Organization Chart for the Claims Handling Blame Game- A Humorous Graph -A Serious Look at Claim Bad Faith IssuesMarch 6, 2009
Insurance Company – Adjusting Firms- Claim Staff -Reinspectors -Independents – Public Adjusters
Claim Litigation Attorneys
→ → (Everyone to R) ← ↓ ↑ → ← ↓ → ← (all 3) → ← (all 4)
What a mess that makes no sense and it isn’t humorous at all. This is a huge insurance consumer issue. Just check out the Bad Faith organization or NAIC (National Association of Insurance Commissioners) for all kinds of information and surveys on claims handling. The link I put to NAIC is their 2009 Report on the Top Complaints by insurance consumers. You can sort by carrier, by type of complaint, by state I think, and much more!
When are we also going to get Insurance Departments on board to help improve this by doing the following things I’ve discussed in this blog before:
1) Require Insurance companies to report to all state insurance departments consumer links where they provide complaint information for carriers to provide information on adjusting firms that have been dismissed by a carrier for trends of bad faith claim handling issues. Presently, I know of no place when independent adjusters can validly find this information until it is too late. Dismiised firms are not required to be reported (if they are I am not aware of it) so they just move on to solicit new carriers so even more insurance consumers continue to be harmed by firms with bad consumer servicing problems.
2) I believe insurance companies require liability and errors and omissions information from adjusting firms before they use them. Are there any reporting requirements by state insurance regulators on claims ratios on E and O policies for adjusting firms or independent or public adjusters so 1) policyholders don’t hire a PA who has a large complaint ratio 2) so adjusting firms have a source to know (other than just checking regulator sites to be sure an adjusters license is still active), and so adjusters can have a valid source to see the complaint ratio of an adjusting firm so they can make a good decision about which adjusting firm they wish to deploy with so they don’t get hooked up with a firm that might be unprofessional?
3) Insurance Regulators should require that adjusting firms be required to disclose the name of the owner and the name of any key executives they may have on the payroll and post them on their website. Often if an adjusting firm develops a bad reputation with adjusters or carriers, they just either a) move to another state so carriers and adjusters cannot find bad information about them at insurance department licensing sites that allow you to research licenses or b) the adjusting firm owners or key executives just change the name of the adjusting firm so adjusters don’t know who they are.
4) Another thing that concerns me when trying to find good adjusting firms for newly licensed adjuster recommendations , when asked by ClaimSmentor members , is that so many of the adjusting firms do not list one thing on their ABOUT pages about who the key owners are. I tell them just to go to http://www.whois.net/ but this only tells you when a website domain was open and the contact name and information for the person who opened the site. Sometimes the only results you get there are to the website company they opened the site with but it is one source of information you might try.
5) Adjusting firms should be required to post links on all of their websites such as Department of Insurance Consumer Complaint contact information AND information for independent adjusters as to where they can report violations of adjusting firm contracts with independents and adjuster non- payment of fee bill complaints. If you don’t think there is a need, just check out this site that opened post Katrina and when overloaded by complaints of non payment to adjusters, their system crashed many many times : www.professionalfeecollection.com (site was opened post Katrina and we have no idea what happened to this agency and it’s alliance of attorneys working proactively to collect unpaid independent adjusting firm fees. We know they were overwhelmed by the claim files faxed in to them and the thousands of adjusters attempting to utilize their services. It was run by a Terry Bagsby out of TX. The interesting thing was that these adjusters were all complaining about the same continuous group of adjusting firms based on discussions I had with him in 05/06.
6) Adjusting firms should be required by State Insurance Regulators to not only have a contract for independent insurance adjusters but they should be required to have two signed originals so one can be given to the independent adjusting firm and one can be given to the adjuster. I cannot even begin to tell you how many new adjusters have been frankly taken advantage of either not being given a copy of the contract or no contract at all.
We wrote in our blog done a few years back called “Splish Splash don’t go taking a bath” on this topic.(See link at bottom of this blog) I always teach new adjusters in our Fundamentals class not to deploy without seeing the contract and making sure they agree to the terms, not to sign blank forms, to watch out for Non-Compete terms, to make sure they know what the fee split is with the adjusting firm (how much they keep of the fee schedule and how much you get based on a percentage fee split) or what your daily rate is if you are getting paid a daily rate how much it is and what your fee split.
There is much more information in the blog I wrote linked to above. The very best advice that I would give you is to see your personal attorney about E & O insurance coverage information in the contract to be sure YOU are protected and to be sure that you are not signing something you shouldn’t be signing.
7) Insurance regulators need to regulate a) the length of time a carrier has to pay independent adjusting firms and TPA’s who process their claims, the time an adjusting firm has to pay the independents, holdback percentage provisions in contracts and hefty fines for those adjusting firms not paying them within a regulated time).
8 ) Insurance Regulators must begin setting regulations for insurance carriers as to what claim handling fines a carrier can pass on and require of independent adjusting firms and adjusters.
They have gotten totally out of control on the RFP requirements I have seen such as Citizens of FL 2007 RFP 08-0016 or 07-0003 with fines as much as 1,000 per vioation. Is what developed after these fines starting being imposed in RFP’s is that independent contracts started transferring these fines on to adjusters in contracts without even specifying what these fines were.
9 ) Insurance regulators have got to put a stop to the erroneous information being advertised about the TEXAS adjuster’s license for independent adjusters. Just take a look at the many classifieds telling those interested in a claims career that the TX license with give them licensing in any where from 25-32 states.
This is inaccurate as the adjuster still has to fill out applications, finger prints and pay licensing fees for those non resident licenses. Dr Birzon at the University of Central Florida’s Insurance licensing online program has been forced to post a warning such as this on their website link (see News flash column on left of that link) because so many residents of FL had taken TX licensing classes thinking that they were waived from taking the FL Resident adjusters license.
I regularly receive resumes from adjusters who are permanent residents of FL that is all that I see in the licensing information of their resume is their TX license info. Dr Birzon has been so helpful answering questions on ClaimSmentor on licensing issues and even helped out a few of our adjusters who were in non compliance on CE’s and had to retake Fl license requirements again so we referred them to his online FL licensing program which the state regulators approved as a means of getting your FL license and bypassing the FL adjusters exam. These adjusters who were working out of a state on a catastrophe assignment could meet the FL Department of Insurance requirement they sit for the exam again by taking Dr Birzon’s online class at night and still service claims assigned to them out of state.
10 ) Insurance regulators need to require that any training firm producing adjuster
training classes be approved by the state department of insurance to meet minimum claims experience requirements ,which I would insist included experience in claims management, as well as professional insurance education requirements that are recognized in the insurance industy such as AIC (Associates in Claims) and/or CPCU course through AICPCU. I have completed IIA, AIC, and 9 sections of CPCU with only one left to go (the much dreaded Accounting session). I cannot tell you strongly enough how much I recommend these courses for independents as well.
11 ) While the insurance regulators do not control which independent firms a carrier uses, they should at minimum require that adjusting firms and TPA’s require some kind of screening. The one I prefer the most is the membership requirements at the National Association of Insurance Adjusters which is an association of independent adjusting firms who have had to go through substantial financial screening and other membership criteria you can view here.
12 ) There are good procedures established by the insurance regulators, emergency management, and state governors for adjusters coming in from out of state. They are called emergency adjuster regulations.
In a new trend the large adjusting firms are now requiring of independent adjusters, they are requiring that adjusters obtain non-resident licenses in all coastal states and those like Oklahoma and Minnesota that have regular windstorms. There are valid reasons because carriers and independent firms cannot activate non resident adjusters who do not hold a non resident license in the state of a storm until the governor announces that by his order at the time of an emergency that independent adjusters are allowed in the state to work claims on an emergency license.
If an adjuster secures a non-resident license in all the states a carrier MIGHT deploy them, they can stay longer because emergency licenses are temporary in nature and only allow adjusters to work a storm designated a catastrophe by the governor. Carriers also do not use their national catastrophe teams if there isn’t enough volume in a given state although I’ve read about alot of improvements on this. This is usually do to the fact that they have to bill the region where they deploy the adjusters for their services. Can we do something about this? It appears to me to be the only way carriers and adjusters can deploy adjusters and get around the governors emergency disaster authority. It has created a huge financial burden on independents and on CE reporting requirements when they should be concentrating on servicing insurance consumers. It is also creating a “dumbing down” of independent adjusters that can be used as we often see less experienced independent adjusters deployed because the experienced adjusters tend to leary of jumping through the huge volume of hoops and know that when the big one hits they will be deployed when carriers through out all pre-storm requirements.
I regularly refer new independent adjusters to these firms meeting the NAIIA criteria as hopefully a safety net for them when finding reputable firms. See their membership directory here. While I cannot guarantee it will, I would think that it would atleast provide a place to start when considering who is your “A” list of adjusting firms you will work for. How about for carrier independent staffing needs when their core adjusting firms “run out “of core adjusters (their A team of who they will first deploy based on experience and certifications and licensing”.
I do know some excellent firms that might not yet meet all of the NAIIA membership criteria who are trying to do the right thing. Several that come to mind as I have gotten to know their owners through years of membership at ClaimSmentor or through the staffing side of my operation are CSP claims (owners are retired carrier management), Legacy Claims (the one owned by the Ellis’s), and Action Catastrophe Claims. I do not post those here lightly as I have spent almost four years now getting to know them and I listen intently to what experienced adjusters working for them have shared with me, I’ve watched their adjuster training programs, and I’ve heard great reports on their CMS Claim Management systems and payment records with adjusters who complied with file requirements.
I know of very very few independent adjusting firms run by owners or managers who have these course certfications. One of my clients who feels as strongly about this is Dennis Martin, CPCU who runs the FL Division and catastrophe division of William Kramer and Associates. He is a joy to work with since he understands the issues facing our claim industry , the Florida insurance crisis , and knows what happens when an adjusting firm doesn’t properly manage claims and claims adjusters and CONTROL compliance with file requirements. This is especially important with their primary concentration on commercial claims such as very large Condominum Claim Associations.
We co -authored an article for Claims Magazine as the featured story titled “ A Box of Chocolates” in 2008 about condo claims handling. We both can’t thank Eric Gilkey, Editor of Claims Magazine for his skills and patience working with us as neither of us had significant experience in writing an article)!
Some Things to Ponder
This is also another thing that inquiring minds want to know! If a file is approved first by an independent adjusting firm manager and sent on to the carrier management for approval and they approve the file and pay the claim based on their review how can they possibly go back and fine an adjusting firm a year later when their auditors catch the mistake. I know of a few firms this has happened to. Where are the insurance regulations on this?
Why do carriers always tell our members and my staffing firm that they don’t want to consider very good experienced catastrophe adjusters for staff positions when they meet all other qualifications such as a four year degree, insurance continuing education requirements,etc? I was astonished over the past four years to receive staffing requests from 3 major carriers that said the following ” we need adjusters but we can’t get approval in our budgets to use a staffing firm. Will you send them out free to your rosters? ” You’ve got to be joking! Take the resources I have developed over 4 years of staffing and building contacts and mass emailing for them free? I did post their notices in our Career Forum where we do post jobs such as these that we come across but I sure wasn’t servicing them free. Also, while I can understand that they think cat adjusters will jump as soon as a major storm hits, don’t tell us that your staff adjusters do not do so as well. What is your turn over rate? The only thing that keeps staff adjusters on your employment lists is the fact you often offer benefits such as health but adjusting firms are
getting just as savvy in some cases and they often get employment applications from your staff adjusters just like my firm does.
Last but not list in the things to ponder list is the failure of carriers to put a stop to “hand me down” claims. Almost every issue of non-payment to new independent adjusters has come through a 2nd or more tier adjusting firm subcontracting claims out to another adjusting firm when they run out of adjusters. Often , I doubt the carriers even know about it. When the unpaid adjusters contact the carrier, they are often told “sorry….we don’t have a contract with that adjusting firm”…well dang….I guess the first tier firm made a sidetrack agreement with the 2nd tier firm leaving the independent adjusters to hang out to dry. I’m referring to adjusters who have a contract with firm 2 or on down the line but they have no contract with the adjusting firm who had the contract with the carrier. During the 04/05 season when the FL Dept of Insurance set deadlines with HUGE fines, I saw many a carriers hurt when the primary adjusting firms couldn’t account for claim file status. I never even knew this went on until I transferred to the independent claims industry. I had one firm call me and say “and we have the 1st tier contract with the carrier” on this one. Maybe I am wrong and this is a regular practice, but I can tell you the majority of calls my staffing firm received on non-payment issues when they were looking for a new assignment because they weren’t getting paid was from 2nd or more hand me down claim adjusting firms. I simply think the practice should be forbidden.
There are four ways I can think of to add these regulations which are long overdue. Not being an insurance regulator, but someone with a huge interest in protecting independent adjusting firms and independent adjusters to preserve our important service to the claims industry:
1) Click on the link here to all insurance departments and print out a copy of this blog (just click on the blog title and it will open up just this blog versus reviewing a string of our blogs) and send a copy to either your state insurance department or to any insurance departments where you have worked assignments and/or are licensed. If you fear for your career in claims, just print it out and mail it in and don’t sign your name. If they get flooded with enough copies of this blog, maybe they will listen.
2) Print and send a copy to the NAIC who is responsible for cancelling the recommendations for National Licensing. Again, don’t sign it if you don’t want to. Volumes of copies of this might help. The link to the blog on this act is included at the bottom of this blog entry.
3) Insurance regulators who are responsible for claim handling regulations can add requirements such as these to their Good Faith claim handling regulations and licensing requirements for independent adjusters and adjusting firm licensing requirements.
4) How about Insurance Regulators developing a Code of Conduct form for independent adjusting firms (similar to what carriers require independent adjusting firms and adjusters are required to sign). Look at the NAIC Code of Conduct they require their member adjusting firms comply with
There are so many possibilities that can be done to improve the industry, reduce insurance consumer complaints, to reduce the number of consumers who have to resort to use of public adjusters thus reducing their insurance indemnification dollars, and to reduce the ever growing field of claim litigation. It is worse now than I have ever seen in over 30 years in the insurance industry.
Which claim career field is really responsible for the problems in our industry? Here’s a complex self assessment test. Is all it takes is four questions:
1) Who issues an insurance policy with insurance consumers with obligations required of both insurers and insureds? (Key to answer you will find the answer in column 1)
2) Who has to take instructions from who? (Key to answer- see column 2, 3, 4 as they answer to #1)
3) Who contributes to the training issues for the claim industry? See columns 5,4,3,2, and 1
4) Are public adjusters and consumer advocate attorneys the only driving force behind the increase in claim litigation? Yes in some instances they are but could they be successful in winning claim litigation cases by the hundreds if they weren’t finding examples of bad faith across the board- see 1, 2, 3, and 4 in the graph). I don’t think they are the only contributors of these huge costs which are being passed on to insurance consumers when carriers have to consider defense litigation costs when rates are determined by insurance companies.
So why are we all mixed up and playing the blame game? This is such a goofy game not befitting of an industry that has such an important place in the lives of every person in America that has been going on as long as I’ve had a career in claims. Here’s how the game works:
Step 1 ) Insurance Companies (common to all major insurers) use independent adjusters when a major storm such as Hurricane Katrina and Ike
Step 2) Insurance Companies provide training before the storm only to independent adjusters with atleast 2 years experience and to their staff claim departments UNTIL the big one hits
Step 3) Carrier Auditing Departments, Claim Examiners and Managers. and Reinspectors start rejecting files because they don’t provide training or enough information to adjusters. It is provided during a carrier certification class which is usually a one day training session put on by CARRIERS through ADJUSTING FIRMS THEY SELECT or at a one day catastrophe induction center where they do present a good outline of file handling guidelines if you are experienced enough to just make exception to general claim handling instructions you already know
Step 4) Newly licensed adjusters are activated to handle claims when carriers lower their 2 and 3 year experience requirements when they THINK they have run out of adjusters based on information from the pre-selected adjusting firms who may service there claims. ***Let me point out here it is like a “where is Waldo” game for independent adjusters entering the industry to find out who is servicing the claims because the majority of CARRIERS provide no information on their website about which firms are handling their claims (God forbid someone might consider them “employees versus independents). See our prior blogs on the cycle
Step 5) Don’t overlook the fact that the file requirements and claims guidelines are changed by CARRIERS almost daily when on storm. Even if an adjuster’s file meets file requirements one day, by the time it make’s it through the claims management cycle (Independent or staff adjuster →Claim Examiner or Claim Manager→Insurance Company who approves claim settlement payment and settles claim with insured (often with in office claim trainees who have never handled a field inspection or an inoffice claim operation TEAM so the insured can get bounced around and never talk to the adjuster who actually inspected their claim?
Step 6) Who pulls the authority from most independents which takes away great customer service of explaining their itemized estimate to the insured in person while they are out there …see column one. This also applies to carriers who have pulled field adjusters from handling contents claims and additional living expenses so the insured once again has to deal with multiple adjusters (field and in office) rather than having the personal claim service they desire from one adjuster?
Step 7) Carriers then blame everyone in column 2, 3, 4, and 5 for causing poor claim survey results and swears to never use much needed independents so experienced independents leave the claim industry as they have no way to support their families.
Step 8. ) A major catastrophe such as Ike and Katrina hit and independent adjusting firms are asked to deploy again to assist storm insurance consumers who have no idea what changes have taken place at the carrier’s regarding claim handling standards as the Carriers in Column 1 do not communicate with individual adjusters or hold yearly claim conferences updating them on the hot topics they have been dealing with while independents were at home trying to support their families. Why don’t they have newsletters for independents (refer to comment above on employee/independent issues). No instead they insist they will stop using independents again.
Step 9 ) Return to Step 1 and the cycle we regularly experience starts once again.
For two examples of the blame game see the final report of the Citizens FL Task Force on Claim handling where they submitted their findings to the Citizens Board of Directors blaming both independents and public adjusters for reopen claim issues. I don’t recall seeing where any responsibility was accepted by this now largest insurer in FL except possibly understaffing with field adjusters but they are moving in the right direction training staff and Independents deployed pre-storm and with face to face meeting requirements that they are visiting unannounced to be sure the adjusters are being taught their claim handling expectations and not just glossed over.
See also this news article I posted recently where General Manager, Jim Oliver, of the Texas Windpool partially puts the blame on inexperienced adjusters. This is very exasperating to me when I am going on my fourth year of searching for all carrier claim certification classes for members of ClaimSmentor. I can rarely find them except by the few adjusting firms posting in classifieds which are cost prohibitive to most firms when they haven’t gotten many carrier assignments such as in 2006 and 2007. Carriers have staffed up with employed staff adjusters due to their erroneous decisions in the steps above instead of looking SQUARELY in the eyes of their claim training operations, their current trend to leave the responsibility of deployment of independent adjustering firms instead of the carrier maintaining control (again employee vs independent issues).
Should anyone question my dedication to keeping independent adjusters informed for the right reasons…it took me 8 hours of volunteer time to produce this one blog entry to provide resources and information for you. I had no clue as all of our resources were internally generated as claim staff employees.
It has been a very long four years studying the independent insurance adjuster industry and learning that while I had managed them for years that I knew nothing about what went on before they deployed with us. It has been a major eye opener which I openly share with those in our field who need to get caught up to speed immediately in their decisions on entering the independent field and once they confirm that decision learning the professional way to perform their duties. **Update 3/7/09: You can follow this blog through RSS feeds as long as you are not placing it on a site that has banner ad sales or revenue generated through google ads (exception CADO who also spends untold hours volunteering his time for his site). I am getting referrals to this site from Blog Colony which I still have to research which are new this week and have another site copying my links on right column on their website. I am taking proactive action through ICAN and this wordpress administration who controls websites so be forewarned if you want to remove them if you are using a link to this site to generate revenue for yours. All independent adjusting firms or claim groups are free to put up a blog roll on this such as the one CADO (www.catadjuster.org) has on their blog page in bottom left corner. WordPress does NOT allow banners or search engine ads at this location so I will be proactive with them to shut your feed to this blog if you are using it for such purposes which we can see on our administation dashboard.
I welcome any volunteers who want to edit my blog entries to correct mistakes made. I was always taught by my mentor , my dad, not to present a problem without a solution….smile. If you have the solution for my lack of social networking editorial skills I welcome your help in this additional e-mentoring project.
For other great resource links, articles, and claims news I highly recommend Roy Cupps CADO site at www.Catadjuster.org which has operated atleast 10 years. His article section, news section, employer rating section, adjuster resume data base, and so much more . The archived forums provide a wealth of information about the independent opinions. We formed ClaimSmentor with Roy Cupps blessing initially in those forums but took quite a bit of harassment from a few bad apples who felt we were taking away their job opportunites so we moved the site to a private site at www.ClaimSmentor.com. I have nothing but the very highest regard for Roy Cupps and the resource links he keeps updating on his site.
Here are links to all prior blogs we have written in our archives since we began this service in July 2007 that discuss these issues on emergency licensing, carrier’s deploying adjusters, claim training, insurance regulations, and all other topics we’ve discussed in today’s current blog for a more thorough understanding of the changes needed :