Archive for February, 2014

Winning the Gold For Your Claims Organization

It might not have been 1980’s Miracle on Ice, but Saturday’s 3-2 shootout victory by Team USA over Russia was pretty darn impressive.   In fact, there has been a lot to be proud of by our athlete’s as they compete for the gold in Sochi.  Our fellow country men and women are the embodiment of what we should all shoot for in our personal and professional lives, as they will do what it takes to not leave the gold on the table.

Talking about leaving things on the table, we have often discussed insurers leaving significant sums of money on the table, to the detriment of both policy holders and their own bottom line profitability.  Whether it is the processing of salvage, identification of subrogation, missed comparative negligence or inflated medical bills, there still remains significant opportunity to improve claims outcomes.  Fortunately, all of these opportunities are far easier to achieve for us than the gold medals are for our athlete’s at the Winter Olympics.

With the New Year under way, now is the time to identify opportunities.  Certainly there are competing priorities, but the big question is whether they will give you the guaranteed lift that a few tweaks to your existing processes can?

Let’s start with comparative negligence.  Those who follow my blogs know that this is a passion of mine.   Perhaps it comes from my claim roots in pure comparative jurisdictions.   Perhaps it has to do with how simple the fixes can be by following a few key steps.   Regardless, outcomes in this particular aspect of claims can significantly reduce leakage in consumer and commercial lines.

Why is it that a mere 3% of claims industry wide are settled with a comparative negligence assessment?  There are any number of answers, ranging from adjusters are busy to lack of accountability to improper metrics to other priorities.  As one of the key rules in Re-Adjusted: 20 Essential Rules To Take Your Claims Organization from Ordinary to Extraordinary, this single metric has arguably the biggest potential to impact results with one of the smallest ROI’s.

Often carriers attempt to drive this metric through internal processes.   While this can be an effective tactical tool, the long term results typically lag other proven methodologies, such as ClaimIQ’s knowledgebase, a process that replicates your best practices while calibrating your claims organization.

While teaching something changes short term behaviors, leveraging technology can institutionalize these same behaviors while eliminating the bad ones.   Some consider this to be the age old question of whether it is the person or the tool that gets results.  The answer is that it is both.  A person alone cannot build a house.  They need a foundation, lumber and tools to effectively achieve a desired outcome. The same holds true in claims for those desiring long term, meaningful change.

This principal holds true throughout the life of a claim.   Now that we have pinned down liability, the focus needs to be on damages, which can be addressed through medical bill review.  While this approach is often used on the first party side of the business, it is often overlooked on bodily injury claims that tend to have much higher total indemnity expenditures.   By providing adjusters with the proper tools to identify benchmark pricing and eliminating deceptive billing practices, such as upcoding, unbundling and modifier abuse, carriers can gain a significant bottom line return on investment with relatively no effort on their part.

With a simple focus on two key aspects of claims, liability and damages, insurers can claim the gold in their quest to improve consistency, accuracy and outcomes.  Just as it was fundamental execution that allowed the Americans to win the shootout with Russia,  it is this type of execution in claims that provides carriers with a significant competitive advantage.


Christopher Tidball is a claims consultant and author of multiple books including Re-Adjusted and Blocking & Tackling: The Playbook for the Winning Claims Organization.   He is a claims veteran with more than two decades of adjusting, management and leadership experience.   To learn more, please visit


February 17, 2014 at 9:40 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

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