September 28, 2022

Archives for October 2014

Adjusters: Learn from Medical Offices on How NOT to Handle Customers

Don’t get me wrong. I like my family doctor.  But it’s the outlook of the medical establishment and the administrative procedures of offices that drive me crazy.


Exhibit A: I just got an automated “robo-call” from my family doctor’s office telling me that it is time to schedule an appointment. It says call the office to schedule an appointment.

End of story.

So, I dutifully call the office.  The first four times I call, the line is busy.

Finally, I get through.

Them:  “Doctors’ Offices – please hold.”  [Nice greeting!]

After a few minutes on hold, them “How can I help you”

Me:  “I received an

automated `robo call’ from your office telling me to schedule an appointment.”

Them:  “What’s the reason for the appointment?” [WTF??]

Me:  “I’m not sure, you called me.”

Them:  “Did it say the reason for the appointment?”

Me:  “It was an automated robo-call. You called me. It didn’t go into any detail or reason.”

Only after this exchange did I get an appointment. Does that make any sense?

Call the doctor’s office at mid-day and you get a recording, “We are closed for lunch. Please call back later…”

I really like my dentist too. BUT, by the way, don’t call her on Fridays. She’s closed that day. If you make the mistake of phoning on that day, you can’t leave a message on her machine.

When I have an upcoming dentist appointment, the office secretary phones me to confirm and — if I do not happen to be sitting by my phone awaiting her call at that moment — she leaves a message telling me to call her back to confirm. (Note: I have no track record of missing or being a “no-show” at dentist appointments. But, I’m not going to waste my time phoning her to confirm that I got her confirming phone call.)  Where does it end?

And don’t get me started about completing the obligatory New Patient Forms. Years after we started hearing about electronic medical records, it still seems like we have to reconstruct our medical histories from scratch for every new referral. Far be it from the docs to simply request the records from another office. Much better to have the patient take the time to fill out more forms. Plus, making them fill out forms keeps them busy, distracting them from the fact that the medical office is always running behind. But don’t forget to show up 15 minutes early, “just in case”!!

Your time has no value to the medical industrial complex.

Who is the customer here and who’s the service provider?

Could any successful business run its operation in such a customer-hostile method?

Rhetorical questions, admittedly.

Moral:  Assess your own front-line procedures, intake processes  and administrative systems in your claim offices and operations. Ask yourself, “Are these designed for the convenience of the claim staff or for the convenience of paying customers?”

It’s like Lily Tomlin’s Ernestine skit where she says, “We don’t have to care – we’re the phone company.”

Many hospitals and doctor’s offices seem to exude the same attitude. It is a privilege for you to utilize their services and you should be grateful and thankful.

Don’t emulate the medical establishment’s hubris.

(P.S. Please confirm that you received this message J )

Defense Lawyers – 3 Reasons You Should Join the CLM

I admit it. Some of my best friends are attorneys. I am also a member of the Claims and Litigation Management Alliance, better known as the CLM. As a member of CLM, I try to be a promoter and ambassador of the organization and nominate defense attorneys for membership. Some of them are receptive to these nominations. Others are skeptical.  Others confess that they are too busy to join yet another professional organization.


I get it. Many of these same lawyers belong to FDIC, DRI, the ABA, ALFA, the Harmonie Group, etc. After a while, it’s alphabet-soup. Attorneys could literally spend every workday attending some organizational conference, seminar or event.

So why add more one more organization the next in the form of CLM?

So the question is – why should a defense attorney join the CLM?

Disclaimer: I admit to being biased in favor of CLM. With that disclaimer, I think the benefits are multiple.

First, the organization includes a huge chunk of decision-makers from the insurance claims and risk management sectors. Involvement with CLM events puts you in contact with individuals who could be sources of new assignments and engagements for you and your firm.

Second, the annual conference, the periodic seminars and the webinars sponsored by subject matter groups provide value-added and substantive continuing education. They also provide presentation opportunities for attorneys who specialize in insurance coverage and defense. These types of presentations are often the best marketing efforts available, since they position the attorney in the firm as thought leaders in this particular area of the law. I’m a firm believer that the best form of marketing is not self-promotion, but generating and delivering value-added content to your prospective market. That content can be through articles, seminars, webinars, podcasts, etc.

Third, the publications (Claims Management and Litigation Management), committee involvement and

the events just cited provide an opportunity for you to get involved, to showcase your expertise and project your firm’s brand as

a thought leader in certain areas of the law.

All of this with the caveat of the car commercials, “your mileage may vary.”

Like any organization, you will get out of it as much as you put into it. There is no turnkey operation here, where you join the CLM and then turn on the faucet for flowing business opportunities. You have to work it. The results may not be instantaneous. You have to plant seeds, develop your network, grow your network and tend to it over a period of time. Before the harvest comes the planting. CLM is a wonderful field in which to plant.

Any lawyer doing insurance defense work is making a mistake to bypass opportunities to get involved in this organization.

Benefits from joining CLM accrue not only to defense attorneys of course but to insurance company claim personnel and risk management professionals. The tougher sell appears to be to defense attorneys.

To connect with customers, to build your own knowledge base, to establish your leadership role and to harness channels through which to generate value-added content in your subject matter area of the law, CLM membership is a terrific investment for defense attorneys!

Would YOU recommend CLM membership to your defense attorneys? Why or why not? Share your thoughts here…



Book Review — Recent IIA Claims Management Text Fills Needed Void

Claims Leadership and Organizational Alignment, First Edition, edited by Martin J. Frappolli and Ann E. Myhr, 2013, Insurance Institute of America

The Insurance Institute of America has long been a leader in claim publishing. Its Associate in Claims – AIC – designation is one of the premier continuing education distinctions that a claims professional can acquire. For all of its excellence, however, one “knock” on the AIC program is that it took more of a micro than a macro view of claims, focusing on desk-level claims-handling with less attention to the broader areas of claims supervision and management.

That missing piece of the puzzle is filled with the introduction of this relatively new text from the Insurance Institute that aims to fill that void. It is the foundational text for the new AIC 47 course that leads to an AIC-M designation.

Both authors, Frappolli and Myhr, are on the staff of the Insurance Institute’s Knowledge Resources Department. They have teamed to provide a useful introduction to help claim professionals who navigate the often dicey transition from an operational to a management/leadership capacity.

The authors divide the text into nine major chapters:

*  The Aligned Organization

*  Cultivating Organizational Alignment

*  Aligning

Claims within the Insurance Organization

*  Employee Development

*  Managing Across Organizational Boundaries

*  Managing the Claims Function

*  Creating Competitive Advantage

*  Business Continuity Planning

*  Claims Decision Support

Executives at many companies assume that the qualities that make an excellent claims adjuster translate into being a skilled claim supervisor or manager. Unfortunately, that is not the case.

Some qualities will be easily transferable, while other new traits must be honed and polished. The new claims management textbook should assist claim professionals who are making this transition, helping them avoid some of the rocks, shoals and pitfalls that they might otherwise confront. The preamble

of the text makes it clear that the book is not aimed at C-suite executives.

That is a laudable disclaimer, since there are scant resources on how to manage or supervise a claims team while bookshelves groan under the weight of tones regarding the nuts and bolts of claims adjusting.

Some of the more nettlesome claims management issues that future iterations may address in greater depth


*  How to determine the optimal caseload per adjuster?

*  What is the ideal span of

control that claim supervisors should have over adjusters?

*  What factors enter into assignment of cases or accounts to individual adjusters?

*  How can claim managers make meetings more effective and productive?

*  What are best practices in conducting adjuster performance appraisals and reviews?

*  What are the best practices in mentoring adjusters and fostering a culture of continuing education?

*  What management techniques invite bad faith claims against insurance companies?

Claim managers and supervisors seek guidance to address these questions. The text touches upon the subjects that does not deal with them in a thorough manner. Those looking for a hands-on cookbook or guidebook of do’s and don’ts for claims management may be disappointed.

Regardless of whether you plan to sit for the AIC 47 exam or not, I highly recommend a close reading of Claims Leadership and Organizational Alignment. Admittedly, it is not the kind of book that you would curl up with for pleasure reading. Nevertheless, any claim-handler who aspires to making the transition into middle or upper management should view this text as a must read.

Likewise, those who already occupy positions of middle or upper management in claim organizations – cialis gratis whether in an insurance company, a third-party administrator (TPA) or a corporate risk management department – owe it to themselves professionally to familiarize themselves with this text and the principles contained therein.






White and Williams “Coverage College” Gets High Marks Again — Conference Recap

Apple’s iPhone muse and general know-it-all, Siri made a guest appearance at the recent 2014 White and Williams Coverage College in Philadelphia.  Name partner Gale White opened the proceedings with a dialogue with Apple’s Siri, who quickly informed the audience that the eighth annual event had over 530 registrants from 22 states. For the third straight year, I attended the recent White and Williams Coverage College on October 2nd at the Pennsylvania convention Center in downtown Philadelphia. If you get a chance to go, I strongly recommend that you grab it!

2014 Coverage College

As usual, the event runs with Swiss-watch precision. There are two morning and two afternoon concurrent sets of master classes. Like a Chinese takeout menu, the event brochure lets you pick and choose the breakout session that suits your needs and interests the best. Highlights for me were the breakout sessions on “Insurance Coverage 101 and the Life of a CGL Claim” and “The Bad and the Ugly: Ten Worst Recent Decisions on Bad-Faith Liability.”

Lunch at Coverage College features no food fights, but typically some celebrity or mystery guest. In 2012, it was the Philly Phanatic, mascot for the local major-league baseball team. Last year, it was Benjamin Franklin. This year, four Jersey Boys impersonators appeared and lip synced — Milli Vanilli style — a medley of Four Seasons classics. The lyrics were not totally clear, but I believe they must have been tailored to the audience since one of the songs went like this:

“Who Loves You”

Who loves you, pretty baby?
Who’s gonna’ reserve coverage rights?
Who loves you, pretty mama?
Who’s gonna’ make your claim DENIED?

Perhaps the high point of the day was the final speaker. A tradition of late is to have a policyholder attorney from the opposing camp offer perspectives regarding insurance coverage and bad faith. This year did not disappoint. Subbing in at the last minute for the scheduled speaker was Carl Salisbury, a partner from the Kilpatrick Townsend firm in New York City, addressing the topic “Ten Things I Really, Really Wish You Wouldn’t Do.” This was more than a list of gripes against insurance company claim representatives, but certainly has implications for the scenarios that ignite coverage litigation and bad-faith suits. The top ten traits were:

#1.  The five-minute claim investigation

#2.  The kitchen sink information request

#3.  The kitchen sink reservation of rights letter

#4.  The passive/aggressive excess carrier

#5.  The thumb-in-the-eye settlement offer

#6.  The sprint to the courthouse

#7.  The “other insurance” brouhaha

#8.  The misdirected allocation brouhaha

#9.  The impossible billing guidelines

#10.  The “notice of circumstances” shell game

Again, if you get a chance to attend White and Williams’ event, take advantage of it. Since virtually all of the presenters are from the firm, one might think that the program has an inbred quality to it. However, the firm now is so far-flung and with such a deep bench of talent in the insurance coverage area, that a diversity of perspectives is locked in and guaranteed.

The other caveat: each session is 45 minutes long.  So, presenters sometimes struggle to adequately cover the topic within that time constraint. No time is given over to Q&A and audience interaction, which are hallmarks of superb breakout sessions. These are, however, minor quibbles on a first-class event packed with substantive content that should catch the attention and close study of any insurance claim professional.

An intriguing note was the announcement from partner Randy Maniloff that next year’s Coverage College will address the insurance implications of the growing trend toward marijuana legalization, both for medical and recreational use. White and Williams will hash out various topics, weeding out the best from the marginal and will leave no stone unturned to assemble an interesting session around this topic. (No word as to whether the presentation will leave you giggling uncontrollably, with an intense craving for junk food.)

This approach of the 2015 Coverage College could lend a whole new meaning to the term CGL, with the development of a Cannabis Growers Liability policy. One would expect a special joint session covering both first- and third-party exposures. In any event, the audience appeared to be buzzed by this ground-breaking topic.

Would marijuana risks be addressed by existing CGL policies? Stay tuned for further commentary from White and Williams, as Siri does not have the answer to that question.

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