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Last Post 01/01/2010 12:22 PM by  Ray Hall
Your Reading Files
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Ray Hall
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09/19/2007 8:54 PM

    Your closed files are the best example of your work. When you are looking at all the vendors who are not seeking your commitment during this very slow period ask permission to email 5-10 of your best work. The narrative reports will get their attention.

    Tags: On The Job
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    OdieWyatt
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    09/19/2007 10:04 PM
    Great tip Ray!
    To further improve my work product, I try to use the the following:
    Instead of complaining about getting the dog files from someone else who goes off to a storm, I try to learn as much as I can from their re-opened or re-assigned files. I read their reports to see if they are including anything that I would want to know as an examiner. Is their format just a little different, or is it better. Is their description of the damage more informative or less? Why did the file re-open, what could I have done as the original adjuster to have kept this file closed. Paying attention to what others do will improve your own work.
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    Ray Hall
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    09/20/2007 1:12 PM

    Most of the old company trained adjusters  were trained by reading other adjusters closed files. When you set down and read several hundred files that were closed by top adjusters with many years experience, your have a jump start on the job you have under taken.

    Then set on the incoming field desk for a week and see the work flowing in with recommendations to pay and the reasons why. This is seeing the good and bad work first hand.

    The IA vendors should be doing more training at the applicates home . The student should ask questions and question why this was done etc. The cost would be UPS back and forth and the quality of work would  improved or the students would wash out.

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    okclarryd
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    09/21/2007 2:37 PM
    If we were to review a stack of files completed by "top adjusters" from various companies, it might surprise you to find how similar they are. The "top adjusters" have learned to focus on what the carrier or supervisor wants in the file and then make sure it is in EVERY file.

    All of the companies are asking for the same things, almost. The similarities are across the board.

    All we have to do is give them what they want, without their asking for it time after time.

    Simple stuff.
    Larry D Hardin
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    Ray Hall
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    10/26/2007 12:47 AM

    If I was a vendor sending adjusters to California on these fire losses..... I would take two of my best files from 2003 and email it to the adjuster and tell  that person it must measure up to this standard of work.... these losses are not like any other work unless you have done it before.

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    cowboy26995
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    10/26/2007 12:02 PM
    Standardization in reporting would go a long way towards alleviating examiner complaints. When I started thirty four years ago we had a reporting manual which indicated what should be covered and why within each loss category. Whether you were dong casualty or property the checklist was invaluable in preparing complete reports. Maybe we could put together such a ckecklist for everyone's usage. I'd be willing to contribute.
    Marc Dubois
    Executive General Adjuster
    M.G.D. Claim Services Inc.
    "Your Commercial Claims Solution"
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    stormcrow
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    10/26/2007 1:26 PM

    I love to arrive and have the Vendor hand me a sample of what they expect. Elimates the trial and error of the first couple of weeks.

    I want to die peacefully in my sleep like my grandfather, not screaming in terror like his passengers.
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    Medulus
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    10/26/2007 6:25 PM

    I would absolutely love to have an example in hand of what is expected from each carrier. Fortunately, when working for my primary vendor I have usually handled files for the majority of their clients in the past and know very well what they want.

    Of course, some carriers (which we will not mention
    [state farm) change their requirements from day to day. That may not be fair since I haven't done any work for the afore-not-mentioned carrier [state farm] in the past several years. So maybe they have changed the practice of changing file requirements [i doubt it] from day to day . I apologize if I have demeaned the unmentioned company [state farm. And, in their defense, there are generally good reasons for being fluid in the midst of a catastrophe and responding to the needs of the insured [or executive whimin an interactive manner.

    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    StormJockey
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    05/27/2009 7:52 PM
    I realize I'm a couple years late requesting this.....but, has anyone picked up on Cowboy's suggestion of a basic check list similar to his "reporting manual"?
    Great idea.
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    HuskerCat
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    05/27/2009 10:51 PM
    Hey Kevin....nice job perusing the archives.    It's not often a new person re-opens a discussion thread.  It's usually the same ol' yada yada, how do I get started??   Looks like you've actually done a little research.
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    Ray Hall
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    05/28/2009 12:27 AM
    Its the carriers/vendors duty to train the adjusters. When was the last time you as an adjuster was ask to prove your competance by submitting a reading file with names and phone numbers. This is the year that worm adjusters will began to be fried on the witrness stand for IKE claims.
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    Medulus
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    05/28/2009 2:38 AM
    Fried worms, Ray? Yum Yum

    Kevin, since I am now working for a carrier I can tell you that I send out a very detailed instruction sheet with almost every assignment. The exceptions are when I send a limited assignment or send an assignment to an adjuster to whom I have sent several previous assignments. The latter already know what I want. I wrote the instructions so I know what's in them. If an independent follows the instructions and they are competent they will give me what I want. The main problems arise when the adjuster doesn't read the instructions. This happens all too often.

    In my previous work as an independent working mostly for GAB, they had a separate instruction sheet for most carriers. For those who did not have specific instructions, there were standard instructions. All I needed to do is read a little bit and I knew how to proceed. If I remember tomorrow, I'll try to post our instructions in this thread.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    Medulus
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    05/28/2009 9:27 AM
    As promised, here are ICW's instructions to Independent Adjusters. They are patterned after GAB's instructions for a couple of their clients. Bear in mind that our whole book of property business is commercial, so modifications would need to be made for handling homeowners claims. Also, this set of instructions apply only to claims worked for ICW. Do not expect any other company to use the same standards or have the same requirements. This is offered as an example of what an examiner might expect.  Oddly, and for some unknown reason, # 14 is violated more than any of the others.  Too frequently I get estimates with no depreciation, or simply transferring a lump sum from a contractor's estimate or, worst of all, all the buildings and contents lumped into one big gawdawful mess of an estimate.

    ICW’s Property Claims Handling Instructions for Independent Adjusters

    1. Assignments: Many assignments will be accompanied by specific instructions. In the absence of specific instructions, assignments should be accepted as full adjustments. Accept claims only from the claim department of Insurance Company of the West.
    2. Coverage Verification: ICW will supply necessary documents and policy forms to indicate coverage and alert the adjuster to potential coverage questions. ICW will make all coverage determinations. The adjuster is not to commit ICW to coverage. Handle all claims where there is a question of coverage under a non-waiver or reservation of rights.
    3. Reporting Requirements: Contact Insured within 24 hours. Acknowledgement within 48 hours. First Report within 20 days. Scope and cause of loss with reserve recommendations should accompany first report. Subsequent Reports: Every 30 days unless otherwise requested by ICW. Contact ICW immediately upon inspection if reserve will exceed $100,000.00 or if any issue of coverage or possibility of SIU involvement is discovered.
    4. Settlement Authority: Unless otherwise instructed, the assigned adjuster has no settlement authority.
    5. Checks: Issued by ICW.
    6. Reports: Reports should be full captioned reports with all supporting documents attached.
    7. Billing: All assignments should be handled at time and expense according to our agreed rates. Phone and fax charges are included in the hourly rate. Set up should be charged at clerical rates not to exceed one hour.
    8. Statements: Statements should be taken when requested by ICW.
    9. Subrogation: Investigate subrogation on all claims. Preserve all evidence. Inform ICW immediately if an expert is needed for subrogation investigation.
    10. Photographs: One photo of risk and enough photos to document the damage, or lack of damage where damage might be expected.
    11. Experts: ICW’s approval required. In many cases ICW will ask the expert to report directly to them.
    12. Public Records: Only if advised by ICW
    13. Value: If requested to do so, provide detailed calculations to demonstrate Replacement cost, depreciation and ACV.
    14. Estimate: Whenever possible, the adjusters are to prepare their own estimate using an automated estimating program and showing RCV and ACV. This should be done whether there appears to be coverage or not. Do not release the estimate to the insured before we approve it. In most cases a preliminary estimate should accompany the first report. Each line of coverage and element of the loss is to be written as a separate estimate. Do not include more than one building, or building and business personal property, on the same estimate. When the loss involves specialty items that are not generally included in the database of automated estimating programs, it is acceptable to use reasonable contractor estimates. If a portion of the loss may not be covered, write a separate estimate for that portion of the loss.
    15. Business Personal Property/Contents: Use of replacement vendors should be considered on large business personal property claims. Consult with the ICW examiner for qualified replacement vendors.
    16. Salvage: Always investigate salvage. When possible sell it back to the insured for a reasonable amount. Otherwise, inform us of salvage potential and advise the insured to retain the salvage for our disposal.
    17. Proof of Loss/Release: Obtain a proof of loss or release if instructed to do so by ICW.

    It's a good idea to ask as soon as you arrive on site if the carrier for whom you are working has supplied specific instructions similar to these to the vendor.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    Ray Hall
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    05/28/2009 6:08 PM
    Very interesting that all assigments of ICW are made to investigate and conclude on T & E. This is the only true way to be paid a fair fee. I have worked several thousand losses less than $20 K that were much more complex than than losses in the 6 figure bracket. Fee bills have been around for less than 60 years and I remember when they started, we all said "we want have to keep track of every call, entry etc. This will swing the small losses under $2500. to more than the fee's and it should be.
     
    In the first 10 years of flood claims it was all T & E and puters were not around, but we had a lot of 30 and 40 hour days billed out. Flood woke up and got with the program and stopped people from lying. Wind carriers have known for years that you get more claims closed sooner on a good fee schedule, but the diary system for CYA is so time consuming I would rather go back to T & E. The carrier actually gets a better finished product.
     
    It still takes about 1000 closed catastrophe losses, before you are out of the worm class. So keep good records that can be verified. Worm adjusters are being thrown under the bus every day on Texas claims.
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    Medulus
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    05/29/2009 9:30 AM
    It is at my insistence that we pay all files at time and expense.  I don't want adjusters cutting corners or leaving out elements of the investigation in order to get a file closed for fee billing. The biggest potential for problem with time and expense, of course, is what Ray mentioned -- billable hours in excess of actual time spent or even in excess of the number of hours in a day. Here's how I see it.

    Charging for actual time and expense on a file is an honest way to work. You can never go wrong doing it that way as long as you adjust the hours down for someone who is training or new to the profession (or charge a lower hourly rate). However, billable hours are similar to actual hours but may not exactly coincide. Some people are more efficient than average; some are less. If someone competent can write an estimate in 1 hour that takes a typical adjuster 2 hours and a less competent adjuster 3 hours, I have no problem with considering 2 billable hours for all three adjusters. That way the excellent experienced adjusters may profit from their expertise. On the other hand, if I am being charged at a higher rate for the very efficient adjuster (as is the case with a general adjuster), then I expect to be charged billable hours based on how long the average expert adjuster or average general adjuster would take to complete a task.

    Since I have the field experience that some examiners lack, I can spot the ones who are padding their invoices significantly with little problem. This is a form of insurance fraud and a felony in most (if not all) states. I have absolutely no problem with turning over seriously padded invoices to our SIU department for further investigation. One in particular was so outrageous that my response to the vendor went something like this:

    "I have forwarded this invoice to my SIU department for further investigation. You have two choices. 1. Send me the same invoice again by U.S. mail, and I will also turn it over to the U.S. postal authorities for investigation for potential postal fraud, or 2. Revise the estimate in the following manner (after which I itemized what were reasonable charges) and resubmit it. Should you choose the first option, please be prepared to show the total billable hours charged on all files handled by this adjuster for the dates on which he worked on this file."

    I guarantee the billable hours would have exceeded 24 hours over and over again. This alone would make a good case for fraud with most investigating authorities.  This adjuster had, for example, charged 3.5 hours for a $10,000 estimate because it involved four different condo units.  This, despite the fact that the rooms in all units had the same measurements and the same three line items.  If the adjuster knew how to cut and paste or use macros, the estimate might have taken a half hour including data input into Xactimate.  If he did each room separately it might have taken an hour or an hour and a quarter.  6 hours to inspect four small condo units is likewise ridiculous unless significant wait time is involved (like four hours worth).  The fact that the adjuster went to great lengths to explain in the log notes that the inspection took so long because he had to look at four units, far from deceiving me, acted as a red flag. 
     
    By the way, I immediately got a revised invoice.  The adjuster in question had already been sent home due to competency issues, if not honesty issues.  If I ever see him assigned to one of my claims again, I will yank the file and give it to another adjuster or another firm.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    Roy Estes
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    06/20/2009 8:58 AM
    I agree with Steve, and Ray, MAY I ADD, a GOOD JIT MEETING for EVERY ADJUSTER and a sample Claim Stack AT that JIT meeting is a good way to start the Storm. I always try to provide some form of Narrative macro, and Storm Macro indigineous to the area and loss types (Wind, Hail, Water, Freeze etc) to those adjusters who I know are more than worms! IF I have a worm on the storm, I will insist that they ride with someone for several claims (Unless the worm is a SHE and SHE is a purty one, then SHE has a storm mentor named ME .... hehehehehe), and provide a claim stack for my review prior to allowing them to perform on their own.
     
    And if there is several carriers I would provide claim stacks per carrier so that there are no questions, and if there are questions shame on those who dont ask!
    "Each of us as human beings has a responsibility to reach out to help our brothers and sisters affected by disasters. One day it may be us or our loved ones needing someone to reach out and help." RC ESTES
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    Ray Hall
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    06/20/2009 2:33 PM
    I have worked on T& E for some of the large NY, Boston underwriters on .5 million and down losses and they seem to accept each $10,000 of stick build can stand 1.0 time. It comes out almost equal to the good fee bills these carriers are use to seeing. I have been on  both sides of this T & E debate and the street adjuster does a much better job on T & E, if the carrier will allow the 1 hour for $10,000 (stick build). I remember $700,000 cold water chillers destroyed in a major flood(Allison Houston 2002). The fee bill was not allowed(nor should it be) and a GA fee for one day was allowed. This is only fair and right, we can not act like two snakes eating each others tails.
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    Ray Hall
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    01/01/2010 12:22 PM

    Happy New year old and new adjusters. A complete read of these old post from three years ago is time well spent.

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