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Good post Jim. After the fiasco of 2004/2005, can you really blame the carriers for going over estimates with a fine-tooth comb? You had a ton of "adjusters" turning in files that were an absolute joke. These are likely the people still crying that they are owed money from past storms.

To me, its pretty simple. Don't take it personal! If the file is kicked back, make the revisions requested and move on. A lot of times at the beginning of a storm I'll get some files kicked back. I take note of these, make the corrections and be sure to not make the same mistake on the rest of my files. After the first batch of claims I turn in, I rarely get anything kicked back. Every office/manager is different and its YOUR job to find out how THEY (the carrier) want the files completed.
Just remember, you're working for them, they're not working for you.

jim,

dont leave us hanging. What else did the rancher have to say. I bet you have an interesting story to tell.

I don't usually have any problems with the carrier.  I have problems with the company I am working for.  Let me give you an example.  I worked a water loss claim the other day.   The carrier called me directly and informed me to take a picture of the slab and get it back to him ASAP.  I asked him should I write any kind of estimate, and he said no.  OK, easy enough.  Or so I thought.  It has been rejected 3 times by my supervisor who has no idea what is going on, even though I put it in the report.  I can't get the damn picture to the carrier because the supervisor is afraid that if he gets this file reviewed he may get a bad grade, like he is taking a spelling test in the 3rd grade.  I find that now I spend almost as much time trying to figure out the best way possible to get the file through the file reviewer as I do writing the estimate and report.

Amen Brother

On a recent storm, I had several files come back for a minor revision. Changed the file after discussing it with the QC and telling him, very gently, that I believed I had interpreted the policy correctly. One week later I get my files back, guess what, I needed to revise them, back to the way I had submitted them in the first place.

On the carrier side, a week after I left the storm, I needed to make a minor change, did not change the claim pay out at all on two claims. This was on the two largest claims I had submitted. This change was not asked for on the smaller claims, many of which had the same food loss. The two files were submitted correctly to begin with. The carrier bought themselves a few days interest on the money they owed the Insured. I am sure the Insured were calling the carriers at that time as they were calling me, so I assume I received the blame for the need for revisions.

I made all the changes requested, did not complain, however, I documented everything.

Gentlemen,
Each of you raise some valid points about some file examiners.
I think a lot of the BS would be stopped if office claims examiners were required to do several days worth of ride-a-longs bi-yearly or yearly......I think that some times their grasp of reality slips by being exposed to their cozy, safe, office environment.

Thanks you,
Joe L.

Great topic!

I found the file examiners at numerous carriers extremely frustrating during the 4 in 04 for many of the same reasons listed above. They would take MONTHS to get to the file reviews then reject them for unbelievable reasons. The biggest one that comes to mind right now was due to adjusters not deducting for painting base trim in bathrooms for the 3 foot door opening. I remember the total price was less than $2.00 per file and we got the usual answer to give our adjusters " well it may be $2.00 per file to your adjuster but if you add up the thousands of claims we are handling it is a significant dollar amount". The unbelievable part was these extremely minor issues were going on when they'd taken months to get to the reviews and we got them back often after the majority of adjusters had been released wanting them revised.This was when we were under the gun of the Dept of Ins on the DOI deadlines and affadavits we had to sign as managers verifying files had been inspected or closed depending on the deadlines imposed. While we considered them minor issues, one carrier out of the Tampa area dwelled on majoring in minors and had the adjusting firm owner, adjuster, and claim manager drive 8 hours down there just to discuss these reinspection issues. I definitely understand the need to have adjusters we manage handle claims according to client carrier specifications but also feel they need to properly consider the salaries involved in moving these minor revisions through the chain of command..RT to staff claim manager back to adjusting firm manager down to adjuster and back through the same channels once revisions are made. It didn't make sense to me from a salary expense standpoint on their end. As staff managers, we were always trained to address "trends" and only document specific files when the "trends" on  errors by a particular adjuster were not corrected on future file handling (when the issues were minor). Keeping an insured waiting for months then weeks for a $2.00 revision is far from outstanding customer claim service but it seemed the power trip was more important to some staff examiners than customer service... how sad.

Mr. Banks,

I do not know what your experience is or how long you have been in this business.

I was staff for over 30 years before I went independent. I know for a fact that in todays claims business, it is not far fetched at all to have "examiners" reviewing you work who have never been out in the field and have never written an estimate as such. I know this as many times, these people would come to me and ask what items were, why is this included as it was not discussed in the "training" class. Many "examiners" are people who have been in this business less that 2-3 years and have been inside the whole time. Gone are the days that an examiner was someone who was long term, knowledgeable and could discuss a file with you. The latter are a rare breed now.

It is not uncommon for a carrier not to give out written instructions on how they want the file prepared. By that I mean deduct openings, how large should the opening be before you deduct, include remove and reset for lights or allow for tape around the light. Minor things, but when left up to each "examiner" you can get 48 different ways of doing something out of 24" examiners". Another thing is the lack of experience many "examiners" have. When you get questions like "you did not allow for removal of the siding on the  facia, why?" the reason was, the facia is attached to the wood facia which is comming off. When you explain that , you hear "Oh, I never thought of that." Many of them have no idea what goes into a structure and even if you do send them a workable/changable copy of your estimate, they do not know how to load it into their system.  Those carriers that do set guidelines on how they want to have the claim prepared can also go so far the other way that it is not worth working for them as the time involved to do all the requirements is the equivelent of a full adjustment without calling the insured re the settlement and it is for an appraisal price.

The industry has lost focus on what is needed. If a carrier wants the job done correctly, then they need to spell out what they expect. What do they want decucted (openings, never base service charges), if you want the policy adhered to on the estimate, make sure you furnish copies with your assignment so there is no disagreement on what is covered or not. Finally, if the field person has a question, answer the phone or at least call back as soon as you can.

Does anyone out there feel this is unreasonable?

Rob,
If you are talking about the Vendor examiners you are correct. However, I believe that for the most part my statement is correct as is Rocke's post.
I know that the staff examiners /inside adjusters of the company that I work for have not been on the road in a couple of years.....and that pertains to the senior examiners. The other examiners are talented adjusters but have been inside all their professional careers......they depend on our field adjusters to be their eyes....and Rob, that is the way it really should be...the outside field adjusters should work as a TEAM with the inside adjusters and examiners to Adjust the Loss to a Conclusion.

Debbie, You were with State Farm forever.......how about it were your inside claims adjusters road warriors or were they office people and if they had been on the road, I would bet that the majority have not been on the road for several years.

Thank you and have a nice day
Joe

I, too, have to agree with Rocke & Joe here Rob.  Particularly when you are talking cats and inside examiners.  To borrow a phrase from Larry Hardin, you can bet your ice cream allowance that better than half of the inside examiners have never first-handedly scoped a loss let alone written an estimate.  When I was working inside on the 04 & 05's, it could become pretty irritating to overhear some of those folks talking on the phone to the field adjuster to get an explanation of his estimate over very simple things.  Like "what does R&I mean"?  "What does scrape texture mean?"  

Some carriers just didn't have any choice but to fill those seats with a bunch of temps and/or with staff from their work comp and liability claims departments.  Now, these staff folks were very handy to have around because they could help the rest of us with the automated system and work flow, etc., and we could help them with the property loss end.  They also had payment authority to some extent and were able to help get payments issued a little quicker had they not been there.  As a former staff/field guy, I appreciated their presence and enjoyed the opportunity to cross train them informally in the limited time we had.  

My thinking is why not make the IA document and explain thier scope-estimate ,during the last two years. Only the trust worthy survive now.

This whole topic reminds me of a catastrophe meeting @ 0700. The hand goes up and the question is: Do we have to do this on each file ?

Translation: Please tell us how little work we can get by with and do you count off for spelling and sloppy work ?

My problem 90% of the time has nothing to do with the estimate at all.  I get them kicked back 5 days after I submit them because I did not mention salvage on a roof claim or I did not write adjuster after my name on the report.  I mean you can argue that the file is not perfect because I did not do these things.   Maybe I am wrong, but making the insured and the carrier wait for over 10 days for something like this benefits no one.   Some people do not have the ability to decide what is important and what is not. 

Joe, to answer your question...

I was with the original group of claim managers who started up the first national fire claim central operation in 97. That was a great experience- all of the managers who were brought in (12) had extensive field adjusting experience and field claim management experience. All adjusters selected were experienced field adjusters selected during reorg for the operation. The operation performed very well although I definitely prefer field operations versus a group of 12 or more managers having to make a group decision even on minor issues such as letting an adjuster on your team off for 1 hour to be sure there is enough phone coverage (if each team just as let off 1 that is 12 off of the call rotation). That was the good side of claim central operations.

I later had an opportunity to take my field catastrophe staff team into a claim central catastrophe operation. The hundreds in there had ZERO field experience with few exceptions. They were provided with all of the claim schools and xactimate classes, in other words the best in office training available as well as policy training. They could work thousands of claims. I did NOT however like the operation personally. It was very hard to hear in office adjusters comments like " will you grab a tape measure and get the dimensions of the LR then you'd next hear them say- ok let me round that up 5 extra feet on each measurement to be sure you have enough money" when you know the field is being held to the exact inch. Initially, they were designed to handle many small claims but the dollar amounts grew by leaps and bounds. The major problem was that these in office adjusters had no experience and they were not working settlements off of field adjuster scopes and inspections. Today, I believe there is much more use of field adjusters on limited assignments when there is a coverage decision such as wind/water, hail total loss,etc so I hope the programs work much better. I also did not like the lack of consistency in management calls or the fact in office adjusters were being promoted to management having no understanding of the reprecussions of decisions they made since they'd never worked suit files so it really bothered me when I heard bad management calls being made. I hear today of this from newer adjusters in my classes who worked claims for carriers during Katrina and many report that they had staff managers who would point blank say they had no prior experience managing adjusters or working catastrophe field claims so they were left to dig up answers to many difficult questions with others they could flag down at their hotel rooms. A pretty sad state of affairs from what many share. From the field standpoint of experienced adjusters left to manage the field assignments, they got VERY tired of only getting either large losses OR claims that had been processed by a number of in office folks and only moved to the field when they were complaint files.

I did start out as an in office adjuster with no field experience and in those days we were required to work in office 2 years in our region before consideration for a field adjuster position. We handled small med pays, theft claims, food spoilage...basically anything not requiring a field estimate. I think the use of inside adjusters was much more efficient then. I do not agree with inexperienced field adjusters managing field adjuster files. I have previously managed a group of combination field adjusters and field estimators and even then there were problems with egos and experience levels. I think the insured is much better served by dealing with one adjuster from start to finish rather than "team" adjuster handling. I know the arguments on both sides and have worked both from an adjuster and a manager standpoint and am not convinced yet that the right thing is being done by any of the carriers in this assembly line process. Insureds pay a very high premium at today's rates and deserve service that excels expectations not being handled by a herd of assembly line workers who don't know them from the next customer. No one likes being treated that way. I loved the story I think Steve Ebner posted in here about his personal experience on a claim which said it all. If adjusters who know the system don't like it, how do we ever expect the insureds to buy in to the concept?

While the inside adjusters may "over scope" or "over micro manage" field adjuster scopes, most operations say any increase in indemnity payments by the allowances made is still less than maintaining the overhead of field claim offices and company cars in the days when everyone was forced out into the field as we were back in 85. It's amazing to see how the in office versus field runs in cycles. It seems about every 5 years the pendulum swings but the concern today is it will not swing back to entire field crews of adjusters due to the technology available today using field estimators, digital photography, and electronic claim file submissions so I'm guessing we all better adjust and move with the work if we are to remain in claims.

Here's a link to a great book "You can't Win A Fight with Your Client" I read the other day about meeting client expectations some may wish to read- it fit independent adjusting firms and adjusters to a "t" discussing quick tips like never arguing with the client (in our case-the carrier) that I think would help us all adapt to the new environment we find ourselves operating in:

http://www.harpercollins.com/books/...index.aspx

Another side note...in 04 almost every new carrier we picked up was due to the fact the carrier management or reinspection department was unhappy with the service of the prior adjusting firm who they alleged did not follow file requirements. We developed an extensive "induction" questionaire for new clients that went over well and helped our adjusters stay on track with the many adjuster file requirements. That is one of the disadvantages for adjusters working claims for a smaller firm who accepts assignments from multiple firms and the adjuster is expected to keep up with the differing file requirements for each carrier which becomes very confusing for all concerned when your under pressure like we were in during 04. The 07 version of that with the carrier seems to be increased use of staff adjusters after their experience in Katrina. Let's hope that does swing back to independents after many carriers have had staff sitting around for 2 years without enough to keep them busy full time.

Did any of you wine'rs ever think the day would come when all catastrophe adjusters are labeled supernumerary's. You people who turn in sloppy-lazy-unedited files will be at the top of this list to let go, after 5 or 6 files do not pass muster for ANY REASON if the carriers examiners are ask to make cuts.

Ask any independant local adjuster why they do not hire catastrophe adjusters. They will not tell you to your face; but it's because you will make this office loose an account that they did part of the work for years.

Now, that was a fascinating story, Deborah.  I'm glad you took the time to share your pilgrimage through the Farm. 

I, too, was involved in some of the beginnings of what State Farm has now become.  I worked for the auto company from 1990 to 1995.  In 1992 (or 1993) a decision was made in Bloomington to study ways of doing claims more efficiently.  Prior to that I will admit that State Farm staff adjusters had it pretty good.  Though I heard several of my colleagues frequently complain about how stressful the job was, those of us who had worked in other professions previously were surprised at how much they paid us for such a non-stressful job.  In particular, one of my colleagues who had been an attorney and I (who had been a minister) used to say to each other, "I can't believe how little stress there is here."  That was due to change, however.  There was considerable fear that direct carriers such as Progressive, Geico, 21st Century (then 20th Century), and Zurich Direct would soon be taking over the lion's share of the auto insurance market.

One of the first steps in the process that became the dreaded "reorg" was to send a group of consultants into a local service center.  The Fox Hills Service Center where I worked on the west side of Los Angeles had upwards of 250 employees.  Because it was one of the biggest local claim offices in the country Fox Hills was chosen as the subject of the initial study.  The Boston Group, a consulting firm, came into the office to study us for several months.  Following this we experienced our own mini version of "reorg".  They split us into two service centers.  The Fox Hills office then became more than stressful as they demanded more and more of the 125 employees they had left.  I would leave the office sometimes at 8PM and be the first one out the door.  Every single person was being written up for every single mistake, no matter how minor.  There was no positive feedback for doing a good job any more - only negative all the time.  The carrot was forgotten in the use of the stick.  The idea was to see who they could weed out by attrition without actually having to fire anyone.  When I felt I had enough and left to pursue life as an independent there were less than 70 of the original 125.  Our supervisor informed us that the target number was actually 45.  No one dared have a conversation with their colleagues during business hours.  The Fox Hills Service Center was beginning to resemble a sweat shop.  I referred to it ruefully as 'the new State Farm".  It certainly was not happy, cheerful people handling the claims any more.  A couple years after I left the Farm, I was contacted and asked if I wanted to join the class action suit several employees had brought against State Farm for requiring more than 40 hours a week without paying overtime.  I think I got about $200 as my share.  With settlements like that, I have no doubt they would do it all again.  Much cheaper to pay the settlements than to pay the overtime.  The irony was that I had often worked overtime and sometimes weekends without thought of extra compensation prior to the job becoming miserable.

I was in on one of the other major trial programs at State Farm, as well.  This was during the Fort Worth hail storm in 1995.  State Farm had brought in over a thousand independents and given them about a hundred claims apiece.  But they held back approximately 200 claims in order to attempt a trial program involving telephone claim handling and hand selected roofers.  They chose three adjusters (I was one of them) and handed us the 200 claims.  They sat us at a table in the temporary cat office and told us to call these insureds and attempt to talk them into using one of the three roofers.  So, for two weeks we sat at the table and dialed insured after insured and tried to explain to them that they would not require an adjuster if they used one of these three roofers.  It was mind numbing work twelve hours a day.  We were all three punchy by the time we got out of the office each day.  To say that the insureds were reluctant would be putting it mildly.  Many did not believe we were really from State Farm because they had never done it that way before.  Many others had their roofers already picked out.  The final outcome was that after we three adjusters had spent 12 hours a day for two weeks calling people and trying to talk them into something they did not want to do, we had a grand total of 4 insureds agree to work with this program.  (Folks I couldn't make this up and expect you to believe it, so I'm simply telling the truth.  But wait -- there's more)

We were then called in to be debriefed by one of the head State Farm cat supervisors.  We explained to him just how the program had gone.  We explained all the problems and the lack of success we had experienced.  The remaining 196 claims were then split between us, and we were sent out to inspect them in the normal fashion.  When the program was reported in the State Farm newsletter, imagine my surprise to find that the trial program had been an unparalleled  and unqualified success!  Imagine my further surprise when I was commended to my local management for helping to make the program such a success.  I can only believe that someone very high up the food chain had originated the idea.  It was, therefore, a foregone conclusion that it would be a success before we even made our first phone call.  But now, as Paul Harvey would say, you know the rest of the story. 

Will the industry cycle back to field operations?  I don't know.  It has in the past, but I'm not sure it will now.  I would like to be more optimistic, but just not sure that would be wise. 

I won't expound on these stories for fear of sounding like just another raving malcontent.  But perhaps Jesus said it best when he told the Pharisees, "You strain at a gnat and swallow a camel."