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Last Post 10/27/2007 1:04 AM by  Ray Hall
Paper pushing file reviewers-slowly ruining the claims adjusting job
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Ray Hall
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10/16/2007 1:51 AM

Wow to both of your stories. This may help someone. I was one of the thousand IA's working for Pilot / SF 95 storm. I remember the examiner I had from Michagan. She liked my files and I remember her saying on the open file review" I love your photos Ray as they do the scope for you" and I agree with your scope and estimate. It,s not hard to be a good hail adjuster with grape fruit size hail coming in at 60 degrees from the West with 60 mph winds. Then leaving after my 100 files in 3 weeks and on to NOLA on the flood that hit the same day that we got to Dallas. This flood lasted to about x-mas.

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Nicka0782
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10/16/2007 1:52 AM
www.whomovedmycheese.com

if anyone is interested in reading. This book is great for learning how to deal with the one constant in this world...Change.

I can suggest a book for some older veterans, but maybe some vets could suggest a book that will help me with getting in to a new career.
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Dimechimes
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10/16/2007 10:01 AM

Here's an adjuster information blog entry we'd written in July  titled "Who Moved my Claims Cheese" since you mentioned that book. There are about 3 blog entries on changes in the adjusting community in the blog archives as well:

http://dimechimes.wordpress.com/200...community/

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Bobabooey
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10/16/2007 12:14 PM

Ray, I am rejecting your post because you misspelled the word lose.  Please, from now on make sure you proofread the post before you submit it.  Everyone can still understand what you posted (the misspelled word affects nothing) but it makes me feel important to point out mistakes of no importance.

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Gulfsun1
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10/16/2007 2:55 PM

I feel your frustration and must admit it is sometimes irritating to have files rejected for what seem to be ridiculous reasons. I however don't agree with you entirely. I disagree where you state (the misspelled word affects nothing). It may be true in a forum like this. I believe that spelling and grammar are important in your reports. The final report that you turn in is actually a legal document. I am confident that if your final report and narrative are brought out in court by the plaintiffs attorney and it is full of misspelled words and grammatical errors it will be used to discredit you and your accuracy on the stand.  I can hear the questions now "Mr. Bobabooey Adjuster would you consider yourself an accurate and conscientious adjuster?” Answer: Yes "Do you believe that it is important to be accurate and pay attention to detail while evaluating the insured’s claim?” Answer: Yes "Mr. Bobabooey Adjuster do you apply the same level of accuracy and attention to detail in your evaluation of the insured’s claim as you do in preparing your final report and recommendations?” Answer: Yes sir I do "Mr. Bobabooey Adjuster did you apply the same level of accuracy, conscience and attention to the details of my clients claim as you do for all of the claims you handle for XYZ Insurance Co?” Answer: YES "If it pleases the court I would like to request that exhibits 1 thru 150 be admitted into evidence. These are the last 150 final reports that were prepared by Mr. Bobabooey in the normal course of his work with XYZ Insurance Co. I ask that they be admitted for the purpose of showing that Mr. Bobabooey adjuster does not care about accuracy or attention to detail or the importance of being conscientious about his work and furthermore that XYZ Insurance Co doesn't care about accuracy or attention to the details of each of the claims that they must adjudicate.” "Mr. Bobabooey Adjuster do you recognize these reports? Answer: Yes they are mine. “Mr. Bobabooey Adjuster would these reports be an accurate reflection of the attention to detail that you give to the handling of all of the claims entrusted to you by XYZ Insurance Co?”  Answer: Yes “Mr. Bobabooey Adjuster if I was to find inconsistencies and inaccuracies in all of these reports would this surprise you?” Answer: Yes “Mr. Bobabooey Adjuster I have had duplicates made of all of these reports and have had all of the errors in spelling and grammar highlighted for you in bright red. Do you see this?” Answer: Yes “Mr. Bobabooey In your effort to be conscientious and exercise attention to detail, do you proofread your work for errors prior to turning it in?” Answer: Yes “Mr. Bobabooey it wouldn’t seem so now would it?” “Mr. Bobabooey how do you expect this court to possibly believe that any of the details of your report or investigation are accurate based on all the errors highlighted here?” Answer: UHH UHH I don’t know? “Mr. Bobabooey Adjuster do you use a computer to prepare these reports that you claim to be conscientiously prepared?” Answer: Yes “Mr. Bobabooey Adjuster does the software that you use have a tool called a spell checker?” Answer: Yes “Mr. Bobabooey do you know how to use the spell checking tool?” Answer: Yes "Mr. Bobabooey why didn’t you use the spell checking tool so that your report would be accurate? Answer: The misspelled word affects nothing!

I wont go on any further, but I am sure you see where this going.  It can and does happen all the time. The lack of attention to the small details of our work can have far reaching implications that many of us do not contemplate. What we do or don't do is very important.

We all have difficult and frustrating assignments at times. It is important to remember that we are being paid to do the job the way the carrier wants it done. 
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Dimechimes
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10/16/2007 3:20 PM
Craig- great post. This reminds me of training at management claim schools. I have never forgotten the impression of watching one of our very best SIU 20 plus year adjusters cross examined in a class by a great attorney to show us what we could expect even from our best adjusters. Having worked with the adjuster for over 20 years, I felt he would stand up under the toughest of scrutiny but the attorney got him coming and going with each answer during this class exercise even though the adjuster provided the best of answers. It taught us all a valuable lesson that when a case goes to court the things that seemed minor when we let a file pass examination were sometimes the very things that were twisted into a mountain in court.
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BobH
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10/16/2007 4:21 PM
Great thread!
I have been on the stand, for a leaking water heater claim, Insured on vacation in Europe for months, mushrooms growing out of the carpet and casings peeling off the wall with long term hot water.

They will use every tactic known to intimidate you, and try to get you flustered, and discredit you. That's a fact, so you just have to be as good as you can at all times. You never know which one might re-open. We won the case, but it was no fun being in the hot seat.
Bob H
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Ray Hall
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10/16/2007 6:54 PM

This is the land mine that will hit you ever time you give your opinion on a covered or non covered occurance. All adjusters working for the London Underwriters have been warned to never put this in a report as ONLY bad things result from making this statement by an adjuster. Thats why the short report forms get carriers in trouble. If you were the first adjuster on a slab in Mississippi for the wind pool what would you put in the box for cause. The best answer would be ?? or Katrina.

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we2
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10/16/2007 10:54 PM
Wheee! I have really enjoyed this thread. Now . . . how many of you have just been waiting with bated breath [please don’t correct this; see Note below…] for an English teacher (former) to read thru your posts? None? That’s what I thought, but it happened anyway. . .
It would take entirely too long to note all the syntactical & mechanical slips (as well as spelling errors, omitted commas, apostrophes, hyphens, etc.), in most of the preceding comments (although misspelling “conscientious” four or five times in a statement specifically related to spelling & grammar may be the most egregious) so I won’t bother. I certainly agree that a well-written and correctly-spelled narrative/report is important, but the accuracy of the estimate is paramount, and this is dependent on the adjuster’s knowledge of policy and his/her ability to enter the proper items into the program accurately, followed by a careful review of the completed estimate. I admit to occasional typos (who wouldn't?), and certainly think they should not be used to call an entire file into question. A picky inside-adjuster, especially one lacking in field experience, can certainly upset the efficiency of the scope/review system, though, if one is lucky, there may be a knowledgeable liaison who can press a good file on through, regardless.
BTW, I know Mr. Joe very well, and, believe me, this gentleman KNOWS what he’s talking about.

[Note: Of course, it’s not ‘baited’ breath, but ‘bated’ breath, as in ‘abated’. Merriam-Webster assures me that the word comes from Middle English. The term ‘bated breath’ means ‘with restrained breath’, a perfect description of the state in which you sit holding your breath listening intently for any sound.]
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stormcrow
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10/16/2007 11:03 PM

Garbage in  - garbage out. If we as a " profession" (?) turn in the kind of estimates and reports that were common in 04 and 05, then we all will pay for it. 

Given 3 days for trainning, you could take most indepentant adjusters and make a cat adjusters out of them,  You coould take a large group of cat adjusters and only a few could become independant adjusters.

I want to die peacefully in my sleep like my grandfather, not screaming in terror like his passengers.
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BobH
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10/16/2007 11:24 PM

Yep. I am back doing Day Claims again in California, and it's everything from fatal accidents to little dishwasher leaks. When you stay put and personally fix the supplements, over the years you learn what you are doing and don't write garbage estimates.

 

Bob H
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Medulus
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10/17/2007 12:21 AM
"Baited Breath"? That one made me laugh. I pictured a guy with his mouth full of nightcrawlers. Ick!
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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10/17/2007 12:38 AM

I don't think I've ever had a file turned back for spelling or grammar. I'm crossing my fingers as I say that. It's not that I don't ever miss a word or make a typo, but I've just never had the experience of having a file rejected for that reason.

I have had a file turned back because there was no diagram of the bedroom. I told the examiner that it was a rectangle and the dimensions were on the estimate. She turned it back to me. So I drew a rectangle and put the dimensions on the rectangle. Took two minutes and she was happy. I have had a file turned back because there was no elevation diagram (though there was a perimeter diagram). Since there was an inset it was difficult to draw a three D elevation in two dimensions. The examiner didn't understand the elevation diagram when I drew it for her, so I had to explain it to her (same examiner that needed the bedroom diagram). I've had files turned back because the file requirements changed between the time I finished the file and the next day when I turned it in. I've had an examiner turn a file back because I recommended denial of the termite damage and the examiner decided it should be covered because the beam might some day collapse if the termites weren't eradicated (a very happy insured there). There are so many reasons why a file might be turned back, possibly as many as there are examiners in the insurance firmament.

The best thing to do is just to follow the direction. If it is a decision with which I disagree, I always include a phrase such as "according to your instructions, I am recommending denial" or "as you requested, I am removing pad replacement from the estimate and including only carpet replacement." AND, I always keep a copy of both the original and the revision on my computer or backup disk. The staffers are not the only ones who know how to cover their derrière (Did I spell that right, or will the post be kicked back?).

Steve Ebner CPCU AIC AMIM

"With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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Tom Toll
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10/17/2007 1:13 AM

One of the problems with many of the younger adjusters, (not all) don’t know how to spell. Of course there are some veteran adjusters that have that problem also. Thank heavens spell checker was created for them, but some still will not run it. Reports are a reflection of your ability and are the final document of your file. It is read first, then the estimate. Our brains can read misspelled words, however they have a deadly glare to that person reading them. Steve is right in that reports and proper spelling are important in a trial.

I used to be a very good speller; however, age does take some of that away from you. I have Merriam-Webster installed on my laptop and go to it at times and type in words of difficulty, just to keep my brain up do date.

Many years ago when I investigated aircraft accidents, some reports would be 20 to 30 pages long and were always checked, double checked, and then triple checked for content and spelling. Due to the complexity of some losses, very accurate reports were necessary, because some went to trial.  Again, your report, whether short or long, is your final product. Many eyes may see it. Your photograph descriptions are also very important, as is the spelling in them, as they also are your product. I worked a very complex in flight collision years ago where the report was over 50 pages in length and over 300 photos were taken, consisting of debris scatter, placement of debris, and condition of debris. Needless to say, the remarks on the photos were very relevant to the loss and spelling had to be correct.

It is not difficult to learn to spell correctly. There are cd's out there and much reading material.

 

 

Success is not final, failure is not fatal: it is the courage to continue that counts.
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we2
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10/17/2007 9:12 AM

Not only spelled correctly, but with the proper l'accent grave mark also . . .  Bravo!    

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Bobabooey
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10/17/2007 11:04 PM
The reason I started this thread is that it is getting harder and harder for me to make money doing daily claims. It seems that I am working twice as hard and making half the amount of money. I totally understand turning in quality files. I have been adjusting for just under 10 years (I do not have as much experience as some of you but I am no rookie either) As stated in an earlier post, I recently had a file rejected for not writing adjuster under my name on the report. I had another file rejected recently for not deducting windows on a room where I was just painting the ceiling.

This stuff seems minor but it slows me down so much in the long run. I end up having to request claims back over com central, or have a problem with the program when I am trying to make one of these modifications and have to spend time on the phone with technical support. All of these irrelovent changes slow me down which cost me money, and they don't affect anything at all. It is really frustrating when I work 50 hours a week doing daily claims and then I get a paycheck that barely covers my expenses. It puts me in a sour mood.
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BobH
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10/18/2007 2:28 AM
Have you been with the same vendor 10 years, or is this a new gig? The stuff you are describing is not typical - and I would look for greener pastures. I have 16 years experience with day claims (and CAT), and I can say that when you get to the experience level you have, people should be thanking you for solving problems and treating you with respect.

If you aren't getting that, I would start looking around.
Bob H
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HuskerCat
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10/18/2007 5:02 PM

Posted By Bobabooey Adjuster on 10/17/2007 11:04 PM
As stated in an earlier post, I recently had a file rejected for not writing adjuster under my name on the report. I had another file rejected recently for not deducting windows on a room where I was just painting the ceiling. ...

All of these irrelovent changes slow me down which cost me money, and they don't affect anything at all. It is really frustrating when I work 50 hours a week doing daily claims and then I get a paycheck that barely covers my expenses. It puts me in a sour mood.

 

The person reviewing your files is obviously neurotic or unbending towards the common sense side of claim handling.  Do other adjusters that work around you get this same treatment?  It reminds me of a story I've told here before about being given non-passing marks on a couple files during a random file audit by a company bean counter.  The rules said that all property losses had to have a diagram in the file.  That's fine, and I've never disagreed with that even if it was only one simple square room.   But 2 of my randomly pulled files just happened to be for theft losses of personal property from vehicles.  Do you think I had a diagram in those files?  Do you think the auditor cared, or even looked at the cause of loss? He handed us our results and files back on his way out the door and out of the state.  I called to leave him messages and sent emails to argue my position.  Never got a response, so I graded him and sent it up the food chain.  The amazing thing is, I never heard anything back on that either...positive nor negative!

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okclarryd
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10/18/2007 8:40 PM
And just what does "reasonable" have to do with it?
Larry D Hardin
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deba
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10/27/2007 12:24 AM

I have read with interest the comments on this topic.  I've worked for carriers as an inside adjuster and examiner, worked all the 2004 and 2005 storms, reviewed files for MS wind pool after Katrina (some were good and some were off the scale at the other end and showed that many companies weren't even reviewing the reports before sending them in - one estimate I recall had a typo of 1000 dumpsters and was priced and billed accordingly and not noticed by the i/a or his company!) and am now with an independent adjusting company handling daily and CAT claims for TPAs and non TPA companies.  I've not worked as a field adjuster, preferring the a/c inside, but have done ride alongs and reviewed a ton of estimates.  File reviewing has changed considerably in the last few years, particularly since the 04 and 05 storms.  Carriers are becoming tougher and tougher on coverage issues and taking stronger stances against inflated estimates, invalid claims and fraud; they have passed this burden onto the i/a companies. They require a lot of information for little money. and documentation, documentation, documentation! We now review our files twice before sending them to the carrier; just like you, we don't like rejects for using "&" instead of "and" in a report; for not having the documents in a specific order when the file is electronically sent or for changing estimating software prices in order to get an agreed price. Estimates are scrutinized with a fine tooth comb and invoices questioned; the profit margin is slim and so companies are using i/as less and less and hiring full time residential field staff as a matter of routine as this is much more cost effective.

There is a surplus of adjusters now; many experienced adjusters are struggling to find work; only the appraisers and umpires are making money it seems! We are getting deposed more and more and sending insureds to EUOs almost routinely it seems. We get bombarded with demands for appraisals and ridiculous allegations of bad faith from PAs who have no clue how to handle a claim and can't be bothered to even meet with the insureds they are supposedly representing. We have a statutory requirement now to pay or deny a claim within 90 days or the carrier has to pay interest at 11% per day, unless the insured is holding up things - and we have to pay replacement cost upfront now. All this kind of stuff is what is not seen on the "outside", but it pushes costs up and up and as you know, stuff only goes downhill from there. Nothing stays the same for long; we change our file requirements on a regular basis because of carrier demands and it is time consuming and, sometimes challenging, to keep up with everything- the different policies, statutory requirements, case law and file requirements for each carrier. To help the field staff we have regular mandatory training sessions, send out "cheat sheets", have regular supervisory ride alongs etc. 

So, yes, it is a tough time, nothing like it was a few years ago; one either swings with the changes or moves into a new career.  Take a look at the new Claims Magazine salary survey - both carriers and independent companies say the same thing - more requirements and less help, average salaries.

 

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