{"id":900216,"date":"2022-08-04T14:56:19","date_gmt":"2022-08-04T20:56:19","guid":{"rendered":"https:\/\/www.myconstructionexpert.com\/blog\/?p=900216"},"modified":"2022-08-04T14:56:23","modified_gmt":"2022-08-04T20:56:23","slug":"claims-resolution-starts-before-loss","status":"publish","type":"post","link":"https:\/\/www.myconstructionexpert.com\/blog\/claims-resolution-starts-before-loss\/","title":{"rendered":"Effective Claims Resolution Starts Well Before Any Loss. What These Carriers and Brokers Had to Say"},"content":{"rendered":"\n<p>Gregory DL Morris | <a href=\"https:\/\/riskandinsurance.com\/effective-claims-resolution-starts-well-before-any-loss-what-these-carriers-and-brokers-had-to-say\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Risk &amp; Insurance<\/a><\/p>\n\n\n\n<h5 class=\"wp-block-heading\">Carriers, brokers, and claims management firms all stress clarity, communication, and collaboration as keys to successful claims resolution.<\/h5>\n\n\n\n<p>All carriers and brokers encourage their insureds to read and understand their policies. <a href=\"https:\/\/www.myconstructionexpert.com\/blog\/construction-contract-dispute-resolution\/\" target=\"_blank\" rel=\"noreferrer noopener\">Claims resolution<\/a> relies on all the work after that.\u00a0<\/p>\n\n\n\n<p>At best, when a claim occurs it is swiftly paid and insureds understand their policy language and feel protected by it. In the worst cases, insurers and insureds spar over what is and isn\u2019t covered. Disagreements can spiral into litigation, leaving all parties frustrated.&nbsp;<\/p>\n\n\n\n<p>While some claims issues arise out of different understandings of policy language, often the disagreement about the claims process itself.&nbsp;<\/p>\n\n\n\n<p>\u201cOften the issue is not a dispute about whether or how much a loss is covered or not,\u201d said Kimberly R. Vaughn, vice president of claims experience and customer analytics at Amerisure. \u201cThere is agreement between the policyholder and the carrier about that. Rather the issue is the claims management process. That could range from how expeditiously the claim is being handled to whether to settle or go to trial.\u201d<\/p>\n\n\n\n<p>Consequently, carriers will want to make sure they begin conversations about the claims process early on in their relationships with clients. More clarity, in Vaughn\u2019s experience, can lead to better outcomes.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Start Claims Management Today<\/strong><\/h3>\n\n\n\n<p>Effective resolution strategies starts early \u2014 often even before a claim is filed. During the underwriting process, prospective insureds and their brokers should be meeting with folks on the carrier-side to understand how the claims management team will operate if a loss occurs.&nbsp;<\/p>\n\n\n\n<p>\u201cIt starts during underwriting, when our underwriters and claims professionals meet with the prospective insured and its broker to understand the insured\u2019s business, loss history and risk management approach \u2013 and to discuss our hands-on claims proposition,\u201d said Beth Diamond, group head of claims at Beazley.<a href=\"https:\/\/riskandinsurance.com\/wp-content\/uploads\/2022\/07\/Kimberly_Vaughn_.jpg\"><\/a><\/p>\n\n\n\n<p id=\"caption-attachment-97659\">Kimberly R. Vaughn, vice president of claims experience and customer analytics, Amerisure<\/p>\n\n\n\n<p>\u201cIt is often during those early meetings that we discuss logistics around claims notification, selection of defense counsel, partnership throughout the claims process, and other key interactions. It is important for us to hear from the insured about what has worked, and what has not, in its past claims experience. These early discussions set expectations, including ensuring the claims process fits the needs of the individual insured.\u201d<\/p>\n\n\n\n<p>\u201cWalking clients through our claims process before losses are incurred, and sharing pre-loss risk aversion practices, help both insurer and insured navigate complexities once a loss arises,\u201d added Anthony Vidovich, chief claims officer for general insurance at AIG.<\/p>\n\n\n\n<p>\u201cStrong pre-loss relationships help our technical claims handlers work together with risk managers to respond to first notices of potential or actual losses and enable fair and prompt resolution. Outside of claims, loss prevention teams are available to our underwriters and insureds.\u201d<\/p>\n\n\n\n<p>The differences in claims resolution are as numerous as there are losses. Insureds will need to understand how claims management teams from different departments will manage their claims upfront.&nbsp;<\/p>\n\n\n\n<p>From a claims perspective, there are definitely opportunities among brokers, insureds, and carriers to walk through the process in advance of a claim, said Robert Romeo, senior vice president of healthcare and casualty claims at Berkshire Hathaway Specialty Insurance, \u201cso that the first contact is not when the world is on fire. That walk-through is the opportunity to set expectations on all sides, to understand the who and the how.\u201d<\/p>\n\n\n\n<p>That starts with the broker at inception or renewal, Vaughn explained. \u201cWe ask brokers about the goals of the prospect and about their history of losses and claims. A lot of forms are fairly standard across the industry, so what makes the difference is the personality of the carrier and how it meshes with that of the insured.\u201d<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>What to Do When a Dispute Arises<\/strong><\/h3>\n\n\n\n<p>Despite best efforts on the part of insurers, clients will still bring forward claims disputes. When that happens, it is often possible to pull things out of the fire so long as you make communication a top priority.<a href=\"https:\/\/riskandinsurance.com\/wp-content\/uploads\/2022\/07\/Anthony_Vidovich_.jpg\"><\/a><\/p>\n\n\n\n<p id=\"caption-attachment-97660\">Anthony Vidovich, chief claims officer of general insurance, AIG<\/p>\n\n\n\n<p>\u201cYou have got to communicate. It is unwise to assume that all parties have the same information and analysis, so you have to communicate constantly. And everyone needs to remember that while there may be differences of perspective, ultimately you are all on the same team,\u201d Vaughn said.<\/p>\n\n\n\n<p>By and large, policy language is written to be as clear as possible about what is covered and what is not, Max Koonce, chief claims officer, Sedgwick, said. The onus is on the claim professionals to demonstrate their expertise. Collaboration between departments has proved effective as a workers\u2019 comp adjuster may have a different perspective than those working in the general liability or property spaces.&nbsp;<\/p>\n\n\n\n<p>\u201cLines of business also vary greatly,\u201d said Vaughn. \u201cClaims management in workers\u2019 comp is very different from the way it works in general liability or property. What matters is how to try to prevent conflict in the first place, and how to resolve it quickly if it does arise.\u201d<\/p>\n\n\n\n<p>Claims managers from different departments can also share what they\u2019ve found effective for a particular industry. An approach, Koonce said, has worked well for Sedgwick.&nbsp;<\/p>\n\n\n\n<p>&nbsp;\u201cIt begins with the individual examiners and case managers, and their ability to ask different questions \u2026 Together they have such a depth and breadth of experience across sectors of the economy, from health care to retail to manufacturing. It\u2019s important to know what has worked for similar companies,\u201d said Koonce.<\/p>\n\n\n\n<p>\u201cWhere things get into questions is when there are events that we\u2019ve never seen before. That can be an individual situation in a specific claim, or it can be a broader issue, such as business-interruption during the pandemic. That question of policy language has been predominantly settled by the courts in favor of the insurer, although not interpreted in the same manner by many insureds.\u201d<\/p>\n\n\n\n<p>As with most organizations, there are also intervention steps when early signs show a claim becoming difficult. \u201cIt begins with the examiners,\u201d said Koonce. \u201cWhen they deem things are not going down the amicable path, they elevate those concerns to the manager who brings in additional resources.\u201d<\/p>\n\n\n\n<p>\u201cAn early sign of trouble is when we receive a policy limit demand in a venue that is notoriously adverse to the defense and\/or insureds,\u201d said Rob Riccobono, senior vice president, North American Claims Group, for Allied World.<\/p>\n\n\n\n<p>\u201cThe insurance industry can\u2019t pay policy limit demands every time, as this drives up the cost for the insured, so our approach is to analyze the facts and circumstances of the claim and try and have an open dialogue with the policyholder about the merits of the claim and our litigation\/settlement strategy,\u201d Riccobono said.<\/p>\n\n\n\n<p>\u201cAdditionally, we ensure that the defense counsel is communicating with the insured by providing regular updates,\u201d he added.<\/p>\n\n\n\n<p><strong>Data Steps In&nbsp;<\/strong><\/p>\n\n\n\n<p>While the relationship management piece of claims management seems more art than science, Koonce noted that the hard science of data processing has become a highly effective tool for heading off trouble.<\/p>\n\n\n\n<p>\u201cIn today\u2019s business we try to catch things at entry. We use predictive modeling, machine learning, and Big Data analysis. There are triggers that are immediately pushed forward to the examiners with ready reference to resources.\u201d<\/p>\n\n\n\n<p>Data processing is particularly effective in workers compensation claims, Koonce added.<\/p>\n\n\n\n<p>\u201cThere can be a run-of-the-mill injury, and then something in the course of treatment, or prescriptions, or the return-to-work plan is not on track.\u201d<\/p>\n\n\n\n<p>If a claim does end up in court, data analysis may just be an insurers\u2019 saving grace. \u201cWe all know that claims become exponentially more expensive once things have gotten to court,\u201d said Koonce.<\/p>\n\n\n\n<p>\u201cThat is another situation where data analysis is so important. We have data to predict possible outcomes, and resources to avoid litigation.\u201d<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>What to Do When a Claim Goes Awry<\/strong><\/h3>\n\n\n\n<p>Despite all the collaborations and interventions, some claims seem destined for litigation.<\/p>\n\n\n\n<p>While such collaboration certainly facilitates claims resolution in most cases, it is inevitable that complications arise. \u201cIn the life of claims there are friction points,\u201d Romeo noted philosophically.<a href=\"https:\/\/riskandinsurance.com\/wp-content\/uploads\/2022\/07\/Max_Koonce_.jpg\"><\/a><\/p>\n\n\n\n<p id=\"caption-attachment-97661\">Max Koonce, chief claims officer, Sedgwick<\/p>\n\n\n\n<p>\u201cWe are big believers in having direct discussions and hashing things out. In my experience most of the friction points are the result of a lack of information, or a difference of perspective. Reasonable minds can have different ideas. But even so, there is usually an opportunity for mutual agreement.\u201d<\/p>\n\n\n\n<p>Some of those differences of opinion arise from policy language. \u201cI am not an underwriter,\u201d Romeo explained, \u201cbut from a claims perspective, I can see that in crafting policy language it is difficult to contemplate every situation. At BHSI both underwriting and claims talk about risks and about what we expect to see before we write a risk. That way, when claims come, it is something we anticipated and priced for.\u201d<\/p>\n\n\n\n<p>To reduce friction rooted in policy language disputes Vaughn recommends employing an underwriting team that is committed to understanding each insured\u2019s specific business. That way, they can hopefully stem future disagreements over wording.&nbsp;<\/p>\n\n\n\n<p>\u201cIt is important for our underwriters to understand the specific insured\u2019s business,\u201d Vaughn noted, not just that type of company or industry. \u201cThat means understanding the possible sources of disagreements. At Amerisure, our underwriters have a close relationship with our claims group.\u201d<\/p>\n\n\n\n<p>Notably, Romeo includes brokers in the relationship with customers.<\/p>\n\n\n\n<p>\u201cInvolvement of brokers runs the gamut,\u201d he said. \u201cSometimes a broker only does periodic check-ins, or provides the original notice of a claim, but others are actively engaged with underwriters and our mutual customers, the insureds. That can include planning strategy or selecting counsel.\u201d<\/p>\n\n\n\n<p>Speaking for his company, and not necessarily all carriers, Romeo stated, \u201cwe welcome that broker participation. They have a seat at the table, and we are happy to have their expertise and perspective. Third-party claims administrators are also part of the team approach. They definitely fill a need and provide a service.\u201d<\/p>\n\n\n\n<p>Most broadly Romeo reiterated that it\u2019s important to remember the mutual goal of insureds and carriers: \u201cWhen there is some question on coverage, that is where we need discussion. It is usually possible to work through a loss,\u201d rather than deny a claim outright,\u201d Romeo said.&nbsp;<\/p>\n\n\n\n<p>\u201cEvery claim is an opportunity for us to work with our insureds. The goal of every claim is for the insured to get the outcome that is mutually beneficial.\u201d<\/p>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<p><strong>When one of your cases is in need of a construction expert, estimates, insurance appraisal or umpire services in defect or insurance disputes &#8211; please call Advise &amp; Consult, Inc. at 888.684.8305, or email <a href=\"mailto:experts@adviseandconsult.net\" target=\"_blank\" rel=\"noreferrer noopener\">experts@adviseandconsult.net<\/a>.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Gregory DL Morris | Risk &amp; Insurance Carriers, brokers, and claims management firms all stress clarity, communication, and collaboration as keys to successful claims resolution. All carriers and brokers encourage their insureds to read and understand their policies. Claims resolution relies on all the work after that.\u00a0 At best, when a claim occurs it is&hellip; <a class=\"more-link\" href=\"https:\/\/www.myconstructionexpert.com\/blog\/claims-resolution-starts-before-loss\/\">Continue reading <span class=\"screen-reader-text\">Effective Claims Resolution Starts Well Before Any Loss. What These Carriers and Brokers Had to Say<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[11015],"tags":[9895,11732,188],"class_list":["post-900216","post","type-post","status-publish","format-standard","hentry","category-construction-claims","tag-advise-consult","tag-claims-resolution","tag-construction-claims","entry"],"jetpack_publicize_connections":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Effective Claims Resolution Starts Well Before Any Loss. 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