Perspectives | EIGHT CLAIMS GUIDING PRINCIPLES

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EIGHT GUIDING PRINCIPLES

by Scott Rodeghiero

Summer 2009 -- In the course of conducting field claim file audits and TPA performance reviews, we sometimes encounter front line claim handlers who are unqualified to manage files and evaluate each exposure in an early, realistic, active, consistent and qualitative manner. Experience and competence levels vary greatly and so do the personal styles of the claim handlers and their supervisors. Insurance companies and TPAs, above all, are compliant with state licensing and statutory regulations and we usually find them to be performing within industry standards measured in terms of workloads, workflow efficiency, and management information systems processing capability.

On the other hand, training betterment remains an improvement opportunity for many claim departments. Back-to-basics claim file mastery and execution are often lacking. Core fundamentals like coverage, liability, damages, theories of defense development, and disposition initiatives are often inconsistently done. Professionalism and excellence are not always reflected in the files. The Who? What? Where? Why? When? How? and How Much? questions are too often not fully answered and documented.

Early, realistic, active, aggressive, innovative and hands-on are adjectives that define an effective claims management philosophy. Passive, reactive, delay, drift, abandonment, indecision, excuses and the status quo are words that define an ineffective philosophy.