Archive for November, 2011

Taking the Jacksonville Jaguars from ordinary to extraordinary!

Along the banks of the Saint Johns River sits a city that never had much of an identity until eighteen years ago today.   On November 30, 1993, the National Football League made the surprising announcement that Jacksonville had been awarded a franchise, beating out cities such as Baltimore, Saint Louis and Memphis.   While this shocked many, it really shouldn’t have been totally unexpected.   After all, Jacksonville is a great city that may very well be America’s best kept secret. 

As the franchise turns eighteen, it is time to shock the nation again, with the sale of the team being announced moments after the firing of head coach Jack Del Rio.   While the latter had been expected, the sale of the team to successful Illinois businessman Shahid Khan certainly was not. 

As it stands today, the team is staying put in the River City.   But this may not always be the case if Khan can’t figure out how to fill the stands at Everbank Field.   With the lucrative Los Angeles market in need of a franchise, Khan may very well decide to bolt.  But would that be the right decision?   

Al Davis moved the Oakland Raiders to Los Angeles in a quest to sell seats; and ultimately moved back to Oakland.   The Los Angeles Rams struggled in suburban Orange County and ultimately ended up in Saint Louis.   Would the fans flock to see the Los Angeles Jaguars? Probably not.

Having lived in both Los Angeles and Jacksonville, my perspective is much different than the pundits at ESPN.   With 3.7 million people, Los Angeles is the second largest city in the United States; Jacksonville ranks 11th.   L.A. also boasts the second largest television market, Jacksonville ranks 50th.  With such a potentially lucrative market, why have L.A. teams struggled to fill their stadiums?

It’s a warm weather phenomenon shared by not only these two cities, but any with close proximity to the ocean, abundant sunshine and pleasant climates.   With the allure of beaches, boating, golf or a million other available activities, why spend a fortune on football tickets?  Plus, many residents have migrated from elsewhere, never leaving behind their allegiances.  Teams in Miami, Tampa and San Diego have struggled for these very same reasons.   

While L.A. might seem like the magical elixir on paper, the reality of crime, traffic, pollution and ridiculously high taxes should all serve as red flags.   California is a tough state in which to do business, which explains the mass exodus of people to places like Nevada, Arizona and yes, Florida, where burdensome business regulations and taxes are virtually non-existent. 

Across the country, Jacksonville boasts one of the highest qualities of living in the United States.   As an owner, why not figure out how to fill the stands here by simply building a product that people want to see.  After all, Florida is a football crazed state.  Friday evenings are spent under the high school lights, Saturday afternoons in the sundrenched Swamp or Doak Campbell Stadium.  During the “world’s largest cocktail party”, the tarps are removed from the seats at Jacksonville’s Everbank Field to a standing room only crowd.  

The Jaguars have this potential as well, provided they have the right leadership to get there.   In  just their second year in existence, this team was one game from the Super Bowl and played throughout the year in a stadium where there were no tarps covering unsold seats because the seats were all sold.  

This is an exciting team in its ascendency that could fill the stands with the right coaching, marquee players and a winning image.   As discussed in the book Kicked to the Curb, there is no room for mediocrity at the top.  The road to success starts with one step, which is precisely what Wayne Weaver did when he brought the Jaguars franchise to Jacksonville.    Now it is time for the new owner to take that next step, transforming the organization from ordinary to extraordinary.  Given his brilliant success in the business world, there is no doubt that he has what it takes to eventually bring the Lombardi Trophy home to the banks of the Saint Johns. 

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Christopher Tidball is a business consultant and the author of Kicked to the Curb and Re-Adjusted: Taking Your Organization From Ordinary To Extraordinary!  He provides consulting services to multiple leaders in the finance and insurance industries.  To learn more, please visit www.christidball.com or e-mail chris@christidball.com

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November 30, 2011 at 8:42 am Leave a comment

Upstaging the staged accident

Staged accidents are on the rise, not only in the United States but globally.   While insurance has always been a magnet for fraud, the ability to stage accidents and  successfully get paid makes it a multi billion dollar proposition.   

According to a May 2009 study by the Insurance Information Institute the U.S. insurance industry incurred $30 billion dollars in losses and loss adjustment expenses as the result of fraud, which accounts for about 10% of all claims. 

One of the most effective scams has been variations of staged accidents.   These types of claims are tough to fight, with insurers often making payments because they simply lack the time, resources or ability to prove the fraud.   In states such as Florida, they are further hamstrung by bad faith laws that can impose significant financial penalties in the event of a wrongful denial.

The reality is that staged auto accidents have been around for as long as there has been auto insurance.  Speaking from experience, my introduction came the first day on the job as a young adjuster handling claims in south central Los Angeles, an area notorious for insurance fraud.  While L.A. has long been a staged accident hotbed, these scams are happening from in locales worldwide.  

Before going into steps to upstage the staged accident, it is important to understand the variations that are being played out.   Some involve a complex cast of characters organized by a capper who orchestrates the entire charade.   He will direct an “insured” will obtain a cheap policy on a car that may or may not exist.   This car will then be run into another in an alley or parking lot and the “injured” occupants will be directed to an attorney for legal representation and medical provider for treatment.  

Other variations, such as a swoop and squat, involve unsuspecting drivers where one vehicle will suddenly pull in front of an inattentive victim and slam on their brakes, causing a rear end collision.  

Another variation is the drive down, where a seemingly honest driver will wave a person merging into traffic through only to accelerate right into them and denying they ever waved them on.   This can also occur in parking lots or left turn situations. 

As discussed in Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary, a rock solid investigation is critical to upstaging staged accidents.   Adjusters need to take the time to physically inspect all vehicles, not only to verify their existence but to photograph and measure the damages in search of clues, such as paint transfers, mismatched damages or metal striations.  

They also need to meet and conduct interviews, in person, with all parties involved in the accident.   During the interview, they should formulate a line of questioning that only people involved in the accident and subsequent medical treatment could answer.   Obtaining descriptions of both cars, other occupants, the responding police officer, the treating clinic and medical providers is a great start.  

As a young adjuster, I often carried pictures of random people in medical garb and would ask those being interviewed if they could identify anyone.  Invariably they would point to someone as their doctor, lawyer or physical therapist.  

Get specific details, such as directions from their home to their physical therapist or clinic.   Ask questions such as what the does the waiting room look like?  Obtain sign in forms and all medical records associated with the treatment.   Review the CPT codes and compare them to the treatment being described.  

Ask about the directional force of the occupants.  If they were rear ended, wouldn’t it defy the law of physics if they say they flew forward? 

Perhaps most importantly, look for the script that may have been provided by the capper which is usually nothing more than a hand written piece of paper telling a person what to say to the insurance company. 

Conducting physical inspections of clinics can speak volumes about a claim, especially when one arrives only to find a vacant lot or a mail drop.   Researching state specific databases on medical providers and attorneys can turn up valuable information about the veracity of the players involved.  

While these are just a few of the many steps that can be taken,  the one certainty is that no stone should be left unturned.   A good investigator recognizes the time that it takes to conduct such thorough investigations and employers should provide them with that latitude.   It is fair to say that staged accident participants know which carriers pay and which ones will fight them, and earning a reputation as the latter will serve to mitigate potential future fraud.  

Christopher Tidball is an executive claims consultant and the author of Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary.   He is a twenty plus year industry veteran and former claims process leader for multiple top ten P&C carriers.   To learn more, please visit www.christidball.com or e-mail chris@christidball.com

November 29, 2011 at 8:43 am Leave a comment

Insourcing vs. Outsourcing: What really matters are people, processes and results

An often asked question by business leaders is, “Why should I pay someone to do the work when I can just do it myself?”  This is very good question, and having worked both inside the financial service and insurance industry and now providing support services for the industry, my answer may come as a surprise.

There is absolutely no need whatsoever to outsource if, and only if, an organization has the resources and infrastructure to do it better internally.   Having spent more than twenty years in the confines of multiple Fortune 500 companies, I can attest to the limitations that exist which have given rise to the myriad of vendors plying a variety of trades. 

The most common obstacle to doing something internally is manpower.  Businesses have become increasingly wary of expanding their workforce for a variety of reasons.   Until there is some semblance of confidence in the economic direction of the country, this is unlikely to change.   Beyond that are levels of bureaucracy that can sometimes impede internal production.  As a result, it is sometimes easier to look outwards for assistance. 

From in sourcing processes to using low cost vendors, expenses often are the overriding factor in making decisions.   While perceived upfront costs should always be a consideration, business leaders should never minimize the potential costs associated with lack of expertise, inefficiencies or dumbed down processes used to drive down price points. 

Consider the case of a large financial institution that opted to utilize a low bid vendor for collection services.   Certainly the upfront costs were slightly cheaper than other bidders.  But to achieve those price points, the service provider relied on a lower skill set of employees which turned out to be a costly error after unfair trade practice allegations began to surface.   In the end, the costs of the ensuing litigation more than erased the upfront perceived savings. 

During my tenure overseeing claims vendor management for a large insurer, daily solicitations were the norm.   Invariably, they always said the same thing.   They were unique, innovative and better than the competition.   I was certainly not alone, as this ubiquitous presentation is what procurement staff in any industry is confronted with.    The challenge is to separate those who can from those who say they can.  The reality is that service providers who have not walked in the shoes of a potential business partner may have difficulty in achieving promised results. 

There is a reason that some products cost more than others.   Reliability, quality, safety all drive our decision making process when looking at commodities such as cars.    The same should hold true when deciding how to run a process.   Can I do it better myself or do I need help?  Will my help know what they are doing or will they get me sued?  Can I save money beyond the upfront perceived savings?   Can I reduce my internal staffing costs? What is my realistic net back to the bottom line? 

Numbers can be very fuzzy and those presenting the numbers should be held to account.   Those asking the questions need to understand what their internal results have been and then measure them against what is being presented.   If something is too good to be true, it probably is just that.  If much of the proposed savings come in the form of “soft” savings, be leery.   Effective and credible business partners will give proposed client’s solid numbers with a quantifiable return on investment.  

The reality is that the most successful organizations identify the most effective processes.  Certainly an organization isn’t going to build a fleet of cars for their staff because it wouldn’t be cost effective; unless you happen to be GM, Ford or Honda.    So the million dollar question remains at what point to economies of scale make sense for internalization of process?  The answer is that it varies, but what doesn’t vary is the need for a quality at all costs approach.  

Expertise costs money.   But with expertise comes results.   Simply put, if given a choice between paying $100 dollars for something that could probably get you $110 back or paying $150 dollars for someone who could guarantee getting you $500 back what would you do?  The same holds true with business processes relationships.  

Rather than looking at the upfront cost savings, focus on the long term benefits.  While a percentage point here or there may be enticing, is it really worth it if millions of dollars are left on the table?  As the Chinese proverb says, “if you are planning for a year, sow rice; if you are planning for a decade, plant trees; if you are planning for a lifetime, educate people.”

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Christopher Tidball spent more than twenty years in multi-level claims related functions for multiple top 10 P&C carriers.   He is an executive claims consultant, contributing writer to Claims Magazine and the author of Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary. To learn more, please visit www.christidball.com or e-mail chris@christidball.com

November 17, 2011 at 7:22 am Leave a comment

Self service claims innovation

Innovation and technology have played remarkable roles in the lives of millions.    Think about where we would be without our smart phones, tablets and the internet?  From a claims perspective, consider where we are today as compared to the manual processes of just a few short years ago.   While this may seem amazing, the steps in our industry have paled in comparison to others in the marketplace. 

It is now possible to shop without going to a store, bank without going to a bank  and travel to the other side of the globe for virtual meetings without ever leaving your home.   The virtual world is upon us where things, while often impersonal, have evolved to the point where we see results with the click of a mouse.  

So what does this mean for the world of auto insurance?  Is there a new virtual reality for insurers?  The answer is yes, and it is the concept of self service claims.  

Just as we shop, fly and communicate virtually, so to can we adjudicate claims.   While not every claim will meet the model, many claims will; which in turn enables insurers to redeploy staff to more complex situations.  

Self service claims is designed to handle lower complexity situations that don’t justify the cost of dispatching a staff appraiser or independent adjuster.   Think of these situations lower cost material damage claims that can be used to drive down severities, LAE and cycle time while improving both customer satisfaction and retention.  

In the simple model, the accident victim contacts the insurer who utilizes a predictive process to determine if the vehicle is repairable.   Based upon a variety of criteria, the claim may receive a self service designation.   At this point, the vehicle owner obtains an estimate from their shop of choice who will, in  turn, work with the carrier or business partner to achieve an amicable resolution. 

Certainly this may be easier said than done, right?   What about fraud, pre-existing damages or inflated repair costs.   In the traditional world, these would have all been valid concerns.   But, with the right technology in place, all of these concerns are proactively addressed.  

The key isn’t that the process will fail, but rather that the company using the process lacks the right tools to ensure success.    Carriers currently using this process are seeing dramatic improvements in across the board metrics.   They are also reaping the rewards of being able to have existing staff focus on claims that have traditionally higher leakage rates.  

Customers are benefiting from the perception that they are in control of the process.   Certainly, carriers never lose ultimate control, but this empowerment creates goodwill among policyholders who are only too happy to renew and claimants who may be enticed by the insurer’s awesome customer service.  

As discussed in Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary, it is this type of transformative philosophy that will redefine the auto insurance industry in years to come. 

By leveraging innovative new technology, the virtual reality of cloud estimating is now upon us.   While this is just one facet of the future of claims, there has never been a better time to seize the opportunity and subsequent benefits.

Innovation distinguishes between a leader and a follower– Steve Jobs

Christopher Tidball is an executive claims consultant and the author of Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary.   He is a twenty plus year industry veteran who has led a variety of claims processes at multiple top 10 P&C carriers.  To learn more, please visit www.christidball.com or e-mail chris@christidball.com

 

November 16, 2011 at 11:44 am Leave a comment

Why won’t my employees listen to me?

Lis·ten is defined as making an effort to hear something or to pay attention or heed.  A seemingly ubiquitous complaint across the claims industry is that of management concerned by staff not listening, following procedures, paying attention or heeding instructions. 

If this is something you have ever experienced, rest assured you aren’t alone.  It has happened to anyone who has ever managed, taught, led or mentored in any industry, coached any sport or raised a family.  But why is it happening in claims organizations where state statutes, civil law and procedure manuals should provide sufficient guidance?

As discussed in Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary listening is a skill.  Just as it takes a certain personality to succeed in the investigation, negotiation, evaluation and settlement of a claim, it takes certain traits to effectively listen. 

It is also important to recognize that one’s perception of another listening may or may not actually be correct.  Consider the old telephone game where you tell a secret to someone and they tell that same secret to another and this goes on for some time.  The end message is invariably different than the original.  By the same token, telling a person to do a more thorough evaluation of a claim is much different than actually instructing them on steps that should be taken. 

There are also degrees of listening, ranging from the maverick that may hear something loud and clear but develop a better way to the insubordinate that simply have no desire to follow instructions.  This can be a fine line in the role of a fiduciary where adherence to civil codes and company procedures is critical to quality and outcomes.

That said, a little streak of independence can be a good thing, provided it adds value to the entire end to end process.   After all, organizations become great when new and innovative ideas continuously percolate.  Never thinking outside of the box would result in the status quo which can stagnate any industry.  

Consider the best of breed, be it Southwest, Honda, Apple, Amazon, Ebay, Cisco, and what their innovations have done to the airline, automotive, computing or retail industries.  Their success didn’t come from adhering to the status quo. It came from innovative people with creative ideas and a management that was confident enough to embrace change.  

So herein lies the problem.   Of the world’s 50 Most Innovative Companies, there are no domestic P&C carriers listed in 2011.   According to Fast Company, which compiled the list, “today’s business landscape is littered with heritage companies whose CEOs battle their industry’s broken model with inertia, layoffs, lawsuits — anything that squeezes pennies and delays the inevitable. How many of these companies will be dominant in 2025? Few.”

So perhaps a better question than why won’t my adjusters listen to me would be what are my adjusters saying, thinking or doing.  This will enable management differentiate the poor and the marginal from the good and the great.   Remember, in most organizations 80% of problems are coming from  the bottom 20% of performers.  Most often, these are the people not listening, constantly complaining and dragging down the company.  On the flipside, 80% of innovative ideas will come from the top 20% of employees.  These are the future leaders who will define the next generation of an organization, depending upon the open mindedness of today’s leaders. 

It is also important to remember that adjusters aren’t the only ones who may not be listening.   The 80/20 rule is universal and somewhere along the way there may be ineffective management that impedes success.   After all, when a football team consistently has a losing record it generally isn’t because of lack of player talent.  

Effective listeners differentiate between words and people, as the latter bring meaning to the former.   The communication of the message is just as critical as the receipt of the message.   Therefore it is important to recognize the intended outcomes when asking people to listen and identify those who are ineffective.

Consider the following example in which adjusters are told to contact claim parties within 24 hours, inspect damaged property within 48 hours and close claims within 7 days.   In theory this should improve claim outcomes.   After all, these are quantifiable and achievable metrics.   Or are they? 

Simply getting people to listen to these instructions leaves a lot of room for unintended consequences.   By rushing the claims process is there the opportunity to overlook fraud or recovery opportunities?  The answer is actually dependent upon the quality of staff.  

Effective performers will not only adapt their processes to improve outcomes, but they will create innovative ways to take the message to improve their work.  Poor performers will selectively listen to the message and try to justify deficient outcomes with excuses such as “unfair”, “unreasonable”, or “unrealistic”. 

While listening is critical, equally important is messaging.   Creating a process by which company initiatives are uniformly conveyed will drive outcomes.   Utilizing a calibration process whereby all employees, at every level, receive the same message can dramatically increase the chance of organizational success. 

When new initiatives, processes or procedures are rolled out, taking the time to educate on not only what is being done, but why, facilitates an environment where change can be embraced instead of resisted.   Far too often, the strategic and the tactical paradigms are at odds, when it takes nothing more than effective communication and listening to bring them into alignment.  

“We have two ears and one mouth so that we can listen twice as much as we speak.” ~Epictetus

Christopher Tidball is an executive claims consultant and the author of Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary to Extraordinary.  To learn more, please visit www.christidball.com or e-mail chris@christidball.com.

November 10, 2011 at 7:03 am 1 comment

Putting the AIM in claim

results

How do you know if your claims organization is producing a quality product?  After all, there are numerous ways to identify quality, right?  While no two carriers or claims processes are alike, there are often similarities.    From FNOL abandonment rate and contact timeliness to cycle time, alternative parts utilization and average indemnity, there seems to be no shortage of usable metrics.   But, is this the optimal way to gauge performance? 

During my years as a process and quality leader for a large multinational insurer, we grappled with a myriad of metrics in our quest to find the ideal formula to drive optimal results.   Much like a football team, the claims organization was measured on statistical data points that were supposed to be indicative of outcomes.   Just like a lot of points should win football games, prompt contact and inspections should win the claims race. 

But what happens when all those metrics are surpassed, yet there is a rise in blown coverage, errant liability decisions or litigation?   While I’m not minimizing the importance of statistical claims data points, I do like to put them into perspective.   Just like football, there is only one statistic that truly matters as winning records are based upon accurate outcomes. 

When designing a quality assurance process, placing emphasis on ultimate outcomes, or ACCURACY, takes into consideration all else.   The actual INVESTIGATION including timely contacts and inspections, accurate coverage and liability decisions, effective negotiations and recovery opportunities will ultimately drive accuracy.   METRICS can then be used to predicatively model process improvement initiatives.      

In many instances, far too much emphasis is spent on metrics as opposed to accuracy and investigation.  In some organizations, so many metrics are measured that very little emphasis is placed on any singular data point resulting in everything being a low priority.   For example, if subrogation identification is 2% of an annual evaluation, how much emphasis will be placed on identification and referral?  To the contrary, a total quality model driven by a single quality score,   should result in improvements in all aspects of the claims process.  If this cumulative total quality score is used to drive individual metrics, the paradigm of the organization will change from chasing numbers to chasing results.  

To emphasize accuracy, certain key milestones should be addressed during the evaluation process.   At a minimum this should include data compliance, coverage, liability, investigations, subrogation, salvage, timeliness and accuracy.   Within each milestone there should be a subset of data that is measured to determine if a file is worthy of replication, or reproduction.    When this occurs, a file may be deemed to meet expectations.   

It is also important to re-emphasize exactly what constitutes an acceptable work product and calibrate the organization so that everyone from the executives to the rank and file employees are on the same page.   Doing what should be done in a file, consistently, timely and accurately, is precisely what should be defined as meeting expectations.   Nothing more, nothing less.  

To exceed expectations, one must go above and beyond the call of duty.   Calling someone in seven hours versus the eight hour requirement hardly constitutes exceptional work.    Rather, a person must take the initiative to think outside the box, dig deeper and farther and turn up critical pieces of information that alter the outcome of what a standard claim investigation would have done.   It can be done; it is the exception.  

As I discuss in Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary to Extraordinary, using concepts to drive ACCURACY, INVESTIGATION and METRICS can fundamentally transform any team.    It will move from reactive to proactive an entire workflow that will expose inefficiencies that can be remediated, resulting in continual process improvement which will give adherents a significant competitive edge in the marketplace.

Christopher Tidball is an executive claims consultant and the author of multiple books, including Re-Adjusted and Kicked to the Curb.   He is a twenty plus year veteran of the insurance industry, having served in various adjusting, management and leadership roles for multiple top ten P&C carriers.  To learn more, please visit www.christidball.com or e-mail chris@christidball.com

November 3, 2011 at 7:13 am Leave a comment


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Chris Tidball is a claims and revenue management consultant and author of the "20 Essential Rules" series of self and organizational improvement books. You can ask him a question at chris@christidball.com

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