Archive for April, 2012

What the NFL Draft means for your organization

With the end of April upon us, it can mean only one thing; the NFL draft.   Each year, team owners huddle with their leadership teams at Radio City Music Hall in hopes of building the foundation for long term success. 

According to ESPN Analyst and former pro football general manager Bill Polian, in today’s NFL, success is built through the draft.    Given the parameters of today’s game, if you don’t draft well, you will lack the foundation necessary to be a perennial playoff team. Free agency can help, but the value of a talented prospect obtained through the draft is far, far greater for an organization. 

Of course Polian knows a thing or two about building winning teams.  As General Manager of the Buffalo Bills, he led them to four straight super bowl games.  He then took the expansion Carolina Panthers to the NFC championship game in just their second year in existence.  Arguably, his greatest legacy will be the Indianapolis Colts dynasty that he built almost exclusively through the draft. 

While there may be no Super Bowl for claims organizations, there is the consistent need to properly execute basic blocking and tackling maneuvers.  Having the right people in place makes that business proposition infinity easier to achieve. 

In the days up to the draft, teams will reflect on their glaring weaknesses from the prior season.  They will scout potential talent at the combine, and look to shore up their foundation for both immediate and long term success.  

This very same concept can be used in your claims organization, and any organization for that matter.   Interviews serve as combines, where talented individuals can show their stuff. Managers act as coaches and scouts, keeping a keen eye on talent. In many instances, those with little prior experience become rookies who work to learn the system in a never-ending quest to take their organizations to the next level.

Like the draft, there are also busts. Having hired hundreds of people during my leadership tenure, I can attest firsthand to my share of Ryan Leaf’s—prospects with immense talent who never panned out. Fortunately, I have a greater share of Peyton Manning’s— players who excelled beyond expectations. 

So just how does one go about finding the talent necessary to take an organization to the next level?  Often it comes from the least-expected places. As I consult organizations looking for long term success, I often draw from past experience.  During my tenure of running claims organizations and quality assurance processes, some of the best results came from those outside the insurance industry who possessed the skills to execute on basic blocking and tackling.

Whether it is campus recruiting or hiring those with experience in fast-paced, goal-oriented organizations both within and outside the insurance industry, there is no shortage of talent. But like the draft, not all players are created equally.

Rather, it takes a combination of intuition, research, evaluation, and a little bit of luck to land the top players of tomorrow. Far too often a disproportionate amount of emphasis is placed simply on background. It’s the mindset of “Hey, he was a great college quarterback so he’ll flourish in the NFL.”  Don’t forget that he played his college ball in a spread offense, which may actually become a liability at a higher level. Rather, focus on what the person brings to the table.

The same holds true in claims.  Just because one has the requisite experience, does not make them an immediate asset.  Can it happen?  Certainly.  But, can there also be bad habits, poor morale, or other factors that could undermine the technical abilities? 

A more effective solution may be to look for the the attitude, the drive and the ambition rather than just technical proficiency.   Keep in mind that some of the most successful adjusters, managers and executives in the insurance industry began elsewhere.  

As discussed in Re-Adjusted: 20 Essential Rules To Take Your Claims Organization From Ordinary To Extraordinary, a myopic view of claims can be very limiting to organizations trying to better themselves. 

Whether it is people, processes or technology, learn from the best in breed, irrespective of industry.   Look at what innovative leaders are doing across the business landscape, and then look to those people who are transforming the world around them.  

Technical skills can be taught; attitude, drive and ambition cannot.  As 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.” By leveraging these concepts in your very own draft, it becomes possible to build the institutional culture, strength and knowledge to truly become extraordinary. 

 

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 an insurance veteran, with extensive leadership experience at multiple top 10 P&C carriers.  He is a frequent industry speaker and contributing writer.  To learn more, please visit www.christidball.com or e-mail chris@christidball.com.

April 24, 2012 at 9:16 am Leave a comment

Mega Millions: is that injury the winning ticket?

With all the hype surrounding the recent Mega Millions, it is easy to lose sight of the lottery in our own backyard, in particular as it applies to those who routinely handle personal injury claims.

During my tenure overseeing auto related casualty losses there were times when it seemed as if we were running our own lottery.   As an insurer, our goal should always be to pay what a claim is actually worth, nothing more and nothing less.  But that may not be the case for the attorney on TV promising millions to those who may have been in an accident, or even thought about it.

At the end of the day, claims will be presented and the biggest challenge is often how one goes about determining value? After all, no two claims are alike and in reality juries are as different as Venus and Mars!

To put it simply, there is no formula set in stone when it comes to evaluating a claim, reviewing damages or assessing liability.   There is no Medicare or Worker’s Compensation fee schedule for putting a value on pain and suffering.  A back injury could be worth nothing or something quite significant.

But, there are basic blocking and tackling steps that those evaluating claims can take to better identify the value of a case.   These 11 critical aspects of the evaluation, while seemingly basic, are often not elaborated on.

1)      Coverage– Was there coverage available for this loss?  Coverage is the most basic element of every investigation, yet there are times when losses are paid that aren’t owed.   A careful review of the policy should be applied, including pertinent exclusions and confirmation that the tortfeasor meets the definition of a covered insured.

2)      Liability– To effectively pursue a claim, the claimant must prove not only damages but liability.   This is one of the most overlooked aspects of the claims process, lacking due consideration of all duties owed and all duties breached.  This assessment should also consider potential aggravating circumstances (i.e. intoxication, fleeing the scene) on the tortfeasor as well as affirmative defenses (i.e. seatbelt defense, assumption of risk) on the defendant.  Keep in mind that nearly half of all claims adjudicated result in comparative fault.   Why is it that lay people assess shared fault at a rate far higher than the experts in claims organizations?

3)      Damages– To effectively pursue a claim, one must establish fault as well as incur damages.   It is critical to review what is presented and make a determination as to what is related versus non related, as well as what is reasonable and necessary.

4)            Mechanics of injury– While claim scenarios may vary, the rules of physics do not.  If a vehicle is rear ended, the directional force of the occupants will be towards the point of impact; not “we were thrown forward” as is often claimed.  A critical aspect of any evaluation should include discussion on whether the injuries alleged are consistent with the mechanism of the accident, including points of impact, directional force and severity of damage to any vehicles involved.  When necessary, utilize the expertise of a bio-mechanical engineer with the requisite credentials for success in court.

5)      Impact on Lifestyle – Injuries impact people differently.   Some people may have a low tolerance for pain.  Some claimants may truly be eggshells, others may be malingerers.   It is important to evaluate the impact the injury had on this individual’s life including their ability to work, care for his or her family, enjoy hobbies and engage in activities of daily living.  There is also often a difference between what they say and what they do.  Seek out independent verification through neighbors, ex-spouses or private investigators when necessary.

6)      Witness potential– What will a jury think of the parties to the claim is a critical aspect of any evaluation.  I recall a deposition some years back when the attorney for the insurance carrier asked the claimant about a rape they committed.   As the claimant looked on in shock, I motioned the attorney to some notes indicating that it was not the claimant who was the criminal, but rather the insured.  Little details can be of significant importance.

7)      Claimant medical history – Yes, details do matter in particular with regard to prior medical history.   A detailed review should include pre-existing conditions, aggravating conditions (diabetes, osteoporosis, heavy smoking, etc.), prior accidents, and prior injuries (including recovery status and permanency/residuals). This section of the evaluation should also include a discussion of any prior claims made by this claimant, which can be identified though indexing sources.  These same sources should be utilized just prior to settlement to ensure that there was no subsequent accident or intervening causes that could potentially alter the valuation.

8)      Medical treatment– This part of the evaluation should include a specific breakdown of the frequency and duration of treatment and the nature of the treatment (i.e., active vs. passive and/or diagnostic tests vs. substantive treatment). The type of provider should also be noted (i.e., chiropractor, M.D., physical therapist, etc.). In addition, were there any gaps in treatment, changes in symptom’s or type of medical provider? What drugs were prescribed and did they achieve intended outcomes?

9)      Prognosis/Permanency– In some jurisdictions, the permanency is required to pursue non-economic damages, such as pain and suffering.   Regardless of jurisdiction, the prognosis will assist in the evaluation process.  Residuals, such as scarring, limping, loss of sensory perception, motor skills or paralysis can significantly add to the value of the claim.

When considering permanency, did the doctor cite an AMA guideline and, if yes, did they refer to the most current edition and did they follow the protocol   established in the AMA to support the finding of permanency? If the venue requires permanency as a condition to recovery has the claimant produced credible supporting evidence to met the venue’s threshold criteria? What is that criteria and what is the evidence which supports recovery of general damages?

10)   Special Damages– Provide a specific breakdown of the following elements of special damages, where applicable: liens, out of pocket medical expenses [separate diagnostic from actual treatment], subrogation and lost wages. Mention if the venue allows for the consideration of credit for collateral sources that have addressed some or all of the special damages claimed.  If any part of the incurred specials is subject to a lien, look at the laws of that venue for potential statutory lien reductions, potential negotiated reductions, fee schedules or comparative negligence.

11)  Probability of outcome– The goal of any injury evaluation should be to properly assess the value of the case, giving due consideration to all aspects as impartially as possible.   Consider claims, cross claims, liability, damages, credibility, type of venue, quality of opposing counsel, and other mitigating factors such as questionable circumstances, pre-existing conditions or low impact.

Did this claim have an undeniable impact on the claimant’s quality of life including (a) Was a job-change necessitated? (b) Was a change of profession necessitated? (c) Was there a loss of job? (d) Is there a permanent inability to work? (e) Is re-education necessary?  Was there an impact on the claimant’s personal/family life, including: (a) Loss of consortium claim (b) Regular hobbies and activities affected (c) Effect(s) on household duties.

These basic elements of the injury evaluation not only provide a foundation for settlement, but success.  The storyline enables anyone, including managers, auditors and attorney’s to see with great transparency who the value was determined.   The level of detail enables adjusters to identify true value with a much higher level of accuracy.   After all, injury settlements were never intended to the be a lottery; they were meant to be fair and accurate compensation when a tortfeasor is liable for damages.

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Christopher Tidball is an executive claims consultant and the author of multiple books including Re-Adjusted: 20 Essential Rules For Taking Your Claims Organization From Ordinary To Extraordinary!  He is a twenty plus year claims veteran, with a variety of management and leadership roles at multiple top 10 P&C carriers.  To learn more, please visit www.christidball.com or e-mail chris@christidball.com.

 

April 9, 2012 at 7:14 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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