Archive for March, 2012

How Tebowmania can improve your business proposition

Did the Jacksonville Jaguars err by not pushing harder to get Tim Tebow, especially during the window when negotiations seemingly fell apart with the New York Jets?   The sports pundits seem evenly split, with some calling Tebow a distraction, while others are openly critical of the Jaguars lost opportunity to fill the stands.   Perhaps ESPN’s Pete Prisco summed it up best,  “Tebow playing for the New York Jets makes about as much sense as somebody in a Manhattan restaurant ordering shrimp and grits with a nice sweet tea.”

So how does this analogy tie into your organization?  Simply put, businesses routinely make decisions; some right, some wrong, some questionable.   From the Jaguar’s perspective, it was a no brainer not to take Tebow when he first entered the draft, as there were many better players on the board.   This time around, the decision wasn’t so black and white.

Now the situation presents itself to acquire Tebow for little more than a fourth round draft pick.    The return on investment, in terms of ticket sales alone, would have been significant to the organizational bottom line.

Arguably it is very easy to play Monday morning quarterback, which many non decision makers do.  For the folks actually making, and paying for the decisions, game time is a far more difficult proposition.

Tebow certainly has his detractors who focus on his awkward mechanics.   That said, he has established himself as a winner with state and national championships, the Heisman trophy and the NFL playoffs.   Perhaps more than anything is his character which makes him an incredible role model for millions of fans in a day and age where such examples are few and far between.

As discussed in Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary, enterprises become successful in direct correlation to the quality of the talent they acquire.  By identifying A players, motivating B players and eliminating C players, it is possible for any management team to fundamentally transform any organization.

While Tebow may not be the greatest quarterback in the NFL, or any teams long term solution for that matter, he is an A player.  His demeanor and work ethic speak volumes about his potential to improve a dysfunctional locker room, as is reportedly the case with the New York Jets.

The same holds true in any organization, as winners differentiate themselves from whiners.  The former lead organizations in the right direction while the latter serve as an impediment to progress, resulting in organizational dysfunction.

Collectively, the lesson learned for business leaders is to always seek the best available talent.   With the three pronged measure for  organizational success being people, processes and technology, it is the people who are the catalyst to ensuring optimization of all other aspects of the business.

Of course, one of the greatest challenges is to identify the sought after talent.   In a situation, such as Tim Tebow, his celebrity status is evident.   He has performed beyond expectation, and has a demonstrated ability to attract fans.   Within any industry, such talent also exists.  As legendary UCLA basketball coach John Wooden once said, “I’d rather have a lot of talent and a little experience than a lot of experience and a little talent.”

To better understand this statement, it is important to differentiate talent and experience.  While the two CAN go hand in hand, they often don’t.   A prime example is Tim Tebow, who does not have a lot of experience, yet is a talented individual, both on and off the field.

Now, how to find the talent:

1)      Recognize that there is not a linear relationship between talent and ability.

2)      Acknowledge that technical skills can be taught, attitude cannot.

3)      Seek out those ambitious candidates, across the business landscape, who may possess the qualities that have driven success within your organization.

4)      Understand that just because a person has never done the job, doesn’t mean they can’t.   Case in point are many of the trainees I have hired over the years who have outperformed long tenured employees.

5)      Look at hiring as a combination of the draft and free agency.   Building a winning franchise will come through the draft, but key components necessary to win the championship will often come through free agency.

While nobody can predict the impact that Tebow will have on the Jets, or a lack of Tebow on the Jags, there are lessons to be learned.   Let’s face it, talent acquisition isn’t a simple process.  We have all had Ryan Leaf moments, but hopefully learning from the success of others will result in fewer of them as we seek to move our organizations from ordinary to extraordinary.

“For all the cries that Tebow isn’t an NFL quarterback, he is still one hell of a football player, and trading a fourth- and sixth-round pick to get him is a good gamble.”

– Steve Politi, Newark Star Ledger

Christopher Tidball is an executive claims consultant and the author of Re-Adjusted: 20 Essential Rules To Take Your Organization From Ordinary To Extraordinary.   He is a twenty year insurance industry veteran, having worked in a variety of claims and leadership capacities for multiple top 10 P&C carriers.  To learn more, visit www.christidball.com or e-mail chris@christidball.com.

 

 

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March 23, 2012 at 8:37 am Leave a comment

Monday morning quarterback: What the Florida legislature should have done to fix PIP insurance

The problem with the recent “fix” to the Florida No Fault statute is that it does not address the root cause of the problems, which run quite deep.   As the legislature dove into auto insurance no fault during their recent session, the focus was on PIP being the crux of the problem.

While this coverage played a role, consider that staged accidents in California, which is not a no fault state, significantly predate the rise of such sham accidents in the Sunshine State.  The difference between the two states is that PIP made it easier and faster to cash in. 

My insurance career began in California, as an auto claims field adjuster in south central Los Angeles, then the nation’s epicenter for staged accidents.   The scams were simple, involving an “insured” striking a vehicle with several occupants whose claims were brokered by a “capper” to unscrupulous attorney’s.     Medical bills were run up and demands were presented.  The entire process took somewhere between three and six months.  

In Florida, the game became much easier.   No fault afforded an instant opportunity to present for treatment and run up medical bills with a $10,000 dollar blank check divvied up amongst the doctor, lawyer, and capper with the scraps going to the pawns, or “accident victims”.    Complicating matters for insurers is the “no fault” tort threshold that should have precluded payments for pain and suffering.  But in its current watered down state, it is as worthless as the paper upon which it is written. 

What the legislature failed to do in their quest to solve the staged accident epidemic is forsake true insurance reform for PIP reform, which will not work.  

Certainly there are things that can be done to rein in out of control PIP costs, and this new law applies a band-aid in the form of a time parameter for which treatment must be obtained from a defined type of provider.   Of course, unscrupulous providers will have no qualms about changing dates of service, just as medical documents from unethical providers have historically been altered to suit the needs of unscrupulous attorneys and claimants. 

When the legislature took up insurance reform, the hope was that it would be true reform of both tort and no fault statutes.   When it comes to auto, both are interrelated and for those who have never handled auto claims, as may be the case with many lawmakers, sometimes hard to truly comprehend.  

From a historical perspective, no-fault looked good on paper. When a party is hurt in an accident, they go after their own coverage instead of fighting with another’s insurance company. The underlying premise was that costs would go down as the result of decreased litigation.   Such was not the case in Florida, no other “no fault” states.

The first thing to recognize that that most states mandating PIP coverage are not truly no fault.  The lone exception is Michigan, which provides this coverage with a strong prohibition against third party litigation.   Other states, including Florida, have so called thresholds that are so watered down they may as well not even exist. 

As a result, PIP coverage has become very costly while never achieving its goal of reduced bodily injury litigation.   This fact has led several states including Georgia, Connecticut and Colorado to abolish this mandate.

Another state, Pennsylvania, gives customers the choice of purchasing auto no-fault or having the right to sue.

The escalating cost of insurance in Florida has many facets, with arguably the biggest challenges being fraud.   According to the Insurance Information Institute, the “fraud tax” levied on Florida drivers was $549 million in 2010 and was expected to double in 2011.

This fraud comes in all shapes and sizes from staged accidents to burying deductibles to claiming injuries that are nothing more than pre-existing conditions.  Holistically, these scams involve much more than a singular line coverage, such as PIP.

Florida has also become a national hotbed for staged accidents. PIP costs associated with staged accidents increased 77 percent from 2009 to 2010, while billings for services not rendered increased 32 percent, according to Insurance Information Institute estimates.    Again, the propensity for staged accidents in the Sunshine State is not the result of PIP, but rather due to a holistically broken system of which PIP is a part.   The failure to recognize this by the legislature is precisely why their “fixes” consistently fail to solve the problem. 

It is important to recognize that Florida is just one of 13 states to mandate no-fault coverage, yet all states see staged accidents or other forms of fraud.  California is a tort state with no PIP coverage and consistently ranks among the leaders in staged accidents.  

While the legislature made another attempt to fix the problem, their solution once again shows that they may not truly understand what the problem really is, or perhaps they are relying from advice of lobbyists who don’t want solutions to adversely impact their special interests.

In case you are wondering, here are 10 solutions to truly fix what is broken in Florida:   

1)      Eliminate PIP.  While this creates its own new set of challenges, it is one less coverage that will ultimately save consumers money.

2)      Keep PIP but strictly enforce the tort threshold with language modeled after Michigan which will eliminate the frivolous soft tissue cases clogging our courts.

3)      Modify the negligence law so that parties more than 50% at fault for a loss are barred from recovering damages.

4)      Bar uninsured motorists from recovery of non-economic damages, a solution effectively implemented in a number of states.

5)      Cap attorney fees.

6)      Cap tort damages.

7)      Allow “bad faith” only in the rare situations in which an insurer truly does not honor their fiduciary duties.

8)    Allow a reasonable amount of time to investigate suspicious claims.

9)      Give law enforcement the teeth necessary to pursue fraudsters while holding insurers harmless during their investigations.

10)  Enact caps associated with Medicare and workers compensation, on treatment for soft tissue injuries, which comprise the vast majority of cases clogging our courts.

While we don’t know what, if any, impact this new law will have two things are certain.  First, staged accidents will continue at an alarming rate.  Second, consumers will see no reduction in their auto insurance premiums.   Just as every prior attempt to “fix” Florida’s broken system has failed, the language of this latest iteration also lacks a true solution.   Perhaps the next legislative session will bring about more meaningful reform.  But in the meantime, don’t look for a lot of things to change.

Christopher Tidball is an executive claims consultant and the author of multiple books including Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary.  He is a twenty plus year claims veteran with multiple top 10 P&C insurers.   He currently provides consultative services to dozens of insurance carriers looking to improve claims processes, fraud recognition and subrogation identification.   To learn more, please visit www.christidball.com or e-mail chris@christidball.com.

 

 

March 19, 2012 at 6:03 am 2 comments

The Florida No Fault Faux Fix

When the 2012 Florida legislative session began, there was hopeful optimism that tort reform, or at least PIP reform, would finally gain some traction to rein in rampant fraud in the Sunshine State.

It took until the final hours of the session, but Governor Scott got the legislation he sought to reform the mandatory motor vehicle no-fault law and crack down on the abuses in personal injury protection cases that have led to skyrocketing increases for coverage.

While this is a step in the right direction, it is somewhat akin taking the first steps of a 600 mile trek from Tallahassee to Key West.    Simply put, fraudsters aren’t going to pack up and move away, nor are the trial lawyers who are undoubtedly crafting lawsuits to challenge this new legislation in court.

According to the Insurance Information Institute, Florida leads the nation in staged accidents driven by easy access to state mandated $10,000 dollar personal injury protection benefits.    The costs associated with this coverage have risen by $1.4 billion dollars since 2008.

The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital, or from a physician, osteopathic physician, chiropractic physician, or dentist.  The full $10,000 PIP medical benefit is available only if a physician, osteopathic physician, dentist, or a supervised physician’s assistant or advanced registered nurse practitioner determines that the insured has an “emergency medical condition.” Otherwise, the PIP medical benefit is limited to $2,500.

The reality is that obtaining this treatment while perpetrating a fraud won’t be overly difficult.   It may crowd the walk in clinics, but this is one hurdle that is far from insurmountable.

Follow-up services and care requires a referral from a physician, osteopath, chiropractor or dentist. Massage therapists and acupuncture was eliminated from eligibility for PIP benefits, which only eliminates a fraction of the systemic abuse.

From a consumer perspective, it is unclear if there will be any benefit.  According to Florida Consumer Action Network spokesman Bill Newton, “Floridians are in for a rude awakening. Instead of measures aimed at preventing true fraud, we’re left with a bill that pads the pockets of big insurance companies.”

It is also unclear if insurers will be beneficiaries, as they have been asked (but not required) to reduce PIP premiums by 10%.   If insurers who offer PIP do not provide their customers a minimum 10 percent rate reduction, they must explain in detail why not. A subsequent 2014 rate filing has a proposal for insurers to reduce PIP premiums by 25% unless they can show why they’re unable to provide the cut.

Perhaps it is best to analyze this new legislation from a historical perspective.   Since its inception, PIP has been a source of fraud in not only Florida but the dozen other states that mandate this coverage, as well.

No-fault looked good on paper.  When a party is hurt in an accident, they go after their own coverage instead of fighting with an insurance company. The underlying premise was that costs would go down as the result of decreased litigation.   But, as is so often the case with good intentions, it is riddled with unintended consequences.

The problem in Florida is substantial. First, the threshold for determining whether a party may sue has been watered down by the courts over the years, meaning that virtually any injury, irrespective of how minor it actually is, can be adjudicated, even if the true interpretation of the tort threshold says otherwise.

Secondly, a person is able to sue for any percentage of damage for which they were not at fault. Even if a person is 99.9 percent at fault, they are able to sue for damages.

This legislative session was an opportune time for the Legislature to enact meaningful tort form, including capping attorney fees and damages. There could have also been careful deliberation to abolishing no-fault, as was done in Colorado, or making the coverage optional, as was done in Pennsylvania.

Another option could have been to keep no-fault but strictly enforce the law so that only those who are truly killed or maimed in accidents have the right to sue for pain and suffering.

Consider having caps, such as those associated with Medicare and worker’s compensation, on treatment for soft tissue injuries, which comprise the vast majority of cases clogging our courts.

Finally, the legislature could have given law enforcement the teeth necessary to take a bite out of crime and holding insurers harmless while investigating these crimes while invoking penalties that send fraudsters to jail which is a rare occurrence today.

The Florida legislature has a history of trying to fix these problems and have consistently come up short.   This would have been a great time to look at steps being taken by other states where successful reform has meant a corresponding reduction in premiums, litigation and fraud.

In looking at what needs to be done compared to what the legislature did, the outlook does not look good for the new legislation.   While lawmakers tout their accomplishment, the reality is that this may be déjà vu to prior attempts to “fix Florida”.    Now that “PIP reform” has occurred, it is unlikely to be back on the legislative agenda anytime soon, even if the problems inherent with PIP aren’t resolved.

Christopher Tidball is a Florida based executive claims consultant and the author of Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary!  He is an insurance industry veteran providing services to a variety of insurers, TPA’s and self insured’s.  To learn more, please visit www.christidball.com or e-mail chris@christidball.com

March 14, 2012 at 9:48 pm 1 comment

Being the doctor, bloodhound, cop, judge, jury and father confessor all in one

“To me, a claims man is a surgeon. That desk is an operating table. And those pencils are scalpels and bone chisels. And those papers are not just forms and statistics and claims for compensation, they’re alive, they’re packed with drama, with twisted hopes and crooked dreams. A claims man, Walter, is a doctor and a bloodhound…and a cop and a judge and a jury and a father confessor all in one.”  – Barton Keyes, Double Indemnity (1944)
Through the prism of history, the adjusting of insurance claims has been a skill.   Some of which can be learned and some of which is innate.   It is for this very reason that not everyone is cut out for the trade.   Sadly, much of the profession has been “dumbed down” over the years, with cross sections of the job dissected and turned into processing roles.   While this can have a positive impact on productivity, it adversely affects true claims quality.

Handling claims and understanding claims are two very different things.  While virtually anyone can answer a series of questions and generate an outcome, comprehending the outcome is what separates the ordinary from extraordinary.

Liability is a great example to illustrate the fundamental challenges when it comes to claims handling.   A common complaint among claims executives is that liability is assessed at either 0% or 100%, when in fact most multi party accidents involve shared liability.

According to Jury Verdict Research, a national organization that tracks such data, rear end auto accidents accounted for only 45 percent of auto cases adjudicated, with the remainder comprised of intersection collisions, lane changes, chain reactions, and parking lot scenarios. In other words, a lot of claims where there was shared liability.

So how is it that juries, comprised of ordinary citizens with a lack of liability understanding can far outperform claims organizations where an estimated 15% of all claims are closed with  missed subrogation opportunities?

Simply put, there is not a consistent focus on the fundamental execution of basic blocking and tackling skills.   After all, isn’t that was liability assessment is?  It, along with damages, serve as the foundation upon which claims outcomes are built.

While it seems so simple, it often is overlooked.   But liability isn’t the only aspect of claims where there are significant opportunities.   What about asking the right questions at first notice of loss?  Canvassing for witnesses? Conducting scene investigations?  Locating alternative parts for damaged vehicles? Investigating fraud indicators?  Identifying pre-existing injuries to refute new allegations?  The list goes on.

As discussed in Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary, insurance carriers have become hamstrung by a number of challenges.  From contacts and inspections to negotiation and settlement, there is no shortage of executables.   But to be able to achieve goals, one must first have in place the foundation for success.

This foundation is comprised of three key elements; people, processes and technology.  While the latter two are important, nothing can replace the hiring of the best and brightest and providing them with a path for long term success.

Often, this is not the model being followed with a prevailing thought that just about anyone can fill the seat of a claims adjuster.  But, as Barton Keyes said in the insurance claims thriller Double Indemnity, “claims is not a desk job.” It is a skill where success comes from keen intuition and the occasional hunch.   Hiring into this skill is critical to the ultimate outcome or any organization.

Identifying the skills for an organization has to start at the top, as the acquired talent will ultimately define the corporate culture.   By recognizing the difference between A players, B players and C players, leaders can build an organization destined for success.

The key is to first recognize that there is a talent gap between the top and bottom performers, with the latter, or C players, comprising about 20% of a typical organization yet being the cause of 80% of administrative and technical problems.   Simply put, if your left tackle is weak, your quarterback will consistently get sacked.   Replacing the tackle not only protects your biggest asset, but creates a solid line of defense against potential problems.

Unlike football, you don’t always need to have eleven men on the field.   With the right people in place, it is possible to do more with less as there is a direct correlation between talent, productivity and quality output.  These economies of quality are precisely what can be used to gain a competitive advantage in an increasingly difficult marketplace.

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Christopher Tidball is an executive claims consultant and the author of multiple books, including Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary!  He is a twenty year industry veteran, and frequent speaker at claims events including the upcoming Combined Claims Conference in Long Beach.   To learn more, please visit www.christidball.com or email chris@christidball.com

 

March 8, 2012 at 9:50 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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