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Last Post 10/31/2010 10:37 PM by  Ray Hall
Ask the Examiner
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Examiner
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09/30/2010 3:06 PM
DO NOT! and I repeat DO NOT! as an independant adjuster sign your name to a denial letter. EVER! You can write the denial letter for the company on their template and send it to them, but make sure your name is nowhere to be found on that denial letter. You do not work as a permanent fixture for that company. If you are sued for coverage bad faith, it is likey the big company will only represent the desk adjuster in the lawsuit. That leaves you, the dummy who put his name on the denail letter.

If an insurance company asks you to sign denial letters I would think strongly about working for them.
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Medulus
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09/30/2010 11:40 PM
Leland,

Good Questions! Goes to prove the point that what one person thinks is clear is not as clear for another. I personally don't mind a few questions from an adjuster who is not sure what I want.

Since I posted it more as an example than as a roadmap, I'm not going to go into the details of what this particular example all means.

My feeling, however, is that the goal is the best possible work product rather than asserting personalities. We are on the same team and have the same goal of indemnifying the insured.
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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10/01/2010 9:43 AM
I have been on CADO for years and it seems a very large % of cat. claim handlers have a mind set of its my job to look after the insureds" entitlement". Private insurance is just that, not an entitlement program. Many leach,s; contractors of all sorts  think its their calling to be the middle man between the evil carriers and justice.
 
The contract is the law that should protect both parties for the consideration paid and the duty to investigate all claims. Each state has laws to protect the public from insurance carriers and contractors . A free market with more bidding for work "required" and insurance needed would lower insurance cost for all who purchase property and liability insurance.
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CatAdjusterX
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10/01/2010 6:19 PM
 
HUH??????????????
"A good leader leads..... ..... but a great leader is followed !!" CatAdjusterX@gmail.com
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Buford Gonzales
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10/02/2010 11:42 AM
I want to go back to the calling statement. When email is used, the personnel side of the equation is lost. Many times I have a difficult time with the intent of the Inside adjuster as to what they want. I feel a brief conversation about the intent or difficult questions should not throw a field adjuster under the bus. In addition, it is difficult to build a repoire with someone through email, it is too impersonal. Am I wrong in this assumption?
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Medulus
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10/02/2010 8:36 PM
It depends on a couple things. First, how busy is the examiner? Patience for having a personal phone call goes down as the workload goes up. Second, what is the intent of the adjuster. I have little patience for schmoozing when I am trying to get claims closed. However I personally don't mind a reasonable number of phone calls with reasonable questions.
Steve Ebner CPCU AIC AMIM

"With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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Ol' Ghost
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10/02/2010 11:21 PM
One more time, File Examiners in Q.C. at the vendors are not paid to train, counsel, or schmooze with the field adjusters. If the field adjuster is confused by the instructions in Xactanalysis Notes to alter an entry code, the adjuster must consult with their supervisor. Only communicate within Xactanalysis Notes or by vendor email. We will get around to responding if we deem it necessary.

Always follow the chain of command, do not short circuit the system. Our function is to review files for correctness so the Carrier will buy them and you can be paid. Yes, I have been in your shoes in the past. No, I did not initially agree with this viewpoint until I observed how much time was taken away from the file reviewing AND how disturbing it is to the Examiners within earshot of the person on the phone. A Quality Control department must be a Zone of Silence as we are concentrating intently on the logic within each file to ascertain the flow of information being presented to explain and justify the disbursement of the Carriers money. Personally, I would like to see Q.C. be phone free; office phone and cell phones. I intend to soon buy a cell phone jammer to silence those nearby who persist on cell phone over communicating on topics such as; What's for dinner?, I love you, do you love me, I love you more., Junior lost his football practice schedule?, What do you mean the car won't start?, anon, anon, anon! If one must use the cell phone, LEAVE THE AREA.

Ol' Ghost
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Blu
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10/03/2010 3:45 PM
I have to respectfully disagree with Ol' Ghost regarding the training and counseling issue. I personally find the time to teach, counsel and in some cases console my field adjusters is generally rewarded times ten buy the quality of their work product going forward.
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Buford Gonzales
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10/22/2010 12:48 PM
I apologize for not returning to this question, got deployed. First, a phone jammer will land you in jail, I guess you know that. Second, I've found that when the inside examiner wants to cover a chicken coop, it really doesn't help to e-mail them with your concerns about coverage issues. Third, when the inside adjuster changes from one day to the next, and I find the macros I've built specifically for certain examiners aren't keeping up with the process, it saves time to speak with them and find out their personal idiosyncrasies. Finally, if making civil discourse over the phone is distasteful to the examiner, or his /her temper cannot be controlled, perhaps a little counseling might be in order. I’m generally upbeat and friendly over the phone and attempt to lighten the load with humor to offset any questions or problems.
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Ol' Ghost
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10/23/2010 8:47 AM
Buford, my assertion exists because I agree with the Senior Examiner and the Executive Vice President of the firm concerning these issues. One day when you sit at this desk you will see why the adjuster should seek help not from the examiner but rather the field supervisor. The examiner function is to review files. The field supervisors function is to train, counsel, and provide tea & sympathy to get the adjuster trodding down the straight and narrow path of wholesome goodness.

Ol' Ghost
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Ray Hall
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Posts:2443


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10/31/2010 10:37 PM
Just re-read Ole ghost post of 9/22/10. I think it would be almost impossible for 10 of the best adjusters in the world to come up with the same scope, prices and line items as this would be almost pure luck as this is not science; but has the art of adjusting involved with two or more objective human minds.

Question: Is the art of adjusting no longer appreciated on property claims ?
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