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Last Post 03/30/2008 6:27 PM by  Tim_Johnson
My gift to Insurance Companies
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Bobabooey
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02/19/2008 6:26 PM

    I found a way for you to save millions of dollars a year.  This grand idea will also save a lot of grief for your insd's and will ultimately lead to more profits.  My grand idea??   Fire all of your file reviewers.   Let your IA's do their job. 

    Ray Hall
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    02/19/2008 6:47 PM

    My  complaining about having your work reviewed by another person with more experience and more knowledge, plus 4 eyes are always better than 2 and someone agreeing with you must indicate you got it right the first time. ALL adjusters have their work reviewed.

    sbeau4014
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    02/19/2008 11:42 PM
    I agree with Ray, and believe that all files need to be reviewed by company examiners. I've reviewed thousands of IA files and some require a close examination where as some you pretty much know the handler and rarely see any problems with them. There are some IA vendors that do an excellent job of screening the files before they leave their office and some not so good. Same goes for individual IA's doing day work. The larger the event, the more problems will slip thru the cracks and make it to the carrier. In an ideal world, what Boba says above would be great, and a lot of the IA's would do an excellent job. Problem is we don't live in an ideal world and there are still a fair amount of them that need to have their work reviewed.
    Crosz
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    02/20/2008 2:33 AM

    Nah file reviewers are great.. its the ones that have -0 personality that need to go..

    why would you not want a file reviewer?  its like being able to turn in a test.. missing a question, then they give it back saying "psst.. fix this before i grade it"

    Tom Toll
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    02/20/2008 8:38 AM

    As much as we try to have the perfect file, mistakes can still be made. It is essential that files be reviewed by a qualified reviewer. Therein lies the problem, QUALIFIED file reviewer and not one trying to impress the higher authority of their knowledge and prowess. We are all in this together and should present ourselves as doer's and professionals.

    Success is not final, failure is not fatal: it is the courage to continue that counts.
    JimGary
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    02/20/2008 8:39 AM
    This just in, sometime in the future from the FNN news wire....Dateline 2025.....

    ...Insurance rates skyrocket, after failed savings plan goes awry. An insurance company spokesman today said the plan on its face looked good, minimizing staff to cut costs. The plan originated on a discussion board, suggested by an adjuster with the screen name of "Bobabooey Adjuster", a name believed to be taken from the Howard Stern radio show. The plan consisted of cutting costs by firing all file reviewers and letting the adjusters estimate the damage and authorize payments. Problems started surfacing when the companies realized that many of the adjusters were actually working with contractors to inflate estimates. "The plan was a total failure" stated the spokesman,"Though most adjusters gave honest appraisals of damage, there were some who just handed out money like it was candy". Bobabooey was unavailable for comment, it is believed he is attempting to remove the tar and feathers bestowed upon him by the insurance companies.
    In an unrelated story, President Chelsea Clinton rejects a plan to save tax dollars by firing all the military and just paying for damage caused by terrorists attacks with the savings. .....



    It could happen,
    JWG
    I know the voices aren't real, but sometimes they're right!
    cantonking
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    02/20/2008 10:11 AM

     

    why would you not want a file reviewer?  its like being able to turn in a test.. missing a question, then they give it back saying "psst.. fix this before i grade it"

    Deja vu-

    That is exactly what they did on the test for the Texas state insurance adjusters license!!!!!! I guess it had somrthing to do with the gaurantee to pass or your money back.

    cantonking
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    02/20/2008 10:18 AM

    Jim,

    You need to see about getting all the short stories you have laying around that you have written in your down time published. Are you this eloquent in your narratives on your claims.

    Medulus
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    02/28/2008 11:25 AM

    One of the hats I wear now that I am on staff is that of file reviewer. For obvious reasons I would not like to be fired. (That's called disclosure of your conflict of interests, a concept those in Washington would do well to learn.)

    Some of the reports I review are amazing, and some are just amazingly incompetent. Sometimes you offer the carrot (like hiring the competent adjusters when you have another assignment available) and sometimes you offer the stick (like pulling the file and refusing to ever use that adjuster again). My philosophy as an independent was, and as a staff guy is, that we are in the claim process together. If we are adversaries, the main goal is not being accomplished. And the main goal, need I remind anyone, is to indemnify the insured in as prompt and fair a manner as possible. It's really not about the examiner or the adjuster. It's about the insured. In the most basic of terms, we simply happen to pick up a paycheck in the process of providing a service to the policyholders by attempting to pay the right amount -- or as George Meherle would have said, "not a penny more or a penny less".

    Overpaying claims creates higher premiums.  Underpaying claims is at best due to lack of knowledge and at worst due to lack of ethical standards.  I rely on independents to supply me with all the information I need to make a reasonable decision about what is the right amount to pay.

    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
    Tom Toll
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    02/28/2008 5:38 PM

    Steve, thanks for your comment about the insured (policy holders). Insureds seem to get lost in some cases and of course, that is who we are serving and should be receiving priority, not the vendors or carriers. The insured has a contract of adhesion for multiple perils and should get a reasonable settlement, within a reasonable period of time.  I understand the carriers have a vested interest in loss claims, but they provide, by contract, a method of indemnification if the policyholder has a covered cause of loss.

    Whoever hired you has gotten a good man, ethcal, decent, and knowedgeable. Keep up the good work. Don't concern yourself with eliminating adjusters that know not what they do.  All they do is damage our profession.

    Success is not final, failure is not fatal: it is the courage to continue that counts.
    LarryW
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    02/28/2008 7:59 PM

    Tom, we need a few bad adjusters. Otherwise folks won't be able to recognize a good one. The bad ones make the good ones look even better.

     

    No one is absolutely worthless, at the very least you can serve as a bad example.
    okclarryd
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    02/28/2008 9:16 PM
    And, Larry should know.
    Larry D Hardin
    Bobabooey
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    03/01/2008 12:12 AM

    I originally posted a 2 paragraph rant but deleted it because I thought I may be recognized.  I had 2 files in the same day get rejected and had to explain to the file reviewer why the file reviewer was wrong.  Both files after wasting my time were accepted. 

    Number one i paid to paint a ceiling which was faux same as the walls, so had to pay to match.  File reviewer did not understand this.  (BUT afterall it is their job to nit pick) 2nd, a file reviewer from 2000 miles away said I was replacing too much drywall that she could see from the photos.  I think it would be easier if someone with 8 years experience such as myself, just take photos and have some one sittiing in a cubicle 2000 miles away make the decisions on what should be painted and how many square feet of materials should be replaced.  AFter all, everyone knows that if 50 adjusters make an adjustment on the loss, then all 50 adjusters will have the exact same total for the estimate (sarcasm)

     

    If you feel the need to have someone that has never been to the loss tell you how to do it,  then more power to you.  It is my opinon that I am being hired for my expertise.  I will agree with you that it is ok to have someone tell me what I did wrong  IF THEY ACTUALLY SAW THE LOSS.  But please don't lecture me on a loss that you have never even seen. 

    JimGary
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    03/01/2008 9:45 AM
    I think everyone has had the experience of having a desk jockey reject a claim for one reason or another. And unfortunately, that is a reality of our business. I recently had a file kicked back, and while talking to the auditor, I found that they have never actually estimated damage, they have been trained to review files by looking at photos. Though I do not advise this, I let her know she could accept my judgment or assign another adjuster, but I was standing by my estimate. I still get assignments and have not spoke with that auditor again.

    JWG
    I know the voices aren't real, but sometimes they're right!
    HuskerCat
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    03/01/2008 12:10 PM

    Posted By Jim Gary on 03/01/2008 9:45 AM
    I think everyone has had the experience of having a desk jockey reject a claim for one reason or another. And unfortunately, that is a reality of our business.

    Many of us have played the role of desk jockey, and also had experience in the field.  But I've related in other threads that while ponied up to a desk during the aftermath of the 04-05's, many of my cubicle neighbors had no field/estimating experience.  Many a one-sided conversations could be overheard that caused the short hairs on the back of my neck stand up.  But I also remember very well the two occasions where the field adjuster thought I was the nit picker.  When reviewing the photos and estimates, things just didn't look right.  So I called him to discuss it, and the discussion did not go especially well in the beginning.  I should add that this gentleman had provided me with excellent product at other times, and had seemed to be a very able & knowledgeable adjuster.  So I guess being questioned may have made him a little defensive.  After a couple minutes of discomfort, we discovered that the photos had been interchanged on 2 files that were sent to me, but were in the correct file that the field adjuster was looking at.  I located the other file that I had not yet reviewed, swapped the photos, we had a good laugh and I lost my temporary designation of worthless, picky file examiner (at least in the eyes of that particular adjuster).  Mark, if you're out there somewhere I hope you're wearing matching socks!!      

    Doug
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    03/26/2008 5:08 PM
    With not much else to do, the carrier my vendor works for now has gotten pretty picky. Without the file reviewers there, sometimes i would have little idea when the carrierrs had made small but important claims handling guideline changes.

    As well, sometimes files get submitted at midnight after a long day in the field. With lots of things going on xactanalysis - it can be harder and harder to proof read the files adequately --- that 2nd set of eyes can be a lifesaver!
    steph9176
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    03/30/2008 1:06 AM

    I interviewed with a carrier last year for a Property Examiner position. I was actually shocked that they didn't require hands on experience. Honestly I think they should. I don't think I would be very effective at grading another adjuster's work if I had never actually done it myself.

    It's impossible for examiners to inspect after you have already inspected. Just because they haven't been there doesn't mean they don't know what they are talking about if they do have experience. And it would stupid for the insurance companies to send an examiner out to every house you scoped.

    Tim_Johnson
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    03/30/2008 6:27 PM
    Yes, but like Steve Ebner said sometime back, some of what you see is total incompetence. When you see a 1600 SF house and the adjuster has figured a bathroom with 4 doors, 4 windows and 2 ceiling fans that file might warrant a little further look - see. It is one of 2 things, either that little house house one kick a** bathroom in it or you have an "adjuster" that has not quite figured out the "duplicate" feature in his software. Which one would you pick?
    Tim Johnson
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