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Claims Management

Last year, I bought a Scrabble game to entertain my guests at my summer home, which is out in the sticks in a little town called Skull Valley. With no TV, a group activity like Scrabble helps prevent descents into insanity from the silence. Although we hear an occasional elk bugle or coyote howl, Skull Valley is pretty darn quiet.

Although I hadn’t played Scrabble in decades, I figured I would pretty much smoke my opponents, since one speaks Czech as a first language and the other reads mostly romance novels (nothing against romance novels, but, the most complex words are usually “sigh” and “crushed”). I was dead wrong. In the first game, the romance reader smoked us both, indeed so badly that the Czech speaker quit in the first ten minutes of the game when we refused to let him spell phonetically and sat glaring at us, his arms folded across his chest.

I started thinking about Scrabble strategy and in anticipation of facing them on their next visit, I visited Google and typed “Scrabble strategy.” I found a great link that outlined top tips for Scrabble players. Upon reflection and because I think of almost everything in terms of risk management, I realized the same rules that applied to Scrabble could apply to managing claims.

What I figured out after my initial Scrabble trouncing is that I was applying the way I settled claims to my Scrabble game. I was trained by some great claims managers who taught me the first important lesson of claims handling—make a decision. There are plenty more files where the one you are agonizing about came from, so decide and move on. That is precisely how I played Scrabble, and ended up with about one-fifth the points of my opponent.

As I read the tips on Scrabble Pages and a few other sites, I translated many of those tips, using or paraphrasing Scrabble language, to efficient and ethical claims handling. Here are a few tips. However, I’m sure if you’re a claims person you could add a few of your own.

Move your tiles!

A file doesn’t get any better sitting on your desk. Pick it up, develop a plan of action, make a decision, and kick the claim forward!

Maximize your power tiles

Don’t squander the biggest advantages you may have. If you have winning surveillance, determine the best time to disclose it. If your plaintiff has a criminal record or previous injury you discovered that may undermine credibility, decide how and if that factors into the settlement equation. Play your tiles closely until you have a strategy; don’t inadvertently let diamonds fall through your fingers.

Be consistent

Inconsistency is some adjusters biggest failing — don’t fall prey to it. In Scrabble, you need 20 points a play to win. Score 10 and you need to score 30 on the next word to catch up. The same is true with files. You may be wildly successful on one file, but if you let 20 others erode because you are too focused on the one you spotlight, your performance will still be criticized.

Get thee to a claims association or obtain an insurance designation

Did you know there are 126 official Scrabble clubs in the US? If you want to improve your game, which for our purpose is handling claims, join an insurance association or take insurance classes and network with your peers. I teach the Associate in Claims designation classes and it is sometimes difficult to convince adjusters these classes improve their chances of promotion. Do you sit around and moan about who gets promotions? You are only as strong professionally as your education, your experience and your network.

Follow the rules

Study ethical behavior and know the rules your company espouses. When adjusters schmooze too much with vendors, saying “no” or criticizing them becomes difficult. Keep a professional distance between you and your vendors, no matter how much you like them. In addition, don’t take advantage of claimants just because you know more about their coverage than they do. I have sometimes heard adjusters crow about the money they saved the carrier on insignificant charges that in reality should have been paid. Candor should be your mantra, even when it costs a little bit more.

Look for the hooks

To score in Scrabble, words hang on existing words. In claims, we generally settle claims one at a time. However, one of the first rules in claims handling I was taught is that we will work with the same people, including plaintiff attorneys, over and over again, so build relationships. Relationships are our hooks. When I have worked with an attorney on one file, I determined what other files I had with that attorney or that firm. Next, I kept notes on those attorneys. What is his hobby? Where did she go to law school? Is she a Denver Broncos fan? Maybe he is a Civil War buff and I can couch a settlement in terms of a famous Civil War battle. Do they take cases to trial or are they simply geared to settle? Early in my career I was led down the garden path by one plaintiff attorney in the Bay Area on traffic light sequencing. When I wrote the denial letter, I addressed him by saying, “Bernie, Bernie, Bernie.” About four years later, I was working in Los Angeles on a claim and which attorney surfaced? Bernie. I was able to pick up the phone, call him and immediately we had a rapport. Little things stand out and improve your “hook.” Those hooks are our signature as negotiators and make the next claim with that attorney easier to settle, sometimes even enjoyable.

Track your opponent

Before beginning negotiations, I wrote a list of the strengths and weaknesses of my case. This way, I know what my opponent is likely to emphasize and I have either an answer, an admission—“You’ve got a point!”— or a counterargument. In other words, I know what my opponents are going to say almost before they say it. I can usually anticipate what is coming next. One word of caution—do not become so focused on framing a response that you stop listening. If you have outlined your case’s weaknesses on paper before you negotiate, you can frame a response so you don’t have to think too long before you reply.

It’s okay to root for yourself or your company

I have an advanced degree in sociology and sometimes I feel badly when bad things happen to good people. However, at some point early in my career an excellent file auditor told me to “lose the sociology” and just handle the claim. Ultimately, you work for your employer, and are not a social service agency, despite how you may feel personally on a loss. I realize this is not a problem for most claims people, but for some, it is. It is perfectly okay to know that you are, overall, fighting the good fight, even if a particular claim outcome bothers you.

It’s just a game

With claims handling, just like in life, you will win some and you will lose some. Get used to it. Savor the wins, learn from the losses, but most of all, once the claims is closed, forget about it. There are plenty more where that one came from.

I often tell others that despite the bad rap the insurance industry receives, I would recommend it in a heartbeat to young people looking for an exciting career. Each day in my career has been totally different and challenging and on some days, downright fun. Much like Scrabble.

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