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Last Post 02/01/2010 6:33 PM by  Olegred
I am so tired of dealing with file reviewers.
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Bobabooey
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11/25/2009 10:10 AM

    Take any estimate anywhere written by anybody.  Give it to 5 different adjusters to analyze and you will get 5 different estimates, 5 different reports, 5 different sets of pictures, 5 different everything.  There is no "right" estimate.  Have 20 contractors scope the same loss and you will get 20 different bids and 20 completley different estimates.  This job is based on the opinion of the adjuster that is scoping the loss.  That is why he was hired to scope the loss.

    There is no "right" estimate.  My idea of a "right" estimate and yours are different.  That means if you send your file to me, I am going to have differing opinions than you.  If I then send it to someone else, he is going to have differing opinions than me.  I am going to end up wasting your time having you change it to what I think it should be. 

    My goodness, dealing with file reviewers has become a tremendous waste of my time, ultimately costing me money.

    It is like asking someone what their favorite color is.  Then asking someone else to give an opinion on it.  

    Maybe one file reviewer thinks the photos are not good, maybe another thinks we should not have replaced the baseboards, maybe another thinks this, maybe another thinks that.  Maybe one reviewer thinks we need pictures closer up, maybe one thinks they should be further away.  Maybe one thinks we should call the carrier and get their opinon, maybe the other thinks we should not call the carrier because they hired us to do the job.  And it is getting worse.

    It is getting ridiculous. 

    tejasjayb
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    11/25/2009 11:57 AM
    with this attitude...... you might want to consider doing something else! Guess you never learned to not bite the hand that feeds you?
    olderthendirt
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    Posts:160


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    11/25/2009 12:08 PM
    Is there anything more dangerous then an examiner with free time on his hands?
    Life is like a sewer, what you get out of it depends on what you put in it
    Bobabooey
    Member
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    Posts:140


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    11/25/2009 12:16 PM

    Tejas, I am rejecting your post.

     

    Please make sure that you do not use run on sentences.  You need to capitalize the first letter of the first word in your post.  Please don't use exclamation marks, it does not look professional.  Your last sentence is not a complete sentence.   Please take time out of your day and make these corrections even though the inside adjuster could care less about any of it.

    Sorry to nitpick your post and to increase your work load, but my job is to find errors that do nothing but kill productivity.   Have a nice day!

     

     

    Medulus
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    11/25/2009 12:21 PM

    I don't think I've had any free time on my hands since I became a file reviewer. How do I get that job, Peter?

    Here's my philosophy. If I disagree with a coverage recommendation sent me by an IA, I don't send the file back to the IA and ask him or her to change their position. I simply note in my file why I disagree, and (usually) call up the IA or email that IA and walk through the policy with them. If I disagree with an estimate, I may ask for a rewrite because I want something to send to the insured. If I had the same software program, I might ask for the archive and change it myself. I'm aware that, in today's market, some file reviewers wouldn't know how to write an estimate if it smacked them in the face. I am not one of those. If I want something changed, there's a good reason for it. Trust me on this. My company pays all files on time and expense. It's not a waste of your time to rewrite the estimate if I ask you to do it. And it doesn't cost you money. Bababooey, remind me not to assign you any claims. I prefer to work with people who like working with me and think I am part of the solution, not part of the problem.

    Now...the file reviewer who once asked me to draw a diagram of a rectangular bedroom....that was a waste.  I told her, "the room is rectangular and the measurements are on the estimate."  She told me she needed a diagram.  I drew a rectangle, wrote in the measurements, emailed it to her.  Took less than a minute, but still a waste.

    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
    olderthendirt
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    Posts:160


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    11/25/2009 12:37 PM

    It has many years ago in another century when I was a desk jockey. At times as an examiner, I had fille loads over 700 claims, other times I had lots a free time and could make a pain out of myself. The last 20 years have been in the field and once in a while I realize that I was occassionally a real jerk. Many that could be a topic. I did and said things when I was learning that still make want to hide in a closet and bang my head against the wall.

    Life is like a sewer, what you get out of it depends on what you put in it
    Bobabooey
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    11/25/2009 9:02 PM
    Trust me steve, when I have to constantly change reports because the font is wrong or Have to reinspect a roof denial because I don't have a picture of the pitch guage (on a denial)it is a waste of my time. I started my career as an inside adjuster assigning claims to IA,s. I never gave a rats a$& about the font.

    Bobabooey
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    Posts:140


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    11/25/2009 9:14 PM
    I stand by my original post. I don't care how good you are or how experienced you are, anyone (including myself) could pick the claim apart with differing opinions. You think we should not have to reset the toilet? You think we only need one coat of paint? You think we can clean the carpet? You think the wood floor can be repaired? Then from now on I will send you the pictures and you can write the estimates.
    Leland
    Advanced Member
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    11/25/2009 9:31 PM
    there's a big difference between a file examiner overiding an adjuster's opinion on whether something needs a certain scope of work and a file examiner overruling an adjuster on policy interpretation.

    It's possible that the adjuster has no idea of how to read a policy but it's a certainty that the file examiner hasn't eyeballed the damage in person. Therefore the file examiner should be careful in second guessing the adjuster's opinion on what is damaged.

    One thing I try to do is take good pictures. When I take pictures of a slightly buckled floor I get down with my face on the floor and put something like the edge of my tape measure on the floor, preferably with the light behind it, so nobody can question why I think the floor needs replacing.

    Bobabooey
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    11/26/2009 9:43 AM
    I have no problem with file reviewers finding legitimate mistakes. I have screwed up coverage decisions before. I have not followed the carriers specific instructions before. These are my fault and it is good that the file reviewer caught them. This is not the same as nitpicking the estimate.
    Ol' Ghost
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    11/26/2009 9:59 AM
    Please allow me to restate the obvious. It's a simple matter of economics. The field adjuster is an independent businessman, he/she is a company. When the field adjuster receives the file from the vendor, who is a business, the vendor wants a sellable product from the field adjuster so they can resell it to the carrier, who is the ultimate source for the money to be paid to the vendor and then to the field adjuster. Are we all in agreement so far?

    Thru years of problematic file quality, the file examiner is now an integral part of the vendors Quality Control operations. Each file from the field adjuster must be reviewed to ensure the file is sellable to the carrier. It is always best to catch and fix a goof before it lands on the carriers desk. If the file meets the carriers preset requirements and the logic of the loss flows evenly from the diary notes, estimate organization, line item entries, and sufficiently captioned photos without any glaring loose ends, 'BAROOSH!', the file is billed and flushed on to the carrier. Then it's a happy day for that file and all who had their hands on it.

    On to the next file. Uh-oh. Why is there all this flowery boiler-plate in the diary notes? Why aren't the facts of the cause of loss and damaging effects on the Risk simply laid out in a comprehensive, yet cryptic manner that is quickly understandable? Why is the organizational layout askew with the siding repairs included with the roofing repairs? Why is the detached garage included in the contents section? And, look, no captions on the photos that are not in order. The roof photos intermix with the contents and garage, while the Risk photos are at the end instead at the front of the photo section. Then there is the issue of the food limits from the power interruption and no grocery list to halfway justify or document the $4793.32 the adjuster entered in the contents section. We won't go into the adjusters attempt to bill this correctly at this time. Nor adding O&P to the contents. Nor the adding 13 window screens to the estimate on a Risk that has only seven screens on the entire house.

    Now do you see why the vendors created Quality Control operations? If the field adjuster can't produce a sellable product to the vendor, how is the vendor going to sell it to the carrier? Then the carrier says, "Scratch that vendor off the list", and goes on to the next vendor. The joke then becomes that same field adjuster is 'hired' by the new vendor and the same result happens again. Talk about your deja-vu!

    It may be of interest to some that I more often than not send a file back to have something added to the loss that was missed. This is a good thing since it adds to the service invoice and actually helps the field adjusters income. As to this business about fonts, and second guessing the inconsequential, there is a Q.C. adage, 'If it is a big stink, send it back, but if it has one small stink, let it slide. Two small stinks becomes the abiding rule for file rejection.'

    Ol' Ghost
    anthony88
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    11/26/2009 10:50 AM
    I am a field adjuster who is on staff with a "carrier." My work load occasionally slows down and when this occurs, i pick up a couple IA claims to review for payment. The faster I knock out this IA claim, the faster I can claim payment sent, and take production. I have to read over everything in the file and make sure it meets our standards and is easily explainable to the insured. Do remember, that although you are the one writing the estimate, I am the one that has to understand it, and ulitmately relay everything to the insured. A key friend and as an IA should be your documentation. If you feel like you forgot something, ie- pitch pic, than document why its not necessary. (claim was a denial, picture of pitch on roof is not necessary). I thoroughly read the documentation as it is how i make my covg decision. If the documentation does not explain what I am paying for, I will almost always send it back out to get some answers.

    If File Reviewers are such a problem for you, and i say this with no intent of slander, it may be in your best interest to slow down on claims and double check every file for accuracy. I know it'll take some time to do all of this, but after a few weeks you may see a huge difference and your problems will be resolved.

    Antho
    Bobabooey
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    Posts:140


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    11/27/2009 7:38 PM
    Evidently, you did not understand my post. A mistake is a mistake and needs to be corrected. An opinion is an opinion and the adjuster that actually scoped the loss and actually discussed the file with the insured and contractor should carry more weight than a person who is sitting behind a desk looking at photos.
    Bobabooey
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    Posts:140


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    11/27/2009 7:48 PM
    If nitpicking claims is beneficial then I propose that we hire file reviewer file reviewers. This should really improve things. That way a reviewer can correct mistakes made by the reviewer. Now we will have 2 people writing estimates for damage they have never seen. My favorite is when I agree with a homeowner that something like cabinets need to be replaced because there is mo way to properly repair them. Then file reviewer changes it to a repair and insured calls asks why there is mo replacement. I have to tell them that an "expert" 2000 miles away that never looked at them says they can be repaired. I love that.
    claims_ray
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    11/27/2009 8:10 PM
    Sounds like the start of a paradox.
    Ol' Ghost
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    11/28/2009 9:47 AM

    Actually, my friend, File Reviewers work IS file reviewed. When one is spending Mr Big's money, it's a good bet Mr Big will be checking all up and down the line to ensure the money being squeezed out his bank account is no more and no less than what needs to be spent. And whether those persons are two feet or two thousand miles away, if Mr Big's expert minions smell a dead rat in the file, rest assured everyone who has touched that file will be nitpicked. You are not alone.

    As one of our esteemed folks here remarked recently, 'Adjusting ain't what it used to be'. Regardless of what the public image may hold, we no longer have the omniscient power of fiduciary disbursement as in the days of yore. Much like the military, with the advent of intense communication and the internet, those above us micromanage our activities down to the nth degree. For those fortunate few who's employers have yet to spend money on this pervasive trend, I am a bit jealous of your continued semi-independence of actions.

    I respectfully suggest that all our sensetive male egos be gently placed in a mayonaise jar on the top shelf of the pantry when we are packing our kit to go on storm duty. Let us all recall the famous adage of that delicate flower of Pilot femininity, Kay Hahn, who constantly intoned, "On this storm that is the way it is and everything is subject to change".

    Ol' Ghost



     

    Jud G.
    Advanced Member
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    Posts:509


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    11/29/2009 10:12 AM
    Posted By Ol' Ghost on 26 Nov 2009 09:59 AM
    Please allow me to restate the obvious. It's a simple matter of economics. The field adjuster is an independent businessman, he/she is a company. When the field adjuster receives the file from the vendor, who is a business, the vendor wants a sellable product from the field adjuster so they can resell it to the carrier, who is the ultimate source for the money to be paid to the vendor and then to the field adjuster. Are we all in agreement so far?

    Yes, and it is this point that should create a renewed perspective when it comes to writing up our claims.  As independent businessmen, we have an extra load on our plate to do things that the ordinary staff adjuster or examiner is just not familiar with.  As gracious and diplomatic assistants in facilitating the closure of claims, it is up to us IA's to be extremely careful in how we approach corrections, or we'll not see anymore assignments.

    I have one carrier where the guidelines are spelled out with the fee schedule, but each examiner has their own unspoken sub-criteria that after some time, I've finally figured it out.  One examiner fussed at me because I didn't recommend cleaning contractors.  With this one, I learned that my estimates are no longer limited adjustments, but are partial-full adjustments with this examiner.  Another one told me to adjust my agreed price from $105K to $99K so he didn't have to do a large loss report.

    This particular carrier has a pretty regular stream of claims.  In an effort to see that it continues, I choose to see corrections as a race and seek out ways to beat the other guy when getting my corrected files turned in.  I also include notes in the file to explain what my corrections are for and/or do.   Yes, you have to swallow your pride- a lot for some carriers, but who said that there was anything noble about being an Adjuster- especially an independent one?  You will be even more successful when you accept and appreciate this role.  It's not glamorous, but it does pay the bills.

    JimGary
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    Posts:470


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    11/29/2009 8:29 PM
    As many have pointed out on this sight, storms are now being populated with the 3 day wonders being churned out by so many schools. With that being the case, the file reviewer will be an ongoing hurdle we all must clear.

    JWG
    I know the voices aren't real, but sometimes they're right!
    stormcrow
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    11/29/2009 10:16 PM

    From a different point of view.  The examiners only picture of the loss is what you send him/her. Your photos estimate and notes are all he/she has to go on. Now the examiner doesn't know you. So when you cut corners and rush the claim, he/she doesn't get an understanding of what she/he is expected to pay. You may be the must upright skilled and gifted adjuster ever to walk on water, or you may be a three day wonder, 1 week out of 7/11. Unless you file tells the story of what happened and what you are paying why should any examiner just pay it?   

    I want to die peacefully in my sleep like my grandfather, not screaming in terror like his passengers.
    Ol' Ghost
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    11/30/2009 9:19 AM

    And...here's a nasty little Quality Control secret. After seeing more than a few of a particular adjuster's goofball files, that name begins to be uttered and remembered by the other File Examiners in the room. How often I have sat there ingrossed in a big commercial loss to overhear the grand announcement, " UH-OH! I got another BUFORD file!" For that one poor soul named Buford, he can rightly expect to have to revisit, fix, and justify one whole bunch of line items, diary descriptions, photo captions, grocery lists, lightning affadavits, metal shed dimensions, basic file organization, depreciation, deductible absorption, F9 notes, and all the other little odors stinking up the file. Then, the next Buford file that shows up on another examiners screen is going to be scrutinized more than a little closely. Woe be unto Buford.

    Please folks, don't be that Buford. Before hitting the send button, walk away for a few minutes then come back with a freshened mindset and read your file. Edit the goofs, justify why the sun sets in the west with F9 notes, place the captioned Risk photos at the front of that section. Make each file a simple, organized story that explains why the money is being spent the way you think it should be.

    You will make more money from not having to rework the file over and over, the Q.C. boys will make less money as we will be laid off sooner, the Insured gets paid quicker so there are fewer phone calls to return. All because the file was fixed before it left your computer. That's the big Quality Control secret.

    Ol' Ghost

     

    Tim Wieneke
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    11/30/2009 7:39 PM

    There are good file reviewers and a few lousy ones. 99.9% of my file reviewers have been good and fair.

    Then again, I was introduced into adjusting through the hellfire system of Farmers Insurance staff training. I was told they were a hard company to work for and I went into it knowing that - knowing that if I started with one of the "hardest" everything else would be easy. For a year and a half I had every file nitpicked and graded on a 4.0 scale based on accuracy, timeliness, customer service and file control...and everyone's results were posted publicly for all to see. Now not many would take this kind of "abuse" and knowing what I know now I probably wouldn't anymore (especially since the hot girl adjusters could see your scores too and you just KNEW they were judging you based on that) but it made every file reviewer after that look like a kitten.

    There was one exception and he was a genuine idiot. I had an agreed scope and price with the carrier and the carrier committed to coverage with the insured and was awaiting my final report (this particular carrier would send their in house adjuster to the site with the IA - go figure). The claim was done and the file reviewer wanted a reinspect because he wanted a photo of a specific type of roof gauge measurement. I explained that the carrier was satisfied and committed to coverage with the insured. He wouldn't budge.  He had to have it his way. I explained to him that by forcing a reinspect after coverage was committed he was pushing the carrier into a position of estoppel. He still wouldn't budge. I resigned my name from their roster and wrote a letter to the VP explaining the legal exposure this file reviewer created for the company and for me. Ego is no place for file review.

    Outside of this one idiot I greatly appreciate file reviewers as they have given me a ton of free education on coverage and claim handling. Sounds like you just may be dealing with one too many ego's at the moment Bob.  There's enough good ones out there to spend time on the idjits.

    Olegred
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    12/02/2009 11:39 PM
    Bobabooey

    You sound like you just had a bad date with an ugly file reviewer and you want to gripe about it to somebody. Well, we are flattered to serve as an audience to your utter frustration and pain. I hope your mood has changed and things are back to normal, because your bitter whining attitude was not going to get you far.

    I have to deal with "my" quality control PLUS with staff adjusters of the multiple clients (aka carriers) we are working with, so it's always a dynamic three party struggle. If I ever have a problem, I try to find more about what caused it and if I was the part of - try to make corrections, not only in the file, but in the way I do things. I treat everybody as a team that is trying to do one thing and one thing only - resolve the problem and satisfy all sides. Carriers want a cleancut, concise, to the point and professional file, which they can process quickly with no problems. And they pay me LOTS of money for being fast, professional, glib and efficient son of a bitch. And that's what I am.

    Ole Ghost

    I admire your style.
    Bobabooey
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    Posts:140


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    12/07/2009 3:06 PM
    I started my career as a staff adjuster who sent claims to IA's so I have first hand knowledge of that side of the business. I wanted experienced and competent adjusters handing the files and meeting with the insureds.

    All I know is that I used to write estimates and reports based on 2 things.
    Determine coverage.
    and
    What do we owe, and is it a fair amount?

    Now I write the reports and estimates based on one thing.

    Is the file reviewer going to be happy with it?

    I guess you guys think that this is progress. I think it is a joke that does nothing but waste time and money.

    I will tell you this much. As far as disagreements go between me and file reviewers. When the file is said and done after the repairs are utimately made, I am right 95% of the time compared to about 5% from the file reviewer. Seems stupid to me that their opinions overrule mine.

    Again, I am not talking about mistakes, I am talking about opinions on the estimates.


    I guess I agree to disagree with you.
    Ol' Ghost
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    12/07/2009 5:30 PM
    Okay, opinions on the estimates. We'll limit the topic to strictly that.

    On a questioned line item, is the rationale for that line item clear? Does it match up with the photo of the damage? Is an F9 note needed? Is the F9 note comprehensive in it's explanation as to why the given repair/replace operation is noted?

    I too started this 'bidnez' as a carrier staff adjuster and have trod your same road. Now, as a file examiner, what I was trained to do greatly influences what I expect the file to be, within the guidelines of the carrier and the vendor. The Great Carved in Stone requirements of a loss file have not significantly changed, the aim for each file is to tell a concise fairy tale of Who?, What?, Where?, Why?, When?, & How Much? in a fashion a trained ape can comprehend.

    Do your files more or less follow this creed? If so, one may wish to ponder who the carrier or vendor is employing to mis-criticize your veritible works of classical art?

    Ol' Ghost
    Tim_Johnson
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    12/07/2009 7:09 PM
    I am an I/A Claims Manager / File Examiner. If your file does not make any sense to me how is it going to make any sense to the carrier when I send it to them? You are dern skippy I will send a file back to you for a re-write if you are not following the guidelines; you are misspelling words in your F9 notes or narrative, etc. I am very cordial about it and easy to get along with for awhile. After awhile I will just cut an adjuster off and send it to another that can do it right the first time.
    Tim Johnson
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