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JimF
USA
1014 Posts |
 Posted - 02/09/2003 : 08:15:28
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This thread is posted for adjusters experienced in 'clean-up' to share their stories with our newer adjusters of the problems which they see which cause a closed claim file to reopen and thus cost the initial adjuster to lose their holdback.
While closed files can reopen while the initial adjuster is still on assignment and thus be reclosed by the initial adjuster, more often these files reopen after the initial adjuster has left the storm site, and a clean-up adjuster is assigned to investigate and then reclose the file.
Please highlight the areas within the claim report and claims process where adjusters are making errors a/o mistakes which cause these annonying reopens.
While many 'slash and burn' or 'turn 'em and burn 'em' adjusters just don't seem to care and concede the 'holdback' when they take an assignment, most adjusters have more personal pride and integrity, and this thread is for those adjusters to learn how to do a better job.
In my own opinion, a 1% or 2% reopen rate is to be expected and acceptable given the nature of not being able to write estimates for damages which cannot be seen until repairs progress, and that process taking longer generally than the adjuster's temporary assignment. Perhaps with a newer adjuster, that reopen percentage might still be acceptable up to say, a 5% rate.
Please share your knowledge and experiences here so others may learn. |
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KileAnderson
USA
875 Posts |
Posted - 02/09/2003 : 10:20:09
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| I've only worked cleanup once. I don't particularly like it, but it is work. Most reopens that I dealt with were one of 3 things not counting RC benefits. 1. Contractor's estimate was outrageous and they were trying to remodel the whole house because of one water spot on the ceiling. 2. Contractor's estimate was reasonable and thorough and adjuster's estimate wasn't. Adjuster did not include painting of crown or base and shoe and did not allow for contents manipulation or just paid for painting the ceiling when he really should have painted the walls too. Things like that. 3. Contractor can't match materials. Be it shingles or siding or whatever. I've never worked for a company that used a holdback and I don't think I would want to, but In cases 1 and 3 I don't think an adjuster should be denied his holdback because those aren't issues within his control. |
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JimF
USA
1014 Posts |
Posted - 02/09/2003 : 11:45:19
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Kile, thanks for sharing, and I especially share the sentiments you outlined by example in your last sentence about holdbacks.
Let's hear from others. |
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fivedaily
USA
258 Posts |
Posted - 02/09/2003 : 19:11:13
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The biggest reasons I see for reopening claims:
1. Matching Issues
2. Outrageous Contractor's Estimates
3. Inadequate explanation of settlement by adjuster
4. Hidden Damages
5. Missed Damages
2 & 4 can't be avoided. 1 can sometimes be avoided by being clear and direct with the insured when settling the loss. 3 & 5 can ALWAYS be avoided. Take ownership of your claim and do the job right the first time.
One more point about the matching issues... in St. Louis, an insured had 3 pieces of double 4", white, vinyl siding with damage, that was it for the siding. I found a match and suggested an alternative repair of using the siding on the 2nd story chimney to replace the damaged pieces and to reside the chimney (maybe 1/2 sq). After a few go rounds with the insured, I even found a contractor who was willing to do the work for an agreed price. Want out on with my manager and he agreed this was a perfectly reasonable repair. Well, 2 weeks after that last appointment, he called his agent who called a friend in local claims. Long and short of it, some stupid local manager agreed to replace all the siding on this 2 story house. Just goes to show... the squeaky wheel gets the grease. I was really burned about this and have lost respect for the local manager who overrode my decision.
Jennifer |
Edited by - fivedaily on 02/09/2003 20:50:58 |
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JimF
USA
1014 Posts |
Posted - 02/09/2003 : 19:39:39
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Jennifer, what about files which reopen because the claim is 'under-scoped' (adjuster missed damages which were not hidden) or 'under-estimated' (the adjuster did not alllow LKQ in estimates)?
Do you see these as causes of reopens as well and if so, how often? |
Edited by - JimF on 02/09/2003 19:44:44 |
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Dadx9
USA
143 Posts |
Posted - 02/09/2003 : 20:13:34
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Jennifer,
Many carriers in Missouri hold fast to legal findings. Match of siding has been settled in the courts many times.
Seems unreasonable, but a match in Missouri would tend to be, you need to find the same manufacturer, color and age of the product to be a match. The P.A.'s have done there homework in Missouri.
The cow is out of the barn. |
Don
"To be held in the heart of a friend is to be a king."
Bruce Cockburn |
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fivedaily
USA
258 Posts |
Posted - 02/09/2003 : 20:53:34
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Jim, forgot that one... see my edited response. Under-scoped losses are one of the biggest reasons to reopen.
Don, it was the same wood grain and color. See http://www.sidingmatch.com They are a premier resource for addressing this issue.
Jennifer |
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Dadx9
USA
143 Posts |
Posted - 02/10/2003 : 13:26:51
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Thanks, I have that before.
Don |
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mgkmrp
USA
27 Posts |
Posted - 04/01/2003 : 13:15:28
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for purpose of simplification-this example is about the damage to roof systems.
---Hailstorm hits a city, damage is spotty throughout town, often windriven and for the most part only windward slopes are damaged.
---Insurance company instructs adjusters to pay for only damaged slopes-want 10x10 sections proving damage.
---Two weeks into storm,Neighboritis sets in,some insured's are getting all new roofs,multiple layer tear off and even new decking paid for.
---Adjusters do thier best to close claims as instructed.
---Claims reopen after Adjuster is gone due to these circumatance beyond the adjusters control-sometimes the Insurance companies change the rules in "midstream"--
---i would just like to know how the experienced adjusters react to this and if there is any recourse.
thanks to a great site |
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CatDaddy
USA
310 Posts |
Posted - 04/03/2003 : 07:52:53
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The most common reason that files reopen is one that Jennifer already mentioned, "inadequate explaination of the claims process/settlement by the initial adjuster." A high percentage of adjusters dont take enough time at the beginning and/or at the end of the claim to give the policyholder a thorough explanation of process and settlement. This leads to questions, doubt, and a reopened file. This is not just the case with what some like to call "turn and burn" adjusters. Its adjusters at every production level. Its a communication problem and not something totally associated with speed.
Files reopen for lots of reasons and its not always the adjusters fault. If you are losing money on holdbacks for reasons out of your control, you might want to find a new vendor to work for. There's a GOOD home out there for every GOOD adjuster.
Jennifer, I feel your pain on the siding issue you explained. I know of lots of files where cat adjusters held the line and made the tough, right decision on a claim and after the cat office was closed, locals take over the claim and roll over on ya. Just try to sleep well knowing you did the right thing. Anyone can write a check but it takes an adjuster to WORK a claim correctly. |
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fivedaily
USA
258 Posts |
Posted - 04/03/2003 : 20:40:36
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Thanks for the support CatDaddy. I think the reason local offices respond to these types of situations the way I described, is because of severities. Why should they worry if they claimant is paid $12000 when all they were owed is $1200... it doesn't count against them.
I don't know much about how holdback works. Would any of you experiences IA's care to explain it to this staff cat adjuster?
Jennifer |
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tomgriffin56
USA
88 Posts |
Posted - 04/04/2003 : 13:33:54
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| The vendor actually keeps 10-15% of the fees owed to the IA in case there are any complaints or reopens that cost the vendor money. This amount is subtracted from the holdback and then after some undetermined amount of time the vendor pays the remainder of the holdback to the IA (supposedly). |
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Why Claim Files Reopen & You Lose Your Holdback
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