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Linda
USA
127 Posts |
 Posted - 01/06/2003 : 01:26:54
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Moderator's Note: This thread was authored by Clayton Carr. At his request the following posts were copied to this topic:
CCarr
Posted - 01/04/2003 : 22:29:08
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This follows my comments in the "Coverage forum - 'Lump Sum' thread. I urge you to review that commentary and the link regarding the MS/B blurp. This is basically an addendum to what I suggested was coming to your street corner via MS/B, which unfortunately seems to be a looming reality.
A few months ago a 'conference' took place up here called, "2002 Property Claims Summit", a white shirt and VP level type event; hosted by MS/B - Canada.
A lot of talk regarding claims types and indemnity costs. A SVP from Chubb was quoted as saying, ".... 2001 marked the first time in Chubb's history (Canada) that we paid out more in water damage claims than fire ....". The increased water damage claims are coming from the following categories; freezing, sewer back up, leaky roofs, water ingress and mold.
Now back to the host of the event, MS/B - Canada. Jonathan Kost, from MS/B, pointed out to the gathering that the control of loss depends on two critical factors; front line claims handling skills, and data analysis.
Mr. Kost was reported as saying, ".... having a strong front line on the claims handling side is critical, although the true effectiveness of this to the bottom line depends on data collection and analysis. Only through data collection can you determine best practices, and whats happening out there, and how it is impacting on your bottom line. "Analytics" application in the USA has cut about 5 percentage points of the combined ratio of some insurance companies. Canadian insurers could expect the same." (*Source: Canadian Underwriter, Vol 69, No. 11, Pg 43, November 2002 *)
I hope you see how my harp on the carrier's need for "control" is really emphasized and pushed by those comments. In my opinion, Mr. Kost via MS/B is shifting the importance of the adjuster, and making the adjuster function secondary to the primary issue he is selling - data collection and analysis.
What Mr. Kost of MS/B was doing, was selling to the captive audience at the conference, the MS/B solution to shave 5% off ratios.
Remember when, long time ago, Price-Waterhouse was just a good accounting firm to the corporate world? Then they got into 'this and that', and now through another name, they are God's gift to whatever ails any company. Hey, they probably doubled, tripled or more, their gross revenue from sticking all their fingers in everyone's pie.
Lets look at 'the' lowly software vendor, way back 5 years ago or less. They had a product, they tried to make it the best; and those with a good versatile product and good service grabbed some marketshare. But there is only so many of 'us' to consume this product supplied by 3 or 5 competing software vendors. The 'us' even expanded to contractors and insurers, still has a defined capacity.
So, you gotta grow to survive, what do you do? Convince carriers they have a need - "analytics", define the need with the intangible parameters of human behavior; and sell a solution.
The solution is what will follow the warning signs now showing on your current MS/B software. The study of "analytics" and its application will chew up a lot of carrier 'IT' dollars, and undoubtedly show the fralities of an adjuster who previously did or didn't know how to utilize flexibility and judgement - in the adjustment process.
The wheel will turn and "analytics" will rule the day.
I'm sure you will hear all kinds of nice and conciliatory things from the MS/B people who may address this issue with you.
However, 'we / us' are insignificant peons relative to MS/B's venture into "analytics" and the revenue they will derive from it, as they take the carriers down the trail.
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Jim Flynt Posted - 01/05/2003 : 09:48:23
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I want to jump into this discussion, by first saying that I have always thought that DDS (MS/B) was a 'great reporting' software program and a LOUSY estimating program. Sorry, but I just don't need pictures to point at in order to write an estimate.
Further, I agree with everyone here that an estimating program with a 'locked' database is virtually worthless to a competent adjuster. If what is being reported here is true, and I have no reason to doubt the veracity of the reports, then the days of MS/B as an 'elective' software for cat adjusters are fast drawing to a close.
I have said it before that Xactimate 5.8 was (and to me still is) the best estimating software ever written, with Simsol a very close second.
Having said those things, I would like to comment on some of the things which Clayton has said, and perhaps 'piggyback' on his warnings to us.
Clayton has hit the nail on the head in his observations that the carriers are looking for, and demanding, 'control' in the claims process. While he explains the 'why' to some extent, I am not sure he goes far enough in his explanations; although I have no doubt he easily could.
Insurance is first of all, a workable 'concept' who's existence depends on statistics and statistical analysis of large numbers of risks and large numbers of loss events (measured in the realm of frequency and severity). Thus, we are told and hear repeatedly, that insurance is founded on the principle of "the laws of large numbers."
It is no secret that insurance companies have been undergoing serious transitions due to underperforming financial markets, unanticipated loss exposures/claims (mold and terrorism), and differentials in expense inflation relative to income inflation. Unlike most industries, insurance carriers cannot just raise prices at whim when 'costs' go up.
A recent CBS News report, outlined how many insurance companies suffered significant stock market losses from the fraud and failures of World Com, Enron and other corporate misfits. Some of the larger carriers such as State Farm, Farmers, Allstate, etc., lost Tens of Millions of dollars in each of these failed investments, and cumulatively, in the hundreds of millions of dollars.
That same CBS News report, went on to report what and how some carriers are doing to compensate for such recent reduced investment income from the financial markets.
One example for instance, was a greater reliance by carriers, on the C.L.U.E. (Comprehensive Loss Underwriting Exchange) system for risk selection and risk underwriting.
In California, CBS showed, the example of a homeowner who reported a 'water loss' to his carrier, which was paid by the carrier. However, this same carrier then non-renewed this homeowner's policy. The HO shopped and was then denied coverage by 47 standard carriers before he was finally able to find 'non-standard' coverage from an out of state surplus lines carrier. The cost of his homeowner's premium went from $750.00 per year to around $3,400.00 per year. The California homeowner related to the CBS reporter how local Realtors now tell him his house is non-saleable and virtually worthless, due to an inability to insure.
90% of the nation's carriers are now using the C.L.U.E. system for risk selection and risk underwriting, and those risks with a mold 'history' can expect their heads to be on the chopping blocks next.
One need look no further than the almost instant response of the insurance industry to bring government into the insurance and/or reinsurance picture, after 9-11, to see how insurers are and have moved to limit if not eliminate terror exposures.
Why are all of these things important? Because they are negatively impacting combined ratios of carriers or an insurance industry response to such, with events sending them to dangerous record breaking levels. Simply, when things are stretched far enough, something has to 'give' somewhere.
So, how does that effect us? How do these things filter or trickle down to the cat adjuster in the field?
Lots of ways but I want to examine only a couple of reasons.
With the "Analytics' approach Clayton discusses, carriers are, as he says, concentrating on the two critical factors which can be utilized to contain costs: front line claims handling skills and data analysis. To me, the later is being or will be used to measure the first.
A carrier by the very nature of being privy to data from a significantly large amount of claims data, can and does derive 'information' from a statistical analysis of such data. Information which a cat adjuster or vendor likely may not be aware of nor have access to.
ABC Insurance Company may have a loss experience over a 10 year claim history of 100,000 wind claims a year (or cumulative of 1 million in an analysis period). In actuality, the largess of the real numbers could well be even much higher.
Through the statistical analysis of those 1 million claim events, ABC can determine statistics of loss frequency and loss severity.
Loss severity analysis can provide ABC with 'mean' 'median' and 'mode' rankings of historical as well as projected claim exposure in the future.
This affects cat adjusters in that ABC has a pretty good idea of what any 'particular' claim is 'worth' whether measured by location, policy type, peril or catastrophe event.
ABC now knows and understands, for instance, that a 'typical' wind claim in a typical or particular location SHOULD fall into a ranked category of cost within a range of values. Especially as underwriting and reporting data techniques improves, so does the 'precision' of this data, as well as the ability of ABC to manipulate this data to provide meaningful and effective ways to improve the carrier bottom line by searching for and eliminating those reasons which reflect some statistical aberration from a historical average or median.
In other words, with the proper data available from each and every cat adjuster (or staff adjuster, or adjuster), ABC could quickly by way of IT technology 'spot' those adjusters who 'seem' to be either overpaying or underpaying a claim, based on a comparison with ABC's database of historical losses and indemnity payouts.
I suggest, that with the advent of electronic estimates, carriers have been moving toward the use of these readily available tools to measure and control the claims process. But even more so, to measure and control the front line claims handling skills, as Clayton has observed.
An incompetent adjuster is going to be 'spotted' much more quickly by "Analytics" than by some human observer for the simple reason that an electronic statistical measurement can do in nanoseconds what, in the old days, might have taken several weeks for a busy or overwhelmed claims manager or supervisor to do: Spot the incompetent adjusters and send them home.
Talk with any adjuster who has worked 'clean up' for a storm, and you will hear story after story of adjuster incompetence. And when we, as a profession, fail to 'police our own', it is only a matter of time, before it is done for us. Hence, that is why and where we as cat adjusters are now.
Let's face it, in the past, vendors have been more concerned about getting files closed (and hence getting their profits quickly) and less concerned with 'quality control'. Those days are fast drawing to a close, whether the adjusters or vendors know it or not.
It is interesting to me to read the MS/B 'case study' entitled Company Measures Trends in Adjuster Performance. No where in that study as I read it, do they take any responsibility for some of the problems which they outline.
This past summer (2002), I worked as an insurance consultant (not as an adjuster nor as a public adjuster), for a smaller area hail storm, wherein I was able to examine both sides of the claims process; seeing both the adjuster estimates and the final cost invoices paid to the roofing contractors. (For information, all of the adjusters were staff or staff cat adjusters, and all adjusters used one of the 4 major estimating programs, including MS/B).
In each and every instance, the adjusters wrote the estimate, reported to their carrier, and closed the claim file, with all prices based on the software estimating program databases. Costs for roof components and allowances were generally comparable and within a fairly narrow range of pricing.
Interestingly, after the adjusters had written checks and gone home; after the insureds received their indemnity payments, and the roofs were replaced, each of these insureds had a new roof, no out of pocket deductible expense, and almost every one of them put anywhere between One Thousand ($1,000.00) and as much as Three Thousand ($3,000.00) dollars into their pockets.
Now multiplied by hundreds of storms and millions of claims each year in this country, these overpayments of individual indemnity claims due to faulty software and/or carrier database pricing, I contend, are costing carriers hundreds of millions of dollars in unexpected, unwise, underfunded and unfair excess costs. Incompetent and/or dishonest adjusters add hundreds of millions more in excess as well.
Honest adjusters using inaccurate cost databases: Who's fault is that?
Incompetent or dishonest cat adjusters being sent out to work storm assignments: Who's fault is that?
So, if you really want to know what MS/B is doing and why, I suggest that some of the reasons, at carrier direction and with their complicity, are contained herein within this post.
The bottom line is that things are changing, and some are not for the best.
I do suggest each and every cat adjuster is not only being watched, but measured and statistically compared with historical data through electronic observation, to determine whether you know what you are doing, and then doing it correctly. That trend will only gain momentum with greater intensity and precision in the days immediately ahead.
And I do further suggest, for the reasons outlined above, that Clayton has been and is right: cat adjusting as we have known it will never be the same again, and I wanted to share what I think are some of the reasons why.
Sorry for such a long post. But I do hope it will help frame the larger discussion of the future which is long overdue.
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Edited by - JimF on 01/05/2003 10:31:10
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Edited by - Linda on 01/06/2003 01:28:53 |
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Linda
USA
127 Posts |
Posted - 01/06/2003 : 01:35:13
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Moderator's Note: The following post was moved at Clayton Carr's request:
Posted - 01/05/2003 : 17:22:30
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I started this new thread, which is really a continuation of where we left off after discussing the MS/B evolution and affect. A few very good posts in that thread, don't really belong in that software thread, as they deal with the bigger issues facing us.
I wish I could 'copy and paste' a number of those posts to this thread, ahead of this post, to allow a clearer focus and continuation of these issues and problems. I'm not good at setting thread titles, but the noted one is more in line with the issues I address here and some of the other posts I referred to.
I leave it to our venerable Administrator or to our First Lady of 'moderation', to do any 'copy and paste' that they may deem appropriate.
Anyway, Jim has quite nicely taken the topic to another level. It all has to do with our (everyone in the insurance claims niche) future and that of 'control'.
It is worth emphasizing the basic principal of insurance - 'the laws of large numbers', and of course that is the 'gumbo of the day' that feeds people who are into 'analytics'.
Again, in the big picture, the main thorn to insurance today is financial, and best described as Jim put it; "differentials in expense inflation versus income inflation". This drives claims cost containment and control issues.
When C.L.U.E. was first brought online, it was thought to be a savior to insurers. Fast, cheap, and again statistical data, for risk selection. Some insurers used the developing database to reduce their reliance on loss control work via risk inspections. Others used it for adverse risk selection in regards to "ZA" (zip analysis) - 'neighbourhoods' statistically prone to certain types of losses - whether they be electrical fires or furnace blow backs in old neighbourhoods with statistically outdated residential mechanical services, or burglary prone zip areas, or water susceptible neighbourhoods.
The CBS news example stated by Jim, is not an uncommon occurrence. It will only get worse in 2003 as market capacity and risk selection processes collide in what will be a 'tight market' in terms of agent's ability to place business and insurers re-trenching in their unwillingness to expand portfolios in one or more classes of business.
"Analytics" existed years ago, in my days with a carrier. One month of each quarter, the person who opened all the claims mail, would copy any contractor estimate or invoice. Then the next month, that coupled with all staff or hired adjuster created estimates, a review of that would take place to study comparative 'value' of the scope, estimate, indemnity payment, and 'recheck' evaluations. We did have spreadsheets that also allowed a close examination of the average value of any type of claim, from any peril, in any neighbourhood. All this was used as a tool to measure and / or recognize trends and try and 'crystal ball' the following year regarding frequency and severity issues. All this now comes to the Claims Manager and his/her peers packaged for much easier review and to be used for 'determinations', as now noted by Jim.
Regarding Jim's stated foray this past summer, and his findings. I want to suggest to you that his finds are not unique to - as the man from MS/B is quoted as saying in my earlier post - ".... whats happening out there, and how it is impacting on your bottom line ....". This in fact is a serious and re-occuring problem. Carrier surveys (both mail and voice) are regularly finding out that insured's are happy to report they did not have to pay a deductible for the eventual repair. Carrier re-inspections are more regularly finding out that reported and estimated damage is not what exists when it is reviewed prior to or after repairs. It should be clear to see the impact this continuing revelation has on the carrier - relative to trust for who is doing whatever in the field and their thirst for control.
Tom is right, as Jim affirms, that selfimprovement is going to be the cornerstone for any adjuster who wants to survive. But, tied to that issue is the deteriorated level of trust in the 'field adjuster'. That will be much harder to over come, as the carrier claims call centers expand and mature with the built in level of trust found with the 'control at hand' that exists with those venues.
Jim's mention of the implications to adjusters of time and expense billing and fee schedules, is as well a current issue. There are software vendors who have had systems available to statistically review and critique litigation fees for a number of years, and there is now expansion of that review platform to review T&E charges by adjusters. A quite common contributor to the loss of trust is the estimating price point threshhold of fee schedules, as Jim has mentioned. I have seen and have heard of carriers regularly pulling all estimates $1 to $100 dollars over the previous threshhold and scrutinize them carefully, and identify trends of what adjusters and from what vendors, this incidence was coming from.
Another contributing element is again as Jim stated - documentation. If you have 100 or more files in front of you from adjusters and you see repeated generic and non-specific file notes - what is the conclusion? I have often harped to adjusters that they must 'sell' their estimate and coverage conclusion, with adequate and clear documentation.
Ghost's comments made me laugh regarding the pricing survey. I got an unsolicited package like that once a few years ago. I am the last or least qualified person to suggest pricing. I started to do some material pricing using the Home Depot book, but lost interest and abandoned the effort. Sadly, what Ghost speaks of, is the root of where a lot of pricing comes from, that is tweaked regionally and gently by the pricing guru inside the carrier establishment. So yes, 'we' are Santa on any given day, even with a locked database. It is that basic pricing development that contributes to the cause of the insured being able to avoid a deductible and / or having money left over to go to Disney. Unfortunately, I do not think the carriers see the relationship between the two, at least not clearly yet. I'll touch again on this when I comment on another trend I see developing.
Linda, who can blame an insured who either gleefully or sheepishly tells us he didn't have to pay his deductible and / or didn't have to pay as much as he got, to get the repair or replacement? The insured allowed us to scope and estimate the damage, it is 'our' pricing. If they are a beneficiary of a flaw in 'our system', I cann't blame them. 'We allowed it to happen, with the tools provided to us, given an accurate scope.
Having noted Jim's comments regarding his consultant function, and the contrast between the estimate and the eventual outcome, and Ghost's comments regarding the development of price points; I want to share a situation that is developing up here.
I don't want to use this area to get into wording analysis or a comparative study of the wordings. However, consider a policy that provides RC coverage for both structure and contents, subject to the conditions of those wordings. Anyway, up here, there has always been the prevailing belief that RC is an insured 'elective'. That is, indemnity is based on ACV, and if the insured choses / elects to claim RC and meets the conditions of that 'election', they get RC.
However, in practice for at least 5 years, carriers in an effort to be considered 'the best' regarding their claims service, took whatever steps to pay out an insured based on RC. It is only in the last 12 months or so that carriers started to realize the shortcomings of these 'marketing' initiatives that were their settlement styles. Consider any sizeable contents loss, regardless of the peril. Insured's being paid out at RC, seldom led to complete replacement of the claimed items. Insured's would tend to replace the core items that were claimed and either pocket the difference or purchase 'other things' on their personal property 'wish list'. The same applies to some structure losses, where insureds paid out at RC were only getting required repairs done (at best) instead of the estimated replacement of the building components or parts. There is many variables to this use of the indemnity funds, but what I am trying to illustrate is that the paid out indemnity at RC was not utilized fully as such for its intended purpose.
Carriers here now are generally going back to dispensing indemnity as per policy wordings, in fact having approved wording changes made to facilitate those actions. Losses are with a greater frequency being paid out at ACV and when (according to defined wording limitations) and if actual repair or replacement is completed and bills submitted, will gladly pay the differences. "Analytics" of this change in approach are showing astounding 'savings' in net eventual payments, i.e. the insureds are not 'electing' to replace to the degree available. When partial or full repair or replacement invoices are being submitted, they are being closely scrutinized to consider LKQ, per line item; and considerable savings are being found there.
Preferred vendor contractors are seeing a retraction of their previous 'automatic authority' levels. No longer is there widespread utilization of a first response contractor with a $10K carte blance authority, before any level of scrutiny is considered.
There is a whole new emphasis on scope of damages, which is completely distinct from any estimate. A renewed and re-energized training is taking place regarding the adjusters role, authority and function in scoping the damages. Adjusters are being mandated to get reacquainted with their cameras to take meaningful pictures to illustrate the damage they are scoping and not just generic shots of rooms or roofs, and to provide a meaningful description of how that picture relates to an item in the scope.
There are new relationships being forged with preferred vendor contractors. Insured's can still choose whoever, but carriers are now guaranteeing the work of their chosen PVC's.
Insurers are taking more and positive steps to make sure the actual damages are identified in the scope, and that the repairs or replacement actually take place. Note, I have left out the 'estimating' component from that previous statement.
Carriers are working towards creating their own regional price databases that are more realistic to the open market conditions of supply and demand competition among contractors. Carrier vendor management people now have departments that research fair market price points regionally.
Again, all this boild down to two issues - trust (the lack of it) and control (the thirst for it).
I don't blame carriers for the lack of trust for the 'field work' over the past few years. It will be hard to regain by the 'field adjuster' at large. The prevailing lack of trust will fuel the thirst for control. As I said on some other forum, the adjuster that will prevail, will be the one who is a professional, and is recognized as that by the carrier who has been exposed to their work. I suggest again that you will see greater carrier involvement soon in just who the claims vendors are 'allowed' to bring in to handle the carrier claims. There is a core of 'you' out there who will prosper from your consistent and recognized professionalism.
The control issue will continue, from what I just previously suggested, to the maturing of the carrier claims call centers, and other results that this years "analytics" will provide.
It is a fundamental concept that everyone 'wants' to trust the next person, and that you or a corporation 'wants' control over what you do or what the procedures are. The professional insurance person will thrive in this current marketplace. They will establish their trust and hence be seen as a provider of control - a reliable and consistent professional who cares about their contribution to the process and who cares about the well being of the carrier. Those that fall outside that picture, will slowly at first but quite steadily be selected against, in that they will not be trusted to provide a professional service and they will be considered as a control inhibitor.
I said it once in another forum, and it is timely to repeat - a carrier can be your best ally. All you have to do is prove your worth to the carrier.
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Country: ca | Posts: 257
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JimF
USA
1014 Posts |
Posted - 01/06/2003 : 07:21:56
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(Originally Posted on 1/05/2003 under the MS/B Thread and copied to this thread)
Tom, Thanks for your comments, and I especially agree that self improvement is going to be the cornerstone for those cat adjusters and adjusters who want not only to survive, but flourish.
I agree as well, that individual state DOI's will largely be unimportant in this process of change, and that change will largely be driven by the carriers.
The implications of claim statistical analysis and readily available electronic risk, loss and claim data, as outlined in my earlier post, goes much further and in so many more directions than what I could share in one post. Those other implications demand exploration and discussion as well.
As an example, it is that very same statistical data (historical and projected) which allows a carrier to utilize inside telephone call centers with great statistical confidence in the reliability and precision of the telephone claims handling process. The same is no doubt true as well for utilizing 'preferred contractors' in the claims process, as statistical comparisons and measurement of individual 'performance' by such contractors allows a carrier to quickly (again in nanoseconds once a 'history' is developed) to spot and remove those who are performing outside of very narrow statistical cost ranges.
Thus the more immediate applications of "Analytics" has helped to incubate and fertilize the growth of alternative claims handling techniques. Growing use of the internet by consumers will quicken the day when the Internet will play a large role in claims resolution to the detriment of the field adjuster; simply because of the amazing precision of historical and projected loss data readily available.
The implications to adjusters and cat adjusters are much greater than I have outlined. Time and expense billing and fee schedule billing analysis immediately comes to mind as one more tool which can be used by a carrier to spot statistical aberrations in narrow range 'expected' billings, to refute or refuse payment for excessive vendor or adjuster billings.
The 'turn and burn' cat adjusters who are not concerned with 'holdbacks' and hence, not reporting comprehensive and complete loss damages, will be spotted and quickly sent home, and in nanoseconds, thanks to electronic technology.
Similarly, the cat adjusters who are writing their estimates consistently just over the next pricing 'breakpoint' in the fee schedule (to increase their billing income), will soon and rather quickly find themselves in the unemployment line.
The implications to each of us are here, whether we elect to see them or not.
In posts ahead, I will share some additional thoughts of what adjusters can and should do to protect themselves from some, though not all, of these forthcoming implications, including implications of greater risk exposures from an E&O standpoint.
As only one example, an adjuster handling commercial or larger than average claims, or any adjuster handling an unusual claim, will find it productive as well as protective, to document the file more fully to explain what statistical data read alone cannot: those losses and claims which fall outside of projected boundaries as measured by narrow range expectations.
Now, let's hear from more of you.
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Newt
USA
657 Posts |
Posted - 01/06/2003 : 09:46:52
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The phrase Jim uses often,"KNOW BEFORE YOU GO" will apply now more than ever. Cyber space is unforgiving and will tell on you in a nano second if your work is sub-standard. So now this phrase is taking on an additional meaning, its a two edge sword cutting in both directions.
It will require more training at the onset, continued training while earning, less time for idle thinking. Most of all your dedication will have to be absolute.
These new concepts will become the norm, they can and will do a lot for the adjuster who apply themselves. They can also do a lot to you if you don't.
I used a system not as complex but effective in my business. Work orders were issued with the GPS location, the problem, the amount of chemicals, prescription, appointment and all the info on the client. If an appointment was late or missed a fed flag appeared and there had better be comments with a good reason or it become part of the adverse data on that technician. This is the cruel control of data bits. I personnaly don't like it but it is a fact of life.
The computer is our new straw boss, it has no heart or feelings. Many will quit this profession because of this.
The problem with this system will be when the big CAT hits and the number of adjusters will have demished to a point where only about half the present force, maybe less are available.
It stands to reason not many will stick around if they are not used, the cost of maintaining the skills required and other fees will make it impracticle. This is not the cheapest hobby to support.
Staff adjusters will also be affected, the system will not show partiality.
Don't look on this as a problem, it is an opportunity to excell. To try and fail is not all bad,not to try at all is a worse failure. |
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2003 Issues Facing Adjusters
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