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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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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.

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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.
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Bobabooey
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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.
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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
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Tim_Johnson
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Posts:243


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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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Olegred
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Posts:363


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12/09/2009 12:57 AM

Bobabooey

 

I am not even sure what are you talking about. From my experience if the QA asks me to change something then I usually just do it and ask for rationale behind their request for my future reference.  In the end they are the ppl that keep me busy and I respect that. I should mention, though, that I have never received any requests that do not make sense, usually, they are all justified. I want to be friends with my branch manager, quality control, and of course, carrier adjusters. More than that, I have one quality control guy, that was one meticulous SOB, he used to send files back to me for little things, like, photographs are not in right order, or some little stuff like that. The way I handled this was not to get bitter and start to exude hubris, like "who are you to tell me" but rather make sure my files are perfect and second I started to call this guy on his phone with all kinds of questions about files. Instead of escalating this thing I tried to use this as an oppotunity to learn and to create a personal tie with one of the people I potentially will be working with. Just lighten up and do what they tell ya.

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Medulus
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12/09/2009 12:32 PM
Well said...and extra credit for using the word "hubris".
Steve Ebner CPCU AIC AMIM

"With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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dnjsdad
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12/09/2009 10:56 PM

If given the choice to work with a supervisor who is going to pick at my files or not working at all I will take working 100% of the time.  We all have a job to do, and generally speaking once they have faith in you they will stop with the picking.

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Bobabooey
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12/14/2009 2:44 PM
I guess it is time to start my own business. I usually discuss any questions with the carrier directly because the file reviewer has no idea what opinion the inside adjuster has.

1. I call carrier with questions on the claim
2. Carrier tells me what they want me to do.
3. File reviewer has problems with file.
4. I have to explain to file reviewer that this is what the carrier wants.
5. File reviewer then asks me to call carrier again to get more details.
6. Carrier says I already told you what to do.
7. Claim gets turned in finally and file reviewer and company get half of the money.

Yup, I do believe that it is time to open up my own adjusting firm.
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blaze70
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01/26/2010 2:30 PM
I get you Bobabooey and I agree completly. I was an inside adjuster for over a year as an IA and you are correct, we can't see if it needs one coat or two and etc. I would never even debate that point. Just throwing my 2 cents in.
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Olegred
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01/26/2010 9:51 PM
You open up new one and get some claims let me know :)
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jlouden
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01/28/2010 9:06 AM
I've been doing this for a couple years now, and I started as an Independent during a CAT loss. I am currently working a contract staff position, to stay busy and learn more.

I never once as an Independent made coverage decisions. I went out, scoped the loss, noted the damage (as a result of the peril or not), wrote an estimate for items damaged as a result of the named peril, and made sure each and every one of my files told the story. My photos are always laid out in a linear, step-by-step fashion. I'm looking at files now where some jackass took a picture of a dent on the siding and didn't say which elevation it was, where it was located on the elevation, so on and so forth. I see pictures of a "damaged roof slope" but do I know which one it is? No. I see a picture of a lifted shingle and do I know if that is indicative of the other shingles/slopes? No.

Like I said, as an IA I never made coverage decisions. I always left that to the inside adjuster. I have had minor issues with the display of one item or another when it comes to file reviewers, and nine times out of ten my reports are far better than 95% of the other people out there. My files fly through because I know how to make them look right while being accurate.

Yeah, people have differing opinions on things, and if you're arguing with a file reviewer over the font I'd ask if it wasn't legible or something similar to (with any luck) have them realize how stupid it sounds to change the font size. Some file reviewers are good, some are bad. It is your responsibility to communicate with them and produce a solid work product. If you want to butt heads, then so be it.

Also, get rid of the idea that your time is that much more valuable than theirs. While you may be working a number of claims and feel like you don't have enough time, think of how many files they're processing for however many field people. Know how to put a file together and keep it next to your desk. Review your work product and make sure it fits the criterion. Font discussions should be on the first file you submit (when the work relationship is new), not the 70th.
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freebob
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01/28/2010 4:57 PM
Adjusters review your own work before it gets to my hands because if you don't do a good job and recognize what needs to be done to correct the damages I will kick it back. Unfortunately you aren't avaialble to answer questions once you turned in your initial report to your CAT company who accepts your report without reviewing your work before sending it on. Take good pictures, discuss the damages in your narrative, talk to the insured (politley) and explain coverage if you have any idea of what and why there is coverage. Don't know coverage, go back to your Home Depot job.

I saw some of the worse claims reporting from many adjusters this past winter doing TWIA reviewing. Those horrible reports were what I had to try to dissect and rewrite. Yeas, this was after you very high paid adjusters left the area and wouldn't return our calls. You know who you are!

I am a professionsl insurance adjuster/reviewer. I expect you all to be the same.
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Ray Hall
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Posts:2443


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01/28/2010 5:23 PM

Two great post.... I agree 100% you clowns will go back to Home Depot this year or the next... it;s over.

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Ray Hall
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01/29/2010 11:05 AM

I do not travel on catastrophe storms any longer and will not post in the general section , but will on the Adjusters Den. See you old pro`s over on that site.

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jlouden
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01/29/2010 4:00 PM
Who are the clowns, Ray?
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Ray Hall
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01/29/2010 10:08 PM

They work in the catastrophe circus.

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stormcrow
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01/29/2010 10:28 PM

And I thought most of us were on the high wire without a net. Or lion tamers without a chair.  and in the end road kill

I want to die peacefully in my sleep like my grandfather, not screaming in terror like his passengers.
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ddreisbach
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01/30/2010 4:35 PM
Geez! Lion tamer sounds a lot better than clown. I think Ray needs a hug. Anybody volunteer for the job?
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Ray Hall
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01/30/2010 6:28 PM
Clowns are people who have worked 6 months as a roof thumper. I still work all type property losses, but I don,t chase catastrophe losses. Leave that up to the clowns and worms (one month exp.) When they can get work. Some good adjusters are working, the winter blast will hopefully get more working.
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