a strategy which ultimately will save indemnity, medical, and expense dollars in the settlement of the claim.

Medicare Set-Asides As outlined by the Center for Medicare Services (CMS) and federal law, Medicare set-asides (MSAs) are the consideration of Medicare’s interest in the settlement of the medical portion of workers’ compensation and liability claims. The law is designed to protect Medicare’s interests in settling claims that may involve future medical expenses, and CMS has implemented strict and specific guidelines that must be adhered to in all MSA cases. Failure to abide by these regulations can result in harsh fines, other penalties, and legal exposure across numerous fronts.

Considering the complex processes, strict regulations, and harsh consequences for non-compliance involved with MSA cases, the use of a structured settlement can act as a key enhancement in workers’ compensation settlement negotiations. As such, claim professionals should consider using structured settlements for all MSAs that are valued at $25,000 and greater. Moreover, structured settlements offer the possibility of substantial cost savings by capping future known and unknown medical exposure and reducing the life of the claim as well as its associated legal expenses—all of which could add up to savings between 40 and 60 percent.

Overall, claim professionals can realize considerable cost savings and still meet the unique needs of claimants by utilizing a structured settlement. In addition to helping reduce administrative and legal costs, structured settlements can play a significant role in the negotiation process and achieve more timely settlements.

As time moves forward, structured settlements will continue to be

Arter InsurAnce Adjusters, Ltd.

ProPerty Damage

Homeowner ² CommerCial ² agriCultural

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President

Property General Adjuster P.o. Box 1245 salem, oH 44460 serving all of oH & western Pa

Over 20 Years Experience

an effective tool in settling physical injury cases, and will continue to expand its presence in nonqualified cases as well as in workers’ compencA sation claims.

office

330.332.9082 fax

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Dennis Drexler is president of Cambridge Galaher Settlements and Insurance Services, a subsidiary of Cambridge Solutions.

CLAIMS ADVISOR | WINTER 2009

31

Concerns That Can Arise from

Water Induced Losses

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s

by Richard Byrd & Jon Schatz

Both large-scale catastrophe-induced losses and small-scale single event losses have the potential to impact employees, individuals, insurance personnel, general contracting restoration firms and associated property loss. In addition to the actual water-loss event, secondary losses can become equally as devastating depending on pre-existing and/or event-related building conditions, and the role the insureds take as part of required catastrophe restoration activities. During the water loss event, all project-related information and environmental data generated is an integral part of the decision making process that may be disclosed at various stages to inform all the various parties involved with the project. All in all, a well-executed restoration project can minimize

the common delays and expenses of an ill-conceived and ill-managed project.

In the event of a water loss, an often overlooked aspect of the restoration is Asbestos Containing Building Materials (ACBM). Based on regulatory constraints, it is imperative that restoration contractors are made aware of the presence of ACBM prior to beginning restoration activities. The mere presence of ACBM does not require that abatement activities be implemented immediately. However, the improper handling of ACBM can lead to an exponential increase in the number and cost of claims unrelated to the initial water loss, but attributable to the restoration activities implemented in response to the water loss.

These claims and expenses can manifest themselves in both the short and long

term. Asbestos contamination caused by uninformed contractors and improper restoration activities can lead to the need for the removal and disposal of building materials, carpeting, furniture and other personal items that would not be affected by the initial water loss otherwise. That is an example of the potential short-term additional cost.

The health effects of asbestos exposure are well known and well documented.

Whether it is the restoration worker, building occupant or anyone that comes in contact with airborne asbestos fibers caused by the mishandling of ACBM, the potential for liability is present. The latency period for the development of asbestos related diseases (10 to 40 years) leads to the potential for future health related claims, and is an example

CLAIMS ADVISOR | WINTER 2009

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of the long-term potential costs. The potential for these additional costs is real and avoidable.

When initially investigating a claim that will lead to the disturbance of building materials present in buildings constructed before 1980, it is prudent to engage a qualified, properly trained Asbestos Inspector to complete an asbestos survey. In many states, a Licensed Asbestos Inspector is required to perform this work. In the case of water losses, an Asbestos Inspector with additional training and expertise related to mold investigation and remediation would be preferable. The Asbestos Inspector will develop a sampling plan and then sample all suspect building materials that potentially will be impacted during the restoration. In the unfortunate event that ACBM is present and will be impacted by the restoration, the sampling results will determine the

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proper response needed. A minor investment in time and the expense of an asbestos inspection will help to avoid major clean-up, replacement, and health related costs.

In addition to materials containing asbestos, mold growth is also an important concern following a water loss event. The difference between water damage and mold contamination is time, and the difference in the costs of addressing each can be staggering. Ideally, when water damage occurs, building occupants or the restoration contractor should act quickly to control the source of the water and limit the extent of the affected area. This first step is often one that does not get the attention it deserves. In many instances, the water damaged area is dried properly and mold remediation is conducted, but the problem recurs when the wind blows from the same direction during a heavy rain storm or when a storm drain

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becomes blocked again. The source of the water problem, whether it is water infiltration through the building envelope, condensation issues, or blocked condensate drain lines, must be identified and repaired to minimize the potential for repeated water damage claims.

Significant accumulations of water usually are removed from the facility using drains, pumps, wet/dry vacuums or any other available methods. Once this is completed, the extent of the water damage must be determined so that fans and dehumidifiers can be placed to maximize their effectiveness. There are several brands of relatively inexpensive moisture meters on the market that can simplify the process of delineating the water damaged area by detecting residual moisture in wallboard, carpeting or other building materials that are not readily apparent by touch. Current EPA recommendations state that building materials that are not thoroughly dried during 48-hours should be considered for removal and replace-

ment due to the potential for mold growth; however, this is only a guideline and there are numerous instances where the drying process took longer than 48 hours with no visible fungal growth and no measurable negative impact on air quality.

One common problem is that site representatives respond to the leak promptly and do all of the proper steps exactly as instructed, but stop before they are completed.

Sometimes it is as simple as not removing the vinyl cove base from the gypsum wallboard to allow for drying of this portion of the walls.

Other times file cabinets and other furnishings are not raised off the carpeting or moved away from the walls to allow for sufficient air circulation for those areas to dry thoroughly. The problem also could be that the affected walls are covered with vinyl wallpaper which tends to trap and hold moisture, providing a perfect environment for mold to reproduce.

Often these problems are not recognized until the drying equipment has been removed from the site, the insur-

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ance claim is finalized, and the area occupants begin to complain of allergic reactions and air quality problems.

Again, the key to avoiding these problems is in the use of experienced water damage inspectors and restoration contractors who have learned how to identify and address these problems. Some states have started to establish minimum training and licensing requirements for mold consultants and mold remediation contractors. Using these trained and licensed firms is critical to minimizing potential liability.

Sometimes, despite the best efforts, a moisture problem is not identified promptly. This often results in mold contamination either directly from the water damage or from prolonged elevated humidity in an indoor environment. This is when the use of an experienced mold inspection consultant is essential. It is true that most types of mold grow on building materials with high cellulose content, such as gypsum board, ceiling tiles, wood, paper, cardboard, and carpet tack strips. However, given the proper conditions, mold

can grow on any surface, using dust and even the oils in human fingerprints as a food source. Areas that retain moisture, such as wall cavities with interior insulation or sound proofing, insulated attic areas, or even wallpaper covering the wallboard can complicate the process of finding the mold growth and correcting the problem.

In general, if there is visible mold growth on the surface of a wall or ceiling, there will be much more growth inside the wall or ceiling cavity.

Finally, there is a tendency for some consultants, contractors and owners to spend too much time and money focusing on identifying the specific species of mold growing in the waterdamaged area. Most mold remediation projects do not need to become science research projects as well. There are literally thousands of species of mold in the outdoor air, any of which can begin to proliferate in an indoor environment under the proper conditions. A few of these species have been labeled as “toxic” or “carcinogenic”; however, scientific evidence is not conclusive, and there

is no federal definition of acceptable indoor concentrations of fungi in an occupied indoor environment.

It should be noted that all types of mold are potentially allergenic should a sensitive individual be in the area.

Current EPA recommendations state that any visible mold growth should be addressed using the same procedures, regardless of species.

Nonporous surfaces, such as hard wood, metal, concrete or plastic typically can be cleaned using commercially available detergent solutions.

Porous surfaces, such as gypsum board, ceiling tiles, carpeting, fabric, or paper products usually require removal and replacement.

Some people also focus on trying to kill the mold with a bleach solution and then just paint over the affected area, but this does not resolve the problem. Dead fungal spores are also allergenic, and the emphasis needs to be on the physical removal of the fungal growth from the indoor environment.

There have been specific incidents where one person in a large open office area was complaining of allergic reac-

tions while the other people in the room had no problems. In one such instance, testing in the area revealed elevated concentrations of airborne fungi that were eventually traced to a nearby pipe chase that had unidentified condensation problems.

In a similar situation, the carpeting in one portion of the office was found to have high fungal concentrations, likely resulting from roof leaks that were not properly addressed.

Every building will experience various types of water damage. It is how the owner responds to these situations that determines whether a simple water damage claim spirals into a major mold cA remediation project.

Richard Byrd (richard_byrd@ efiglobal.com) is a district manager for EFI Global. He is a licensed asbestos inspector, project designer, and management planner, as well as a certified mold remediation supervisor. Jon Schatz (jon_schatz@efiglobal.com) is a senior project manager with EFI Global. He is a certified environmental specialist, and a licensed asbestos inspector and project designer.

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Estimates Unveiled: 36

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Their Differences, Secret Meanings, and the Devil in the Details

By Bradley D. Sharp, BA, AIC

A credible estimate is critical in determining the proper amount to pay on a claim.

If you start with a bad estimate, the indemnity and expense of the claim can be higher than necessary.

Protect a Valuable Asset Claims adjusters can lose their credibility from the start of the claim negotiation process with a thoughtlessly prepared estimate. Conversely, erosion of credibility also may be suffered if opposing experts’ reports demonstrate a more thorough understanding of the platform and assumptions used.

We all have heard the saying “garbage in, garbage out� and the same holds true for estimates. Not many years ago, handwritten esti-

mates detailed the amount of material with factors applied for different types of labor.

This was a subjective way of writing estimates. With the advent of computer estimates, careful inventory, diagram, and measurements provide estimate input which results in a more objective and accurate end product. Pricing within the programs is researched and supplied by experts who gather and verify such data.

They essentially have made writing an estimate less labor intensive. But beware; it also can mean faster but less accurate estimates.

Understanding the Process The purpose of the estimating platforms, such as Marshall Swift Boeck,

Xactimate, Simsol and others, is to provide a means to enter necessary elements of the repair process and derive a quantification of the value of the work. Successful end products depend on organized methods and approaches to inventorying the repair process necessary to return the structure to a pre-loss condition.

These companies employ expert researchers who survey contractors and suppliers across the country to determine current market conditions. Through their research, a body of information about the costs of each line item is assembled and verified so that within the estimating engine accurate pricing is available across the country. This does not relieve the adjuster from knowing if there are particular localized materials or labor price fluctuations.

The first and most important step to writing a good estimate is to properly

and thoroughly identify the necessary scope of loss. This is not to be confused with the estimate, but is simply an itemization of what needs to be repaired. Some items require little sophistication to identify, such as drywall, paint, or carpet. Knowledge of repair methodology, technology in the mitigation industry, and construction materials is what separates a logical and defendable scope from one that is illogical and indefensible. Spend some time either in trade magazines, including engineering and construction disciplines, or on the Internet looking at products and methods available on the market.

Other sources of information are material wholesalers and service providers. Also, make sure the quality level of the components being inventoried is known. It may be necessary, for example, to have carpet sent to a lab to determine the weight, weave, composition and

CLAIMS ADVISOR | WINTER 2009

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other details so you can use an accurate material price in your estimate. If a unique item needs to be priced, additional research or assistance may be necessary.

Negotiation can be more effective if one process at a time is addressed. When addressing a construction process, negotiating an agreed scope of loss can be accomplished more easily without the pricing attached.

This can be done by a joint inspection to review the scope of loss in a text format. Once the scope is agreed upon, apply pricing to the scope. When entering the pricing, look for duplications. For example, when an adjoining wall is involved, it is unnecessary to calculate the linear footage of that wall in both rooms. Doing so doubles the cost of framing the adjoining wall.

Understanding Line Items Each of the scope lines becomes a line item in the estimate. It is imperative to understand what is included in the work process of the line item selected. If the particular unit processes

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are dissimilar, the pricing should be different. If there is a significant difference between your estimate and the one you are reviewing, and they are both on a computer platform, request an estimate printed with line item descriptions. If you are deadlocked over pricing and both parties want to come to a resolution, be methodical when approaching the other party to identify the points of disagreement. If scope has been agreed upon and the disagreement is over price, line-by-line review of the estimate can be helpful.

Understanding what is included in the line item price is the first step in deconstructing the source of disagreement through line item detail. Of course, this assumes the price or details were not being edited for dodgy reasons. There should be an explanation for any pricing modifications.

Part of the editing process involves placing the process in the proper trade category.

This typically is found with items like mask and tape.

If this isn’t included in the line item process, a selection

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between drywall or plaster work vs. painting should be made so a trade breakdown of the estimate includes the price in that trade segment.

An example of the effect line item descriptions have on the scope of loss is drywall replacement. Some estimating platforms provide line items that include sufficient steps to provide a wall ready-to-paint from the selection of only one line item.

Some, like a total component system, allow for an accurate estimate for varying degrees of installation, but several line items must be selected in order to accurately depict all the steps necessary to bring a replacement wall to a pre-loss condition. If the estimating engine provides one line item that provides a finished wall, the line item description may look like the following: To replace wall drywall ½” thick, taped, textured and ready for paint.

If the estimating platform is a total component database, the necessary line item descriptions would look like the following:

Replace drywall ½” Manufactured, preformed sheets used for interior finish construction; includes 1/2” drywall (gypsum board, blueboard, etc.), tape, joint compound, sanding and sandpaper, nails, corner bead, and installation labor. Includes 6% waste.

There are many circumstances where material prices fluctuate between database updates. Although the databases often are updated on a quarterly basis, some significant price changes may occur in the interim. Shingle prices often inflate after a large-scale hail storm or hurricane. Copper prices and steel prices have increased steadily, however scrap copper prices have fallen recently. The steel price increases are due to rising demand and energy prices.

Estimating platforms have editing windows that allow for such price fluctuations.

You can edit the material or labor price in the line item.

To reflect this change, or override, a notation should be made in the line notes. If you are challenged because of a perceived inadequacy of your estimate, you can show verification of your price.

If you find your estimate was based on inadequate costs, the line can be edited to reflect the price fluctuation and you can recalculate your estimate.

Figure 1 demonstrates decreasing the productivity rate or hours per unit by 30% because of a loss in productivity. If work must be performed at a height greater than the 8-10’ wall height assumed, it will take more hours per unit. If there is an increase in the price of material, that can be adjusted in

this function. If scaffolding is necessary, an additional line item for it should be added.

Where there is increased difficulty in performing the work, think through the conditions for each trade. If the walls and ceilings must be replaced, then the demolition, replacement, masking, finishing and lighting fixtures would need productivity rates evaluated. An accurate estimate considers all factors necessary to complete the job. Notations on the estimate indicate the things accounted for, and the estimate may not be challenged.

If price is challenged, the assumptions should be apparent for proper resolution of any estimate discrepancies.

Variations in labor rates come from union or non-union labor rates or a lack of skilled workers. Most programs allow you to select closed shop (union) or open shop (nonunion), thus factoring in this labor rate variation. It is necessary to understand the labor conditions in the area and job you are estimating.

Comparing estimates from different platforms Not every item necessary to estimate a building may

be available in a computer estimating program. Be familiar with some of the printed construction cost guides including RS Means, National Construction Estimator, etcetera. These resources include many items and have volumes specific to electrical, mechanical, excavation, and interior finishes among others. There are square foot estimates for items such as electrical or mechanical systems within these guides. Square foot costs in some computer estimating programs may not be as accurate because of a lack of specificity. The printed guides tend to give more accurate square foot pricing through variables in quality and building type.

If the estimate presented is divergent from your own, a line-by-line or trade breakdown may identify the areas of disagreement.

If you have not received a trade breakdown in an estimate prepared on one of the computer estimating platforms, request one. If the estimate is from a general contractor, a breakdown by trade should be available. Computer estimates based on the same

Figure 1

Replace Drywall, Wall 1/2� Taped original

new

Hours Per Unit

0.0220

0.0286

Labor Rates Per Hour

$34.50

$34.50

Labor

$0.76

$0.99

Material

$0.47

$0.47

Equipment

$0.00

$0.00

Other

$0.00

$0.00

Total

$1.23

$1.46

Labor Rates Per Hour

scope and assumptions of difficulty should not have a significant difference. A difference of plus or minus 10% is not unusual.

Be a valuable asset With these basics in mind, understanding and use of computer estimating platforms is limited only by curiosity and willingness to explore the programs. Make careful notes and photographs to refer to during the development of the estimate. When assumptions or changes are made to the unit pricing of the estimate, know why they are made. If the estimate presented has line items or entire trade categories that are significantly different than what you have estimated, you now have the tools—with some additional research of your own—to know

where to find the difference. Carefully prepare the scope of damage to produce an estimate that is precise and detailed, not garbage. It can be difficult to defend or negotiate from a garbage estimate. If there is a disagreement over the cost of the work, let the other party be guilty of providing garbage.

Protect your credibility with detailed and carefully documented work. When your work is challenged, you can enter negotiations with confidence and a sound understanding of the scope of the project you are discussing. cA Bradley D. Sharp, BA, AIC specializes in complex and litigated commercial property claims for GuideOne Insurance headquartered in Des Moines, IA.

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Becoming Irreplaceable Fabric Restoration Providers Adapt to Needs of Insurers

By Jim Nicholas

During the last several years, fabric and textile restoration cleaners have adapted and tailored their services to meet the needs of the insurance industry. As claims professionals have come to rely more heavily on the services of these specialty cleaners after incidents of fire and floods, the companies that offer these cleaning services have become more adept at working closely with adjusters after a catastrophe. The capabilities for saving time and money for the insurers while also exceeding the expectations of policyholders have made restorers indispensable to many carriers.

For claims in which clothing

and other fabrics and textiles are affected, adjusters now tend to call on the services of restoration specialists immediately.

As this niche of the drycleaning industry has matured in its work with insurers and their policyholders, specialty cleaners have been able to learn and adapt in order to streamline their services and avoid potential fraud or abuse that could add unwarranted costs to claims. While the potential for serious and substantial fraud involving the fabric restoration portion of a claim is somewhat limited, savvy and experienced specialty cleaners are able to help ad-

justers discern and eliminate questionable and suspicious items or ploys by policyholders. By documenting and reporting every aspect and item involved in each claim, these cleaners help claims professionals provide important and immediate services to the policyholders in their time of need while also lowering claim payouts for the carriers.

Documentation is Paramount As with most aspects of claims investigations, documentation of the loss site and the items to be covered under the policy is crucial to the effective use of restoration cleaning services. The

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best and most experienced operators now use several methods to document their work, starting—most importantly—with thorough onsite inspections and photography.

The work begins with the complete photo documentation of the loss site, so a timely response to the site is very important. By photographing the outside of the home/building as well as the rooms, and especially the closets and furniture that contain clothing and other fabrics, the specialist is able to chronicle the overall conditions and extent of the damage.

The next level of photo documentation at the loss site during the initial phase involves the expensive bigticket items, which typically include furs, leathers, window coverings and area rugs. With these items, an extra level of onsite inspection and documentation is necessary. For example, rugs could have stains that have set in underneath already and may have nothing to do with damage related to the incident. These stains, and any flaws from previous wear and tear that are unrelated to the incident at hand, must be documented with close-up photos at the site before the items are packed out for cleaning. In addition, rugs and other high-end items should be measured at the site to guard against any claims of shrinkage that may be posed by the policyholder after the restoration cleaning.

For expensive furs, which range into the thousands and even tens of thousands of dollars but normally deteriorate over time, the best restoration specialists will conduct a thorough onsite inspection, preferably in the presence of

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sun damage over time that creates a yellowing effect, and the fibers become dry and brittle. However, most owners tend not to notice, so they could become disappointed with the condition of the items when returned after being thoroughly cleaned and restored. It is imperative for these and the other high-end items to be inspected extensively and photo-documented before they leave the premises.

policyholders. They should ensure that the pelt is not dry and fur is not flaking off, check the lining, and thoroughly review the condition of the garment. Again, documenting everything with photography whenever possible as well as using detailed notes, logs and forms helps to guard against any potential for future disagreements with the policyholder.

Window coverings also are greatly susceptible to discoloration and other issues through normal wear and tear that may not be noticed by the policyholder. Drapery often gets a great deal of

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Working with the Policyholder It is important for fabric restoration cleaners to understand how to interact with and service the needs of the policyholder who has experienced the loss. Due to the nature of the business, these individuals are under a severe amount of stress and strain as they regroup and recover from a devastating fire or flood that has caused a major disruption in their lives. By working closely with them and maintaining the highest standards of professionalism while also communicating all of the important considerations involving the specifics of the items to be cleaned, experienced restorers are able to help avoid potential disagreements or questionable claims.

The process begins by establishing and expediting an emergency order of items that the home/business owner needs returned as soon as possible. In most cases, these items are casual clothes and undergarments.

By cleaning and returning these items within 24 hours, as the best providers are now offering, policyholders gain a great deal of confidence in the capabilities and follow— through of the cleaner.

For items with wear and tear damage unrelated to the incident, it is always best to show the condition of the item to the policyholder in advance and ensure they understand that the cleaner is going to use its best effort to restore it as much as possible.

Once the initial investigation and documentation at the loss site is completed, it is important for the cleaners to conduct the pack out and removal of all of the items to be cleaned in an organized and professional manner.

For example, using plastic garbage bags for the damaged items that are being removed for cleaning would serve the purpose, but they send the wrong message to the owner and create the impression that the garments are being treated as garbage. The most experienced and resourceful restoration cleaners use reusable and durable cloth or vinyl bags to avoid creating the wrong impression and to help preserve the environment.

Some policyholders will call a restoration cleaner to return to the site and remove additional items that they indicate require cleaning.

This occurs fairly regularly, and it is incumbent upon the cleaner to determine whether this addition to the restoration portion of the claim is valid and legitimate. The cleaners certainly can miss items that require cleaning, but sometimes items that may not belong to the insured or were not actually damaged in the incident suddenly materialize.

Experienced restoration cleaners are able to determine if it is likely that the additional items are indeed covered under the claim.

If they become suspicious that a customer is attempt-

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ing to add items to the claim which may not be covered, they will alert the adjuster immediately. However, in many cases a return visit to the site and an inspection of the items in question with the policyholder present can help to determine whether they are indeed eligible for restoration cleaning under the claim.

For example, the insured may mistake clothing left in drawers at the site of a fire to be damaged with smoke odor and in need of cleaning. The best restoration specialists understand that these items may or may not be contaminated with smoke odor, depending on the circumstances and the level of exposure. However, in order to accurately gauge whether these garments and other fabrics indeed have developed smoke odor, they

must be brought outside of the premises and into the outdoors. The odor of the soot and smoke from the fire inside of the structure prevents odors from being spot checked on these items while they are still inside, but clothing in closed drawers is somewhat protected and may already have been properly inspected and determined by the restoration specialist to be odor free.

It also is important for the restoration specialist to personally return the cleaned items to the policyholder whenever possible. This allows the cleaner to present and discuss any issues with the items directly. Keep in mind that in cases of severe house fires and major catastrophes, the return of the items could take many months or even up to a year due to lack of space in the

temporary housing of the insured. The restoration specialist with personal knowledge of the order can answer any questions that may arise at delivery. If there are structural changes to the home, draperies may no longer fit on the windows; or perhaps remodeling included a change in flooring and the drapes no longer hang at the proper length. The restoration specialist can point out that the changes are due to the construction and not to any distortion of the drapery itself. In addition, any items that were not able to be restored to their pre-loss condition can be reviewed with the policyholder so that a final claim settlement can be made. This ensures that only those items deemed non-restorable by the restoration specialist are included on the final loss inventory.

Finally, it always is wise to have policyholders complete a brief survey regarding their level of satisfaction with the restoration cleaning services that they received.

The results should be shared with the adjuster who handled the claim—it is important that adjusters know these results and are reassured that they can continue to depend on the cleaner to provide superlative services to their policyholders.

The best and most experienced restoration cleaners have adapted their procedures for working with the insurance claims professionals and helping them to accurately forecast and determine their reserves while also reducing the additional living expense payouts of a claim. The immediate turnaround in the initial emergency order often greatly eliminates much

of the need for replacement clothing. Also, by meticulously cataloging every item and creating a highly detailed and itemized inventory sheet for the adjuster and the policyholder within a few days, the cleaners are able to create accurate figures for the restoration or replacement of every item.

These detailed inventories often can entail hundreds and even more than a thousand items, and the information they offer enables adjusters to quickly set their reserves and close the file.

The detailed inventory of high-end items should be completed onsite as part of their close inspection, but the comprehensive inventory should include the pertinent details about every single item. It should be prepared by the cleaner within several business days.

For insurance claims resulting from catastrophic property losses, the reality is that it costs less and often makes a great deal more sense to clean and restore clothing and other fabrics rather than replace them.

This has made restoration cleaners irreplaceable. As the insurance industry continues to call on these specialty cleaners, their level of customer service and attention to detail in meeting the needs of both the claims adjusters and the policyholders will continue to grow. cA Jim Nicholas is president of FRSTeam, one of the largest fabric restoration franchises and providers in the country. For additional background information or to contact Nicholas, visit www.

FRSTeam.com or call 866374-FRST (3778).

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Investigating H

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g Negligent Hiring Claims An Investigation of the Investigation

By Kyle Roehler, Esq.

Negligent hiring claims can make anyone feel like he or she has fallen down a rabbit hole and landed in Alice’s Wonderland. At first, they appear nonsensical. For example, when a customer was attacked in her home by a fired employee of an electronics service company, she did not sue her assailant.

Instead, she sued the assailant’s former employer. The assailant gained access to the home by holding himself out as a current employee of the electronics service company.

The customer claimed the electronics service company had a duty to give her notice

of the attacker’s separation.

Her claim survived summary judgment.

According to a 2003 USA Today report, 79% of negligent supervision resulted in plaintiffs’ victories. The average settlement for these claims was $1.6 million. In the Internet age where anyone can collect mountains of information on almost any subject imaginable, juries expect more and more from employers’ investigations of prospective employees.

Thus, negligent hiring claims must be taken seriously.

Here we’ll look at the evi-

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dence a claims professional should consider collecting to properly evaluate a negligent hiring claim.

Differing Forms of Negligent Hiring Claims Sixteen states have addressed negligent hiring in legislation, and almost every state’s common law recognizes at least some of the forms of negligent hiring. The primary forms of negligent hiring include: • Traditional Negligent Hiring. It arises from the failure to screen employees properly, resulting in the hiring of an unfit employee because either: (a) the employee has a history of violent or criminal acts, or (b) the employee lacks sufficient skill to perform the job duties that give rise to the claim.

• Negligent Retention/ Supervision. It is an extension of negligent hiring. It is based upon an employer’s continuing obligation to monitor its employees’ fitness.

• Negligent Training. It

•

arises from an employer’s failure to ensure the employee has the requisite skills to perform job tasks through continuing education.

Negligent Entrustment. It relates to injuries caused by an employer that “entrusts” an employee with an instrumentality that the employee is unfit to operate.

Regardless of the form taken of a particular negligent hiring claim, the basis for liability is generally the same.

Liability arises when: (1) an employer knew or, in the exercise of reasonable care, should have known, (2) its employee was unfit for the job or to perform a particular task, and (3) as a result of the particular unfitness of the employee, (4) a coworker or third party suffered injury.

The Investigation of the Investigation Is the employee’s bad act an intentional or criminal act, or is it simple negligence?

The nature of the employee’s

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of the Claims Adjuster

Newton’s Laws of And the Physics Motion of Fraud Is Less More? Protecting Medicare Interests

act necessarily will play a significant role in the direction of your investigation.

When the bad act is intentional or criminal, your investigation must focus upon what a reasonable screening process would have revealed about an employee’s criminal history, civil record, or propensity for violence. Evidence of this type includes: • Criminal records: The employee’s record at the time of hire and at the time of the incident are both relevant because of the potential for a negligent retention claim.

• Civil records: A propensity for violence can be reflected in domestic orders of protection, restraining orders, or child endangerment actions. When the criminal act is fraud or some other similar nonviolent criminal act, a history of civil suits of the same nature is relevant.

• Observations of Coworkers: Coworkers’ statements are critical.

Coworkers sometimes observe an employee’s violent propensities on the job. Coworkers also share details of their personal lives in lunchroom discussions, and know details about each other’s personalities. If the employee is quarrelsome, quick tempered, or has a problem with drugs or alcohol, you can expect such evidence will be discovered in litigation.

When the bad act at issue is simple negligence, the employee’s criminal record or propensity for violence is less relevant, and his qualifications are more

important. Investigating an employee’s qualifications is discussed below.

What are the employee’s job duties?

What a reasonable screening process will include is based on the job the employee is hired to do. What a jury will expect from the screening process for a restaurant dishwasher, who has limited contact with others or access to valuable property, is different from what it will expect from the screening process of an armored car guard/driver. Oftentimes, the potential an employee has to cause harm to others is not readily apparent. For example, an automobile mechanic might have limited contact with customers, and, therefore, one might conclude a jury would not expect an extensive screening process for that job. On the other hand, a poorly qualified mechanic who works on braking systems can pose a serious risk of harm to the customer. A mechanic may test drive vehicles to diagnose problems and to determine the success of a repair. Thus, a mechanic with a poor driving record or a history of substance abuse can pose a threat of harm to other drivers. Evidence of job duties includes:

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•

•

•

Written Job Descriptions or Want Ads: The focus should be on the specific job task the employee was performing at the time of the claimant’s injury. If the employee was expected to perform that task frequently, the jury will expect that the employer examined the employee’s fitness to perform that task.

Performance Reviews: In addition to providing evidence of a particular employee’s fitness, the criteria on which an employee is evaluated sheds light on what is entailed in performing the job.

Insurance Applications or Schedules: If an employee is included on a list of scheduled drivers or operators of equipment, it follows that the employee is expected to operate the equipment at issue.

Are there legal or regulatory standards applicable to the work? How does the employee stack up?

It seems virtually every job has an educational minimum, a required license, voluntary license, or some other industry certification.

Maintaining the licenses and certifications often requires continuing education or retesting to ensure compliance with industry performance benchmarks. With the proliferation of licenses and certifications, juries expect employees to have available certifications or licenses, even if the certifications are not legally required. Government regulations sometimes impose mandatory alcohol or drug testing for certain

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Negligent hiring provides a claimant substantial strategic benefits including: Creating Liability for a Deeper Pocket

The Employer: Ordinarily, an employer is not liable for the intentional torts or crimes of its employees. However, if the employer knew or should have known of an employee’s propensity to commit a tort or crime, it may be liable for negligent hiring or retention of the employee.

Providing Coverage for an Otherwise Uncovered Tort

Many liability policies exclude intentional torts and/or criminal acts from coverage. However, liability policies may provide coverage for a claim based upon the employer’s negligence in hiring or retaining an unfit employee who commits an intentional tort or crime.

Providing a Foundation for Punitive Damages

Even though an injury may be the product of an employee’s simple negligence, nevertheless the employer may be liable for punitive damages when the employee was obviously unfit to perform the injury-causing task and the employer exhibited conscious disregard of the employee’s unfitness.

Opening the Door to Embarrassing Facts

When negligent hiring is asserted, facts related to the employee’s background and how the employer operates its business are relevant. Embarrassing evidence that might not be admissible in a traditional negligence case can be admissible in a negligent hiring case.

jobs. Information regarding licenses, certifications or regulations applicable to a job can be found through: • Professional Associations & Unions: Professional associations frequently participate in the regulation of licensed members. They can tell you what licenses are available, the requirements for obtaining the license, and any continuing education or testing obligations for maintaining the license. Professional associations can also apprise you of the

•

particular governmental regulations applicable to the job. In some instances, professional associations address consumer complaints or impose discipline.

Federal & State Agencies: Governments frequently issue professional licenses. Furthermore, the Missouri Division of Professional Registration provides licensing support to 39 professional licensing boards and commissions regulating hundreds of different trades. Other states have similar agencies.

Does the employer have relevant hiring/firing policies? Were the policies followed?

In those instances when the employer has a hiring/firing policy, it sometimes fails to follow its own policy. For example, the employer will contact only one reference when the company policy calls for three. The employer will give a driver a third chance, even though company policy is to discharge drivers with two speeding tickets. Obviously, a thoroughly documented hiring process is best, and the more sophisticated your insured employer, the more a jury will expect of it. Relevant evidence includes: • Employee Manuals • Human Resource Manuals • Job Descriptions or Want Ads • Disciplinary Records for the Employee at Issue • Meeting Minutes Discussing the Employee’s Performance or Job Tasks The intention is to determine if: (1) the employer collected all the information required

by company policy at the time of hiring, (2) the employee had the qualifications required by company policy, and (3) the company held the employee to the stated standards of performance.

Is there a Negligent Training Claim?

On the job training, including safety training or training related to the proper operation of equipment, occurs on almost every job. The most important training information relates to training provided to the employee for the injury-causing task.

However, this does not mean all other training provided to the employee is irrelevant.

Being able to show the employer provides thorough training in general can go a long way to convincing a jury that the employer is safety conscious and, there-

fore, not guilty of negligent training.

Training is an area in which there is a tremendous amount of regulation. It is critical to identify what the applicable minimum training standards are and compare them to the training provided to the employee.

Negligent training evidence includes: • Governmental or Industry Training Regulations • Employee Training Logs or History Reports • Training Meeting Agendas • Training Meeting SignIn Sheets • Testing Results for the Employee at Issue Was the Employee Unfit or Dangerous?

The injury-causing employee must be scrutinized closely not just on his record, but on the impression he/she

will make on the jury. Even a qualified employee can pose a serious threat of a plaintiff’s verdict. If possible, it is helpful to meet the employee to evaluate the intangibles that affect credibility. It also is helpful to obtain the general perceptions of the employee from coworkers’ statements.

When trying to evaluate the employee, the key evidence includes: • Employee Appearance • Application and Resume • Performance Reviews • Disciplinary Record • Drug and Alcohol Testing Records • Psychometric Testing Record • Training Records An investigation of a negligent hiring claim is designed to establish what the employer knew or should have known at the time of hiring,

at the time of entrusting an instrumentality, or at the time of assigning a job duty.

After a thorough collection of the evidence, a good barometer of the potential risk a case poses can be established by asking a relevant hypothetical question such as: “would I be comfortable allowing that employee to drive my son or daughter to school?” or “would I be comfortable allowing that employee into my unattended home?” or “would I be comfortable working around that employee while he was using that potentially dangerous instrumentality?” cA

Kyle Roehler, Esq., is a shareholder with Foland, Wickens, Eisfelder, Roper & Hofer, P.C. based in Kansas City, MO. He can be reached at kroehler@fwpclaw.com.

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By Ian Cunningham

Direct Repair Programs, or DRPs, ideally offer auto insurers a greater degree of control over the claims process than situations where one is not present. As the programs have matured, however, shops have developed divergent views of such programs—ranging from supportive to combative. Additionally, legislation in numerous states is looking closely at the DRP practice to determine legal compliance. Faced with growing governmental pressure, consumer pushback, and mixed press, insurers are reexamining DRPs to ensure their claims handling processes are the best reflec-

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tion of today’s realities.

DRPs have many advantages, but they are not the best solution for every insurer, every place, or every time. The real issues revolve around cost control, customer satisfaction, and reduction of cycle time. Insurers need to seek innovative alternatives that can provide many of the advantages of DRPs without the disadvantages.

Strong in Theory, Complicated in Reality General consensus places the inception of the DRP sometime in the 1970s as a perk Allstate Insurance offered to its policyholders.

The original intent was to create a prescreened network of shops which could be relied upon to do quality

work in a timely manner.

As DRPs have spread and evolved, they have become more complex; now they include agreements on rates, the types of parts that can be used, and other operations which had been the domain of the collision repair expert.

DRPs give carriers several advantages such as controlling costs and supporting strong service advantages for their customers. Under the right circumstances, they allow the insurer to command results from the shop in terms of cycle time, quality and savings. DRPs also add stringent key performance indicators (KPIs) that are measured monthly to ensure the advantages to the insurer are being met by the shop.

A major drawback,

Quick Look C

DRPs have advantages but work best in areas where insurers have high customer density.

C

Most insurers do not allocate sufficient resources to managing their DRPs.

C

States are passing anti-DRP laws.

C

A Web-based repair referral program offers a quality alternative to traditional DRPs.

C

Advantages include generating more leverage by combining insurer efforts, reducing the amount of oversight needed, and offering consumers greater choice and control.

Repair rams

natives in Today’s Market

though, is that a DRP works well only in regions where the insurer has many customers. They work best as a partnership, which means they need to be perceived as mutually beneficial on both sides. Shops need enough volume from the insurer to make it worth their while to comply with DRP rules.

If only a few jobs are being sent every month, there is little incentive to play by the rules. Customers in those areas where there may be less volume still want and deserve good service; if they don’t receive it, they will find another carrier.

Another downside is that running a professionalgrade DRP takes a real commitment by the insurer— time has proven they cannot run on autopilot. It is the insurer’s job to stay on top of monitoring and managing DRP shops and their results.

A majority of insurance company executives believe their company is managing the DRP program properly, but that is not always the case, especially if there is no uniform measurement of performance. Managing the DRP is often an add-on to existing duties rather than a position unto itself.

They also can cause political problems for insurers. A number of states have passed anti-steering laws, and more are considering new or stronger legislation. Tales of consumers being forced by an insurer to use a particular shop and getting poor treatment or shoddy repairs have reached legislators’ ears. Many lawmakers and insurance regulators feel the DRP concept easily can be abused.

Insurers may find themselves facing the shut down

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of DRPs in some states or, at least, greater restrictions on how they can be run.

Luckily, changes in consumer behavior and the implementation of Webbased technologies can help pave the way to a bright future for the handling of auto claims.

Changing Consumer Habits Help Point the Way Consumers seek, share, and store information in new and ever-changing ways. For example, according to a study released in May of this year by independent research firm Common Knowledge Research Services, texting has become a mainstream communication mode with over 55% of consumers using text messaging. This is a rapid adaptation of a relatively new technology.

Every day, consumers are integrating electronic methods of exchanging information into their daily lives. They search online for information, read peer reviews, and send e-mails by the billions. Today, claims processing barely scratches the surface of available Web-based tools.

Carriers need to utilize the Web and other technologies to close gaps ranging from customer service to overall claims monitoring.

Currently, the systems used to handle claims are either custom-built or piecemealed together from various external sources; yet few take advantage of the power of Web-based solutions.

Consumers want access to information 24/7, they want to access it on their terms, they want to view their claim’s progress, and they want to be able to evaluate based on peer re-

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views as well. A Web-based service offers solutions to each of these requirements.

As consumer expectations for technology utilization increase, meeting and surpassing those expectations becomes a strong differentiator—as well as a competitive advantage—in the marketplace.

Be a Hero in Your Customers’ Eyes Customer service is the lynchpin of any program.

When insureds are in accidents, they often do not know where to go to get their cars repaired, or even how to go about doing it.

There is a great deal of confusion: Are they responsible for getting estimates? Do they need more than one?

Will there be pushback on cost estimates they submit to the insurance company?

How can they find a quality shop? The list of potential consumer questions goes on and on. This is one of the times when insureds look to their companies most— seeking guidance as well as information. It is also when insurance companies find themselves in the delicate position of helping their insureds without being interpreted as steering them.

During an active

claim, the insurer has to make good on the promises of its policy. The quality of the customer experience makes the difference in whether the company keeps a customer or does not. Utilizing Web-based technology is a solid solution for ensuring a smooth, customer-centric process.

J.D. Power’s insurance report from August 2006 notes that a consumer is twice as likely to switch companies because of poor claims service than because of rates.

Here is an example of how Web-based technology can direct and support

the consumer side of the auto claims process. When an insured has a claim, the claims representative lets the customer know about an option allowing them to choose a repair shop online.

If the customer opts in to the system, each step of the claims process becomes automated for the claimant. First, an independent appraiser is assigned to inspect the vehicle, take pictures, write an estimate, and upload the estimate and photos of the damaged vehicle to the Web. Then, the customer is notified via e-mail or text message that his estimate is posted for review, and that local body shops will be

submitting cycle time proposals for the job.

Consumers easily can review the shops interested in their business. Once they login to a secure portal, they can find additional information about the shops, ranging from rental car policies to accreditations. They also can read reviews of individual shops from previous users. This helps them make informed decisions without calling all around town. It allows for an apples-to-apples comparison in an easy-tofollow format.

Once the repair is completed, the vehicle owner fills out a brief survey about his or her experience. Being part of a peer-to-peer community helps further engage insureds, which is crucial for retention. This type of system positions the insurer as technology-forward without additional investment in infrastructure. It allows for automation of all aspects of the repair process through a central hub, and makes insureds active participants in the process—creating a win on all sides for the consumer.

This type of program also helps with cost control because costs are shared between carriers and body shops. It also enables a reduction of cycle time because the Web-based process moves along automatically, keeping the job on track.

It’s All About Leverage A Web-based system can offer something that a traditional DRP cannot: leverage.

Because many different insurers use the system overall, the system itself will have clout with the participating shops. This way, if there is a claim in an area where volume is low, there is

a direct benefit from the collective power of everyone’s claims. The shops are happy with the amount of business coming in the door, a low-volume firm is treated as one of the “big guns” in an area, and the customer can count on a process where he is treated well. And, because of the inherent automation, little oversight is necessary.

Servicing the Customer The roots of a DRP are all about control, but control doesn’t always equal results for consumers. For instance, one major national insurer has a highly controlled DRP, but when J.D. Power surveyed consumers on the quality of their repairs, the resulting ratings were poor.

By contrast, the Webbased solution provides a framework that allows both the insurer and repair shop to service the customer to the best of their abilities.

This type of Web solution appeals to consumers as well. They are used to accessing a broad range of products and services online.

By putting them in the “driver’s seat” and boosting their involvement, their satisfaction increases.

DRPs have their pros and cons, but they don’t work effectively in every place for every insurer.

Carriers need strong alternatives, and a Web-based solution offers a way that’s uniquely suited to the 21st century. cA Ian Cunningham is CEO of Scene Genesis, a technology company in Pittsford, New York, serving the auto insurance and collision repair industries. He can be reached at icunningham@ scenegenesis.com.

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An Insuran

fo

Enterpri Outsourcing to a SaaS or Hosted Backup Site Supports Disaster Recovery Strategies

By Jason King

Avoiding hardware and system failures due to natural and manmade disasters can be made easier by using new technologies such as enter-

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prise content management (ECM) solutions. With ECM, insurance carriers and agencies can ensure that policyholders get the service they

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need through several deployment options, including • Deploying entirely via software as a service (SaaS), allowing the

solutions for storing documents and automating processes to be housed in a completely outsourced, redundant,

nce Policy

or

ise Data •

•

and secure data center.

Incorporating a hosted solution into the disaster recovery strategy for an in-house ECM solution, allowing the system to be backed up at regular intervals to a hosted repository that acts as a hot site in the event of an emergency.

Deploying a warm site, allowing backup media to be stored at

the service provider and loaded onto a live server when a disaster is reported.

Disasters have a tendency to bring out either the best or the worst in people. How people handle themselves during difficult times communicates a lot about their true nature. Similarly, policyholders will judge insurers by how they react when the

worst happens. Because the business model is built on the policyholder’s trust that an insurer will be there in a worst case scenario, losing documents or failing to maintain operations can cost much more than simply lost data. A business continuity plan that leverages secure online technologies to protect enterprise documents and data can maintain business continuity, customer

satisfaction, and a hardearned reputation while avoiding additional liability or regulatory findings.

Unfortunately, there are multiple kinds and levels of disasters that can prevent access to policyholder data and affect a carrier’s ability to provide service, including natural disasters, hardware/ system failure and manmade disasters. Natural disasters are often the first scenario

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considered thanks to vivid media footage of flood-ravaged communities, towns torn apart by hurricanes and tornadoes, and neighborhoods being evacuated as wildfires come closer, resulting in loss estimates in the billions of dollars.

However, the National Archives and Records Administration (NARA) estimates that less than one percent of data loss is attributed to natural disasters; the greatest vulnerability is the infrastructure trusted to protect data. The NARA estimates that 78 percent of data loss is caused by hardware or system failure. Many organizations rely on the integrity of their backup solutions to create recoverable copies of their content, but too few perform a system restoration on different hardware to ensure that it is effective.

When the effectiveness of database backups are first tested, many organizations find that they have issues which would prevent full recovery. These are not incompetent organizations that lack skill or resources.

Incomplete, insufficient or otherwise failed backups can result from seemingly routine (and advisable) actions, such as the installation of operating system service packs, newer versions of backup software and agents, database software, or virus detection software.

Manmade disasters may be the most difficult to protect against. From massive devastation such as terrorism or destruction that affects an entire region, to malicious actions by an individual in a single data center, data stored onsite is vulnerable.

Offsite media storage is an

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option, but the potential for theft or loss associated with transporting data has been widely publicized.

SaaS, Hosted Systems Support Business Continuity Many insurance carriers are evaluating SaaS and other hosted ECM strategies to ensure that policyholders get the service they need, whether that is in response to a widespread disaster or an agent’s need for immediate retrieval of a policyholder’s documents related to a minor claim.

One option is to deploy ECM technology entirely via SaaS, which means that the entire solution for storing documents and automating processes would be housed in a completely outsourced, redundant and secure data center. With the same functionality as a premises-based solution, a SaaS solution is available via a standard Web browser. In the event of a disaster that closes a location, users still have the opportunity to sign into the system from another location. In addition to world-class validation and recovery, an outsourced data center is physically secured against unauthorized access, reducing vulnerability to internal sabotage.

Insurance carriers also can opt to incorporate a hosted solution into the disaster recovery strategy for an in-house ECM solution. For instance, an ECM solution can be backed up at regular intervals to a hosted repository that acts as a hot site in the event of an emergency. If a carrier’s physical location is not functional, authorized users simply would have to access the online repository to maintain

immediate business continuity. Depending on the level of risk, some companies opt for a warm site, which means that backup media is stored at the service provider and loaded onto a live server when a disaster is reported.

Though less expensive, this option has a somewhat longer recovery period.

Regardless of whether a carrier chooses to use an outsourced data center for SaaS or for disaster recovery, the service provider should be able to provide the following: • SAS 70 II audit - Developed and maintained by the American Institute of Certified Public Accountants (AICPA), SAS 70 is an audit of service providers that can impact the control environment of customers. A Type II audit is preferable to a Type I audit because, in addition to a list of controls, it also includes the auditors’ tests and opinions on the efficacy of the controls.

• SysTrust certification - A SysTrust audit evaluates and tests system reliability. It measures availability, security, and integrity. Service providers with this certification will be able to produce an auditor’s report.

• File-to-file replication – Most replication technology copies blocks of data, a method that increases the likelihood that any corruption will be replicated at the backup site. A solution that automatically replicates new/changed files and monitors data synchronization between the sites will provide the safest and most reliable failover site.

•

•

Database validation – Hosting providers periodically should run through the actions taken during an actual server failure, including restoring the database to a different server.

Tests should be run to verify that the data has been successfully and completely restored, the media is readable, and the database itself is free of internal errors.

Geographically disbursed locations – Regardless of how much redundancy a primary data center has, even the most hardened site is susceptible to a major disaster. A host-

•

ing provider should be able to assure availability by providing multiple locations for storing data reliably.

Industry expertise – Whether engaging a SaaS or a disaster recovery services provider, insurance carriers should work with ECM specialists that understand the insurance industry and its processes and have a track record of experience with the technology. This expertise, combined with a willingness to listen to the specific needs of an individual company, will ensure

•

that the proper balance of functionality, compliance, and budget is maintained.

Vendor independence – Particularly in a SaaS environment, insurance carriers need to ask about exit and migration strategies.

If the SaaS is using an industry standard software solution, insurers have the flexibility to move the solution in-house if they wish. Documents stored in their native formats (e.g. Microsoft® Word, Excel®, PDF, JPEG, etc.) will be easier to access and migrate if the relation-

ship with the SaaS provider sours.

There is no single technology that instantly will solve all of the challenges of disaster recovery, business continuity, and risk mitigation. However, a growing number of insurance carriers are evaluating how outsourcing ECM functionality to a service provider can increase control and reduce risks. cA Jason King is director of financial services for Hyland Software, Inc., the developer of the enterprise content management (ECM) software suite OnBase. Mr. King can be reached at (440) 788- 5000 or jason.king@onbase.com.

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Best Prac

for Mobile Machinery Claims

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www.claimsadvisor.com

By David Shillingford

As much as $1 billion of mobile off-road equipment, such as that used in construction and farming, is stolen each year. This is due to the lack of physical security on equipment and at worksites as well as the ease with which stolen off-highway equipment can be sold since it is not titled and registered.

What may be more of a concern for insurance com-

panies is how seldom stolen equipment is recovered.

Compared to auto recovery rates that have consistently been above 60% in recent years, equipment recovery rates, although hard to measure accurately, are as low as 10%. Worse yet, due to poor record keeping, recovered equipment that was previously the subject of an insurance settlement sometimes does not get returned to the insurance

company. In the case of damaged equipment, values assigned to a machine often are incorrect because the machine data is incorrect.

But there is some good news. The industry recently has taken steps to address many of the issues that relate specifically to equipment claims, primarily through the Insurance Services Office and the National Insurance Crime Bureau. Adjusters who know

ctices

e y

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how to maximize the use of industry-wide systems such as these are ahead of the competition and make life riskier for equipment thieves.

Here are a few of the techniques and resources used by the industry’s most successful adjusters: Serial Numbers Like the VIN of an auto, it’s all about the serial number when it comes to equipment.

This is where many of the problems lie. In many cases, an adjuster will receive a notice of loss that either does not have a machine serial number or has an incorrect or incomplete serial number. There are two things an adjuster should do: 1. Become familiar with the most common serial number formats. Given that 80% of losses are from less than ten different makes, this is not too difficult.

2. Ensure that the machine is reported quickly and correctly to ISO’s ClaimSearch.

Correctly means that it is flagged as Construction Equipment (CE), Farm Equipment (FE), or Mobile Off-Road Equipment (MO). This information will be filtered to the National Equipment Register (NER) database where an equipment expert will quality control the serial number.

(See resources side bar for more information and a free technical equipment guide.)

What if the owner says that he does not have a serial number? He should, but if he insists that he does not, the adjuster either can advise the policyholder to call

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the person that he bought the machine from or he can make that call himself. If it was a dealership or auction company, good records generally are kept. If this does not produce a result, use the resources here to find an expert who will use industry databases to research the machine. A better ”best practice” is to address the missing serial number issue before the theft occurs.

Before The Theft It may seem obvious to say that policyholders should record the serial numbers of their valuable machines accurately, but in practice it is not so easy—particularly if a blanket insurance policy is in place. Note also that equipment owners often will assign and stencil their own inventory control numbers to a machine. This is usually not the serial number and may be why they do not record the serial number. The challenge is to get underwriters to understand the importance of having policyholders record their serial numbers (a minor challenge), and then to persuade insurance agents and policyholders of the genuine value—to them—in recording serial numbers (a major challenge). One method that many equipment insurers use is to offer a deductible waiver for policyholders who pre-register their fleet on the NER database. To do this across an entire book of business is a long term project but, in the short term and at the very least, an insurer should have this discussion with a policyholder after a loss has occurred. That is something a claims adjuster can initiate even if loss prevention or

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underwriting actually offers the advice.

Proof of Ownership Proof of ownership generally is harder to establish than it is for an auto loss because off-highway equipment is not subject to mandatory titling and registration.

Although unlikely, it is possible and not illegal for an insured to have little or no documentation. The first step is to ask for a Manufacturers Statement of Origin (MSO). The challenge here is that these are not issued universally, nor is it mandatory to retain one—but it’s worth asking for all the same, even if just to demonstrate knowledge. The next step is to ask for a bill of sale and, if in doubt, call the listed seller. A signed statement from the insured may be the best documentation that an adjuster has. If reported correctly to ClaimSearch, an NER analyst also will run the serial number against millions of ownership records as an additional check.

Year of Manufacture A common mistake in equipment loss reports is an incorrect year of manufacture.

Unlike auto model years, an equipment model may be produced for a number of years. For example, a machine made in 2006 that is sold in 2007 may sometimes be recorded as a 2007 machine. While this may not have a major impact on value, greater variations in year of manufacturer will. It is important to confirm the year of manufacturer using the serial number and industry resources.

Customer Service One area that can influence

client retention and should be improved is the interface between claims, loss control and the policyholder. After a theft, an insured not only is upset but also is more receptive to constructive advice about theft prevention or safety. For example, following an equipment theft claim, a ”theft response” package that gives practical theft prevention and safety advice should be offered to the policyholder. This demonstrates to the policyholder that the insurer understands the challenges and wishes to help. As this might vary from project to project, it is good to provide a broad range of advice; this also allows the template to be standardized.

Loss prevention also may include information about security products, particularly when an insurer is able to negotiate a discount for policyholders.

An insurer should bear in mind that, as noted above, equipment is relatively easy to steal, so the fact that a policyholder had a machine stolen does not necessarily mean that he is a bad risk. He may be, but this should not be assumed. One benefit of constructive contact with a policyholder is that his response to this advice may help to assess future risk.

Help Law Enforcement to Help You Although an officer is likely to call the NICB and be able to run the serial number of a suspect machine against the ISO, NICB and NER databases, the first place that an officer will go is the National Crime Information Center (NCIC). The claim will have a police case number, but has the loss actually been

Resources entered into the NCIC? If it is in the NCIC, was the serial number entered correctly?

Finally, on settlement of a claim, has a letter of the insurer’s interest been sent to the reporting agency?

Hire An Expert In addition to the resources listed here, there are many independent adjusters who have significant expertise in handling equipment claims.

A good source of information on such people and companies is the National Truck & Heavy Equipment Claims Council, whose member adjusters have been vetted for subject matter knowledge.

Good claims adjusting is a competitive advantage for an insurer both in terms of increasing recoveries and customer retention.

This is particularly true in equipment claims given the huge chasm between the best and worst practices—not only between companies but sometimes within a company. It often is said that experience and subject knowledge are the overriding factors in a good claims adjuster. Increasingly, however, the knowledge and effective use of external resources is a critical factor; a good adjuster may not know the answer, but knows who to ask. cA

Insurance Services Office (ISO) – all types of equipment losses should be reported correctly and quickly to ClaimSearch. Training in equipment reporting can be provided by WebEx. Contact Info.claimsearch@iso.com.

Internet – there is a wealth of information about equipment on the Internet. Some good Web sites are www.machinerytrader.com, www.ritchiewiki. com, www.tractorhouse.com, www.CE.com, www.constructionequipmentguide.com, or the manufacturer’s Web site.

National Equipment Register (NER) – ClaimSearch members can call the NER at any time during a claim to get technical advice from an NER equipment analyst or to order a free technical equipment guide: 866-663-7872 or info@NERusa.com: www.nerusa.com

David Shillingford is the founder and president of the National Equipment Register, a national database of stolen construction equipment and equipment ownership. For more information, visit www. nerusa.com

National Insurance Crime Bureau (NICB) – investigative leads and suspect claims should be flagged to the NICB: 800.447.6282. www.NICB.org.

National Truck and Heavy Equipment Claims Council (NTHECC) – association of independent adjusters that specialize in truck and heavy equipment claims: www.nthecc.org

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Temporary Housing Special Section

There’s No Place Like Home Like Dorothy said, “There’s no place like home.” But when a

client’s home is either demolished, damaged or unlivable, where do you turn? Here, in the new Temporary Housing Special Section, we give you a closer look at some of the industry’s temporary housing service providers.

Temporary housing service providers were invited to provide information about their companies to help you determine the best options for your needs. The following in no way implies endorsement of their products or services.

Assured Relocation Assured Relocation always keeps focus on the company’s core value—customer service to the adjuster and policyholder—one claim at a time. Over the past five years, Assured Relocation

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Temporary Housing Special Section has been able to capture a market of informed insurance companies, which recognize our commitment to service and price, and keep us busy with repeat business. We are service performers.

At Assured Relocation, we want each and every adjuster and insured to know that we aim for the highest possible level of service. We are only as good as our last claim.

Assured Relocation operates its claims process with a single point of contact.

This is what’s best for the adjuster and policyholder.

The service is seamless and a claim completed with continuity and competence with one relocation specialist handling it from move in to move out. We care.

Temporary Accommodations

This extreme level of pride in service demonstrates why our company is the leader in providing temporary housing to the insurance industry.

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How a qualified ALE partner can make your work life easier?

Every good adjuster has a team of trusted vendors they rely on to give the best possible service to the policyholder as well as make their jobs easier. That team should include contents specialists, contractors, and temporary housing vendors.

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Studies have shown that when temporary housing goes well the claim goes well. Since this is the first “touch point� with the customer where your company can service the policyholder, it can start the claim off in a very positive or very negative direction.

Your ALE vendor can make the policyholder feel special, well taken care of and relieved at a very stressful time. This special treatment reflects back on their carrier. Or, with the wrong vendor partner you end up adding stress to your policyholder without even knowing it.

When the policyholder needs you the most.

At Temporary Accommodations (TA), we focus on customer-centric

advertorial

service while finding the most cost-effective like, kind and quality housing in record time. Our policyholders give us a 94% customer satisfaction rating while our adjusters give us a 96% score. We are proud to be a trusted partner for our adjusters.

Our teams of experts are hired to meet a caring, compassionate and detail-oriented profile.

Many of our professional staff have gone through disasters themselves including hurricanes, tornados, and most recently a manager experienced a fire. We know how to handle a distraught policyholder, hold their hand and assure them of quick, easy solutions. With TA, you as the adjuster can

Temporary Housing Special Section

advertorial

be certain that with one call to our 24/7 hotline you can move on to the next claim or work on the rebuild confident that the temporary housing needs of your policyholder are solved. Whether it is finding long-term housing quickly and close to home or meeting an immediate need with our hotel program, TA takes great pride in assisting people in need.

Short term immediate assignments don’t scare us.

With our enormous hotel volume, we have buying power across all U.S. hotel chains. We do not use travel agencies and therefore can negotiate the best noncommission rates, and we follow up to get the sales tax returned

on stays of more than 30 days. Because that call for a hotel can and will come in the middle of the night, we put the stay on our own credit card not on your company or on the policyholder. It’s simply one easy call to Temporary Accommodations and your policyholder is in a hotel and fast. And, we will even send you one convenient invoice—no chasing down hotel folios and disputing charges.

Temporary Accommodations has the experience to help you with all your claims.

At Temporary Accommodations we are always looking for ways to make a difference for our adjusters. We are con-

stantly developing customer service programs some of which include: Elite Adjuster No two adjusters are alike so we personalize our services to fit your unique business preferences. Your TA profile will include all your information so that you spend less time during the claim process on the phone or on e-mail. We will contact you the way you want to be contacted and we know how you want your claims handled. Your Elite Adjuster team builds a trusted relationship with you for your peace of mind—your claim is taken care of. And, our Web portal gives you access to all your claims online in real time.

STAnd Guard™ With the proliferation of identity theft, Temporary Accommodations proactively developed a program to secure policyholder and insurance carrier information in our possession. STAnd Guard™ is a complete security program developed to protect each customer’s valuable and sensitive information. The program includes security plans for data—both electronic and print— background checks on all employees, firewall protected and hacker proof physical storage, security officers on site, and an audit twice a year.

So the next time you have a need for temporary housing, make sure

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Temporary Housing Special Section you choose a qualified vendor like Temporary Accommodations to make your life easier. Our team makes the difference for you and your ALE policyholder.

Temporary Housing Directory Temporary Housing Directory is building customer relationships- one innovation at a time!

Temporary Housing Directory (THD) knows that in today’s hectic working world it takes more than expertise, cost savings, and great customer service to win over clients.

Innovation and flexibility are equally as important

as the bar continues to rise for companies that are service-oriented businesses which rely on clients that outsource their needs.

This is especially true in the temporary housing industry since most insurance companies have continued to pursue their need for more innovation and service branded delivery systems.

Tackling the needs of the insurance companies has changed beyond the basic needs of just offering affordable pricing and a variety of housing options.

Temporary Housing Directory’s success stems from drilling down to their customer needs and delivering even more than is expected.

To the surprise of many insurance companies, outsourcing their temporary housing services has not only proven beneficial to their bottom line, but has saved their adjusters valuable time and drastically improved overall customer service. In order to do this “one has to be more than just flexible on the types of housing choices that are given to their policyholders but also be innovative in their ideas,” says Teresa Vidger, president of Temporary Housing Directory.

“We have to continue to think of new ways to make our services unique and beneficial to our customers in order to separate us from the herd,” says Vidger. “It takes a special commitment and talent to merge these ideas into a format that will work productively and economically for our client. We have found that we, as a company, constantly need to be innovative and technically flexible in order to succeed.”

Most recently this has involved THD’s need to design a reporting system that best communicates with their adjusters in a fashion that is easy to use and always available. By THD creating the adjuster portal, it has filled that request and demonstrates THD’s passion in delivering tools for their customers which reflect their flexible and innovative approach. The adjuster’s portal has also helped the communication lines between THD and their

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insurance adjusters. The need for adjusters to get state of the art technology to help assist in the tracking of their insured’s claim process has become increasingly important. Through this system, the adjusters can print invoices, request information, grant extensions, give notice of payment, and view reports to show billing history. These system functions have enabled insurance adjusters to stay in front of the insured while on top of every aspect of the claim status.

In addition to better communication, the adjuster portal essentially creates a virtual office for the insurance adjusters. Many companies are going green to help in the fight to better our environment.

The portal gives adjusters the ability to manage their files online without having to worry about paper.

Temporary Housing Directory has also been innovative in their ability to deliver when most companies are limited in terms of housing or hotel solutions during a house fire or a catastrophe. They are also one of the few companies that do not charge additional fees for hotel stays even if they do not place the policyholder in long-term housing. This is another innovative change brought on by the need to provide more value-added services to their customers at no additional cost.

Temporary Housing Directory has also shown their innovation when it

At this very moment,

This AdjusTer is TAking cAre of his displAced policyholders.

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CLAIMS ADVISOR | WINTER 2009

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Temporary Housing Special Section comes to housing options.

Not everyone wants to stay in the same type of housing solution or has the same type of need.

Having the expertise to find different solutions is crucial. Oftentimes, the adjuster needs a solution that is not a typical housing choice and wants their housing company to provide furniture or alternative accommodations like an RV or trailer rental.

Finally, THD knows that it is important to remove the complexity in doing business with the insurance housing industry. “The key is listening to your customer’s needs, and then creating flexible and innovative solutions to match the way they do business,” says Vidger. The industry continues to change and their ability to keep up, and even ahead, has made Temporary Housing Directory a leader in the insurance housing industry.

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Unknown

3%

No 6%

Yes 91%

does your company actively pursue implementing best practices?

Best Practices—a phrase that some have heard one too many times. For others, it evokes a challenge: How can I do my job better? For claims professionals, the need to increase knowledge and efficiency is not a trend but an ongoing component of the job. Nobody understands the need better than you. Does your company get it? Are they consistently pursuing better ways to serve the client and keep the company profitable?

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Ever forget to do something? Well, then you must be human.

But how can you get better control of your life in 2009? Why not give Re:Snooze a try. If you’ve ever emailed yourself something just to keep it in mind, this may be the solution for you. Re:Snooze is good for remembering to: visit Web sites, make a phone call, pay a bill, make an appointment, follow up on something, etc.

www.drop.io

Free, Private, Online File Sharing Drop.io is a free, online file sharing service that provides users with a simple and private way to share images, video, audio, documents and other digital media. Just type in the URL you’d like to use, upload your files, set password/privacy settings, and share the URL with others. There’s no registration cost or limit to the number of URLs that can be created.

www.nctc.gov/docs/ct_calendar_2009.pdf

Annual Counterterrorism Calendar In case you didn’t receive yours in the mail, you can download the 2009 edition of the Counterterrorism Calendar in a PDF format. Sponsored by the National Counterterrorism Center, this daily planner has been published since 2003 and contains information on terrorist groups and wanted terrorists. Hmm… we’re not sure how cool this really is.

Reach your audience by

advertising Reach new or experienced adjusters Connect with your target audience.

National distribution of over 20,000 claims professionals - Our readers seek the best for their clients.

No guess work - Grow your market share.

You simply reach the right people with the right message.

If this quarter’s Pulse Poll is any indicator, the answer is a resounding “Yes!” with 91% of respondents confirming that their company actively seeks implementing best practices.

For the other 6-9%, what are you waiting for?

Take this month’s Pulse Poll online at www.claimsadvisor.com

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GET YOUR MEDIA KIT AT

www.claimsadvisor.com/advertise

the commish

The Commish: Spotlight on Insurance Commissioners This issue: Steve Poizner, California Insurance Commissioner California Insurance Commissioner Steve Poizner was elected to office on Nov. 7, 2006. He is responsible for regulating all insurance sold in California and overseeing the nearly 1,400 insurance companies and 280,000 agents licensed to do business in the state. Poizner earned a bachelor’s degree in electrical engineering from the University of Texas and an MBA from Stanford University.

Insurance companies have a multitude of responsibilities, fiscal and otherwise, but perhaps the most essential role they play is to pay the legitimate claims of policyholders. At the end of the day, delivering on the product sold to the consumer is fundamental to insurance companies’ core performance and overall brand value.

With fire season effectively having become a year-round concern in California, the number of those who suffer losses and file claims regretfully has continued to increase. Like any business, it is important that insurance companies periodically assess their operations. In the case of insurers, the claimshandling process is one of the most important business functions. And it is important that the Department of Insurance ensures that these processes are as fair, reasonable and expeditious as possible.

Less than two months after the 2007 Southern California wildfires, I convened a first-of-its-kind roundtable meeting with CEOs and top executives of leading insurance companies. The goal of this meeting was to streamline and expedite the claimshandling process.

After gathering first-hand feedback from fire survivors at a series of Insurance Recovery Forums hosted by the California Department of Insurance, I brought this group together collectively to examine ways to improve the claims handling process. After reviewing the data and analyzing the existing processes, I personally called upon insurance companies to comply with a number of proposed reforms. I was pleased that a number of companies voluntarily adopted the reforms.

Among the better practice changes were expedited processing of Additional Living Expense payments, as well as automobile and debris removal claims (particularly in the event of a total loss); billing leniency for fire victims in disaster areas; and inventory process simplification. These claimshandling practices recognize the realities of wildfire disaster

recovery—consumers need support immediately, and especially following a total loss, it is not conceivable that their residences will be replaced within four months. Some fire survivors lose their insurance renewal notices, which can result in victims losing their insurance coverage for nonpayment of premium.

The process is smoother for all involved if insurers accept recognizable, non-company inventory lists that are reduced for itemization in a total loss. All these reforms make the process more responsive to consumers’ needs.

A great deal of progress clearly is being made with regard to the claims process. After the 2003 wildfires there were 870 complaints filed with the Department of Insurance.

Four years later, after the 2007 wildfires in Southern California, that number fell to 568. This showed great improvement on the part of both insurers and the department in getting tough cases resolved. And given the reforms adopted last year, I believe the number of complaints after the 2008 wildfires will be even lower.

It is essential that insurers provide customers with fast, caring service. Delivering on this promise is even more imperative in the wake of a disaster. I am pleased with the progress made so far and look forward to working with the industry to identify ways that we can collaboratively do even more on behalf of consumers.

NEXT ISSUE: In the Spring 2009 issue of Claims Advisor, we’ll take a look at Coverages from every angle. New stories, new authors and new feedback from readers make every issue a must for every adjuster. Don’t miss it!

Be sure to fill out an online subscription, or update your existing account, to continue receiving Claims Advisor. go to www.claimsadvisor.com/subscribe

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interview

What makes you tick?

Claims Adjusters have one of the most interesting and demanding jobs in the insurance industry. Here you get to tell us about the job and how you make it part of your life.

What prompted you to become an insurance

that they have a top notch claims handler.

adjuster?

I was hired as an assistant to the VP of Claims and found that every day brought a different challenge in terms of loss type as well as insureds, claimants, field adjusters and attorneys.

I was looking for a career that would maximize my natural investigative skills, common sense, and ability to read people and come up with creative ways to resolve conflict. Preparing for and passing the adjuster test in no way prepares you for the real world. Fortunately, I have the ability to “hit the ground running” and, upon receiving my adjuster’s license, was entrusted with million dollar commercial property and liability losses with million dollar umbrella policies in 22 states and Puerto Rico.

How do you deal with the stress of the job?

If you are organized, or have a sound diary system, you have eliminated 50% of your stress. Personally, I am a songwriter and musician, so I spend my free time working on new material.

What strategies have you employed to manage your e-mail?

Make your e-mail work for you. I agree with the adjuster who advised reading the e-mail once and handle it then. There are occasions when doing so is not possible, so I prioritize my diary so that the issues in those e-mails are handled later.

What type of adjuster are you? (e.g. inside or outside, auto, property, workers’ compensation, etc.)

All-lines property and casualty staff adjuster. In my opinion, “alllines” is becoming a harder adjuster to find. I have found most of my contemporaries are one or the other. There is even a perception in some areas of the country that personal lines and commercial lines are two different disciplines and that adjusters have to be somehow “specialized” in one or the other.

How long have you been in the business?

Twenty years

What type training do you feel would help you perform more efficiently?

Ongoing training and mentoring. It seems when the industry gets tight, monies for training are the first cut from the budget. But there are many opportunities for free seminars put on by various vendors and law firms. Networking through claims associations. Having senior adjusters paired with younger adjusters for some one-on-one training in the office environment. Exposure to lines of business that you may not be currently handling. All these ideas have been the foundation of my training which helps to keep me efficient in my work.

Can you explain a recent problem with a difficult customer and what strategies you used to ‘win

If you could change one thing about your job,

the day’?

what would it be?

As a supervisor, I get many calls where the customer is upset, wants to vent and tries to blame the adjuster for their frustration. First thing that I teach my adjusters is to be “the question person”, not super-adjuster with all the answers. I ask the caller for their name, then their claim number. I ask them who their adjuster is. These questions help the caller to focus on the true purpose for the call. I find it is harder for people to vent and answer questions at the same time. Asking questions shows you are trying to connect with them and it also helps to diffuse the sometimes scattered anger. I ask the caller: How can I help you today? I then repeat the words back to them to confirm my understanding. I don’t make heroic promises, nor do I encourage the caller to call anyone again except their handling adjuster. This helps to encourage my adjusters that I back them as professionals, and it also affirms to the caller

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I have the perfect job. I attend mediations, examinations under oath, court hearings, and the like. I am able to work from home and on the road. It takes a high amount of discipline to accomplish the work/ results that I provide to our Carrier, but I enjoy the flexibility and the challenges. I am able to contribute to the Company’s bottom line by actively participating in claims and litigation strategy. I feel like more than “just an employee”, I am part of a great team. ―Susane S., Senior Claims Examiner/SIU

Would you like to be the next “Interview”?

Go to www.claimsadvisor.com/interact and tell us about you.

write

by Gary Blake

Claims Writing Checkup Does your department need to revisit claims writing training in 2009? Good writing saves time and money for you and your company. Here’s a simple way to find out if your or anyone on your team needs to fine tune their writing skills.

Take the Claims Writing Checkup and see if it’s time to get back to basics.

1. How many hours a week do you spend writing claims letters, e-mail, and other documents? ____ a) Less than 5 hours ____ b) About 5-10 hours ____ c) More than 10 hours 2. How long has it been since you had any type of writing training? ____ a) Within the last 2 years ____ b) Within the last 4 years ____ c) More than 4 years ago 3. When you have to write a letter, how long do you feel “blocked” before you start: ____ a) I start immediately. ____ b) Sometimes I puzzle over it for 10-15 minutes. ____ c) At times, I sit and stare at the computer for more than 20 minutes before actually starting.

4. If you bring your letters or other documents to someone for review, how pleased are you with the results? ____ a) Very pleased. It’s quick and I agree with the corrections. ____ b) Somewhat pleased. I’m not always sure why something is being changed. ____ c) Not pleased. The person reviewing my documents either puts the thoughts into his or her own words or doesn’t fully explain what I have done wrong.

5. Do you use a definite outline or organizational pattern when you write a letter of more than a few paragraphs?

10. How would you rate the length of the sentences and paragraphs in your letters? ____ a) Just about right ____ b) Some sentences and paragraphs are lengthy. ____ c) Some sentences and paragraphs go on too long.

____ a) Yes, most of the time. ____ b) Once in a while. ____ c) Almost never: I just let it flow.

6. How confident are you in your own punctuation and grammar skills?

Scoring your answers:

____ a) Very confident ____ b) Somewhat confident ____ c) I’m sometimes unsure if I’m using the right punctuation mark or if I’m using proper grammar.

If you answered “B” or “C” up to three times, you probably are not in immediate need of writing training.

If you answered “B” or “C” from four to six times, you should consider some type of claims writing training within the next 12 months

7. Overall, how would you rate the importance of writing as a claims competency?

If you answered “B” or “C” more than six times during the audit, you probably need to make claims writing training a priority for yourself –or for your entire department.

____ a) Very important ____ b) Somewhat important ____ c) Not that important 8. Have you ever seen a situation in which writing caused a claims professional embarrassment, angered a claimant, or even was part of a bad faith lawsuit?

Take the Claims Writing Checkup online at

____ a) Never ____ b) A few times ____ c) I’ve seen it happen a lot

www.claimsadvisor.com!

9. Is your writing authoritative? ____ a. Yes ____ b) Somewhat. Sometimes it’s a bit vague. ____ c) No, it often has lots of “weasel words” that are vague.

Gary Blake is director of The Communication Workshop. He is also an author and presents seminars on effective business writing for claims professionals. Blake may be contacted by visiting www.writingworkshop.com or e-mail at garyblake@aol.com.

CLAIMS ADVISOR | WINTER 2009

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Event

2009

2/11/2009

1/18-23/2009

National Association of Catastrophe Adjusters

2009 NACA Convention, Lori Ringo, naca@bacatadj.org, 817498-3466, Riviera Hotel & Casino, Las Vegas, NV, www.nacatadj.org 1/25-28/2009

Windstorm Insurance Network

2009 WIND Conference, Program Committee, info@windnetwork. com, 850-473-0601, Rosen Centre Hotel, Orlando, FL, www. windnetwork.com 1/25-28/2009

American Bankers Association

ABA Insurance Risk Management Annual Conference, Marisa Broka, mbroka@aba.com, 800-226-5377, Hyatt Regency Bonaventure, Weston, FL, www. aba.com/Events/IRM.htm 1/29-30/2009

Florida Association of Self Insurance

FASI 2009 Winter Conference, Jessie Laux, 800-226-3274, Orlando Marriott Lake Mary, Lake Mary, FL, www.fasi-fl.org 2/4-6/2009

National Association of Mutual Insurance Companies (NAMIC)

National Association of Independent Insurance Adjusters (NAIIA)

NAIIA Southeast Regional Meeting, Marty Brown, assist@ naiia.com, 479-444-6304, Doubletree Paradise Valley Resort, Scottsdale, AZ, www.naiia.com 2/17-20/2009

Reinsurance Association of America

Restoration Industry Association (RIA)

National Association of Insurance Commissioners

Central Jersey Claims Association Monthly Meeting, Donna Bradshaw, dbradshaw@litsol.com, Mercer Oaks Golf Course, West Windsor, NJ, www.centraljerseyclaims.com

NAIC Spring Meeting, NAIC Meetings Department, meetingsmail@naic.org, 816-7838100, Manchester Grand Hyatt, San Diego, CA, www.naic.org

2/26/2009

3/19/2009

NAIIA Southwest Regional Meeting, Marsh Gentry, 210-3423036, Royal Conference Center, Corpus Christi, TX, www.naiia.com

Central Jersey Claims Association Monthly Meeting, Donna Bradshaw, dbradshaw@litsol. com, Mercer Oaks Golf Course, West Windsor, NJ, www. centraljerseyclaims.com

3/1-3/2009

Eastern Claims Conference

Atlanta Claims Association Luncheon, John Bobo, 678587-9262 ext. 104, Maggiano’s Little Italy, Atlanta, GA, www. atlantaclaims.org

21st Annual Combined Claims Conference, info@combinedclaims. com, 888-811-6930, Westin Long Beach, Long Beach, CA, www. combinedclaims.com

Combined Claims

3/5/2009

Atlanta Claims Association Atlanta Claims Association Luncheon, John Bobo, 678587-9262 ext. 104, Maggiano’s Little Italy, Atlanta, GA, www. atlantaclaims.org/index.php

www.claimsadvisor.com

National Association of Subrogation Professionals

Subrogation Litigation: Skills & Management Conference, Leslie Wiernik, leslie@subrogation.org, 800-574-9961, Tradewinds Island Resort, St. Petersburg Beach, FL, www.subrogation.org 4/3-4/2009

Central Jersey Claims Association

National Association of Independent Insurance Adjusters (NAIIA)

Society of Insurance Research (SIR)

4/2-3/2009 3/10-14/2009

3/15-18/2009

3/2-4/2009

|

2009 SIR Annual Conference, Seminar & Exhibit Fair, Ed Budd, 317-398-3684, Flamingo, Las Vegas, NV, www.sirnet.org

2/19/2009

2/5/2009

WINTER 2009

2009 Insurance Fraud Management Conference, info@ iso.com, 800-888-4476, Royal Pacific Resort at Universal Orlando, Orlando, FL, www.iso.com

Cat Modeling in Uncertain Times, Registrar, meetings@reinsurance. org, 800-259-0199, Grand Hyatt Tampa Bay Hotel, Tampa, FL, www.reinsurance.org

Eastern Claims Conference, Donna A Conticchio, donna.conticchio@ prudential.com, 973-548-4520, Waldorf Astoria, New York, NY, www.easternclaimsconference.com

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ISO & National Insurance Crime Bureau

2009 RIA Annual Convention & Exhibition, info@restorationindustry. org, 443-878-1000, Wyndham Palm Springs Hotel & Convention Center, Palm Springs, CA, www. restorationindustry.org

NAMIC Claims Conference, Registrar, registrar@namic.org, 800-336-2642 Ext 1057, The Westin Riverwalk, San Antonio, TX, www.namic.org

Atlanta Claims Association

3/8-11/2009

Health Benefits Continuing Education

18th Annual National Health Benefits Conference & Expo, info@hbce.com, 941-484-1430, Tampa Waterfront Convention Center, Tampa, FL, www.hbce.com 4/15-17/2009

Central Jersey Claims Association

3/22-25/2009

Property Loss Research Bureau/Liability Insurance Research Bureau 2009 PLRB/LIRB Claims Conference, conference@plrb. org, 888-711-7572, WA State Convention & Trade Center, Seattle, WA, www.plrb.org 3/26-27/2009

American Society of Workers Comp Professionals 2009 AMCOMP Annual Meeting, info@amcomp.com, 212-5145917, Mandalay Bay, Las Vegas, NV, www.amcomppro.com

Atlanta Claims Association

Atlanta Claims Convention 2009, Esther Powers, 770-671-2591, The Gwinnett Center, Atlanta, GA, www.atlantaclaims.org 4/16/2009

Central Jersey Claims Association

Central Jersey Claims Association Monthly Meeting, Donna Bradshaw, dbradshaw@litsol. com, Mercer Oaks Golf Course, West Windsor, NJ, www. centraljerseyclaims.com 4/19-22/2009

Southeastern Claim Executive Association

SCEA Spring 2009 Meeting, Neil Timmons, neill.timmons@ canal-ins.com, 864-242-5365, The Renaissance Resort at World Golf Village, Saint Augustine, FL, www. southeasternclaimsassoc.com 4/19-23/2009

RIMS

RIMS 2009 Annual Conference & Exhibition, 212-286-9292, Orange County Convention Center, Orlando, FL, www.rims.org

source

Advertising Directory

ADVERTISER

PHONE

WEB SITE

E-MAIL

PAGE

1-800-BoardUp

800.585.9293

www.1-800-boardup.com

mdh@1-800-boardup.com

31

Able Mobile Housing, Inc.

800.273.5774

www.ablehousing.com

tom@ablehousing.com

67

AICPCU

800.644.2101

www.aicpcu.org

customersupport@cpcuiia.org

ALE Solutions, Inc.

603.513.6434

www.alesolutions.com

rowena.zimmers@alesolutions.com

Arter Insurance Adjusters, Ltd

330.332.9082

Assured Relocation

888.670.9700

www.assuredrelocation.com

Claims Advisor Advertise

866.276.7970

www.claimsadvisor.com/advertise

Claims Advisor Subscriptions

866.276.7970

www.claimsadvisor.com/subscribe

Claims Advisor Online

866.276.7970

www.claimsadvisor.com

Claims Pages

800.290.1347

www.claimspages.com

info@claimspages.com

Claims Verification, Inc.

888.284.2000

www.cvi.com

cases@cvi.com

Donan Engineering Co., Inc.

800.482.5611

www.donan.com

donan@donan.com

EFI Global, Inc.

281.312.3157

www.efiglobal.com

heather_suttle@efiglobal.com

4

Expert Advantage

866.749.3107

www.expert-advantage.com

expertadvantage@mchsi.com

28

Katie School of Insurance and Financial Services

309.438.3368

www.katieschool.org

debbie.babcock@ilstu.edu

11

Insurers World

781.821.0087

www.insurersworld.com

scott.lacourse@insurersworld.com

19

Patton & Ryan, LLC

312.261.5376

www.pattonryan.com

dan@pattonryan.com

25

Property Loss Research Bureau

630.724.2200

www.plrb.org

Reitz Consulting, Ltd.

701.235.0859

www.reitzmetallurgy.com

wreitz@reitzmetallurgy.com

39

RGL - Forensic Accountants & Consultants

888.RGL.4CPA

www.rgl.com

Richard Blaise & Associates

516.742.9515

www.richardblaise.com

support@richardblaise.com

35

Simsol Software, Inc.

800.447.4676

www.simsol.com

jenniferd@simsol.com

18

Temporary Accommodations

800.548.5196 x201

www.temporaryaccommodations.com

jmiegel@temporaryaccommodations.net

69

Temporary Housing Directory

800.817.3220

www.temporaryhousingdirectory.com

request@thdmail.net

65

Vaisala

520.806.7300

www.vaisala.com

claims@vaisala.com

12

Weather Decision Technologies

888.255.7099

www.weatherforensics.com

lynnelawry@weatherforensics.com

23

17 back cover

arteradjusting@aol.com

31 68

advertise@claimsadvisor.com

72 58, 71 51 inside back cover 13 inside front cover

7 29

For a media kit, editorial calendar and advertising opportunities, call 866.276.7970 or visit www.claimsadvisor.com/advertise.

• 4/30-5/1/2009

Texas Association of Special Investigation Units

2009 Gulf Coast Insurance Fraud Expo, Mark Louviere, mlouviere@ safewayins.com, 210-336-4959, South Shores Harbour Resort, League City, TX, www.tasiu.org

5/3-6/2009

5/6-8/2009

5/17-22/2009

2009 PCS Catastrophe Conference, info@iso.com, 800888-4476, InterContinental Miami Hotel, Miami, FL, www.iso.com

Midwest Claim Conference, Susan McCullough, Susan. mccullough@verizon.net, 309826-8814, Grand Geneva Resort & Spa, Lake Geneva, WI, www. chicagoclaimsassoc.org

2009 IAAI Annual Training Conference, 410-451-3473, Sheraton Arlington Hotel, Arlington, TX, www.firearson.com

Insurance Services Office (ISO)

5/3-6/2009 4/30-5/2/2009

National Truck & Heavy Equipment Claims Council (NTHECC)

NTHECC Spring Meeting, Tom Fergus, 603-569-8910, Embassy Suites Dallas, Grapevine, TX, www.nthecc.org

15th Annual Canadian Fraud Conference, events@acfe.com, 800-245-3321, Hilton Toronto, Toronto, ON, www.acfe.com

International Insurance Institute, Inc.

Claims Education Conference, Carl Van, cvan2@aol.com, 504-3934570, The Coeur D’Alene Golf and Spa Resort, Coeur D’Alene, ID, www. claimseducationconference.com

International Association of Arson Investigators (IAAI)

5/28-30/2009

5/12-15/2009

Association of Certified Fraud Examiners

Chicago Claim Association

Florida Defense Lawyers Association

13th Annual FL Liability Claims Conference, ljude@fdla.org, 813885-9888, Disney’s Contemporary Resort, Lake Buena Vista, FL, www.fdla.org

CLAIMS ADVISOR | WINTER 2009

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story

Claims Adjusters Have a Million Stories.

What’s Yours?

Clip-Ons Ties, No laughing matter

Back in the early 1980s, when I started out as a claims adjuster, we wore neckties. It didn’t matter if the temperature was near 100 degrees, or you were climbing on roofs and underneath cars…we wore neckties.

My claims manager introduced me to Ron, a senior adjuster, who provided this rookie with a lot of mentoring as I learned the claims business. Ron always wore a clip-on tie and as Wally said to the Beaver, “the guys are really going to give you the business.”

We relentlessly joked how Ron never learned to tie a necktie and how he shopped in the young men’s department at K-Mart. On and on it went. Ron, being a good-natured guy who could dish it out himself, just smiled and laughed as we poked fun at him.

One day Ron and I were on duty appraising cars in our two bay Drive-in Claims Center. A man came in with a receipt for a new battery claiming the original battery was stolen. Ron asked the insured to pull the car in and he would verify the new battery was actually installed.

With the motor running, Ron popped the hood and leaned over to take a look at the battery. In an instant his tie was sucked into the fan and twirled around at 20,000 RPMs. Ron turned to me and smiled as he explained, “now you know why adjusters should always wear a clip-on.” So...I headed off to the young men’s department at K-mart.

—Mark S., Overland, KS Truth or Fiction?

Several years ago I was an adjuster for a large major railroad when a circus train came to town. During the course of unloading the elephants, a switch engine struck and killed one of the elephants. I was called to investigate and met with the owner of the circus.

Now since I had never had an elephant claim, I had to check with my supervisor to verify the value of a circus elephant. After several phone calls, it was determined that the elephant had a value of $10,000.00. That offer was made to the owner of the circus who replied, “Ten thousand dollars? I wouldn’t accept anything less

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than $100,000.00.” I was taken back by his demand and indicated that we only killed one elephant. “Yes, he replied, but you pulled the tails out on nine others.”

—Don C. It’s What We Do Best

Our employees’ response [during Hurricane Ike] was extraordinary. I could tell countless stories of how our people put their personal situations aside to service our customers. Here are some of our employees’ experiences helping customers in Texas in the days after the storm: • Learning that an agent was working out of a trailer in their office parking lot, Houston employees helped by hauling 100 cases of water to the agency. “When people need help, you just do what you need to do,” said David K. • One claim professional serving the Beaumont area got an unusual request from our dispatcher: Can you check on and feed our customer’s cats? The customer was an elderly woman who had been evacuated but had not been able to return home, and was very concerned about the pets she had to leave behind. Our claim professional not only found the animals and fed them, but was able to solicit neighbors’ assistance in helping clean up the flood damaged home and continue the care of the pets in advance of the woman’s return.

• Another claim professional driving a branded vehicle in Houston was pulled over by a customer who needed to file a homeowner’s claim, but was unsure how to do so. The claim professional followed the customer to her house and assisted her through the reporting process.

—Lisa W., Houston, TX

Do you have a true claims story that is interesting or funny? Tell us all about it!

Send an e-mail to “Story” at editor@ claimsadvisor.com. Your tale may be the next story featured in Claims Advisor.

All Eyes are on YOU...

...with

Online Resources.

Claims Pages Reach over 110,000 claims professionals looking for your services by advertising with the largest circulated source for insurance claims adjusters.

Thousands of claims industry links, news articles, forms, events, discussion forums and adjuster tools.

Print Directories.

500 page directories sent free to all claims professionals.

Employment Listings.

Thousands of professional career opportunities. Search job listings and post resumes.

Claims Yellow Pages.

Over 1,000,000 claims services providers in print and online.

Visit us at www.claimspages.com or call 1.800.290.1347

Maybe he shouldn’t have lit that cigar while fixing the gas clothes dryer. Oops!

(For all your temporary housing needs no matter how strange they seem.)

As you might imagine, when it comes to challenging housing requests, we’ve heard them all. Everyday we work with adjusters to find creative solutions to their toughest housing problems. So, the next time you’re facing an unimaginable situation, think of ALE Solutions, your resident experts in temporary housing.

(866) 885-9785

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www.claimsadvisor.com