The Three Ps of Effective Claims Management -

PLANS, PROTOCOLS, & PARTNERSHIPS

Gary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLAPrincipal, Strategic Claims Direction LLC

Gary.Jennings@StrategicClaimsDirection.comwww.StrategicClaimsDirection.com

678.520.3739

When should you consider these issues?

When you are setting up a new program or adding lines of insurance.

When you need to evaluate your current program to achieve the best results you can.

Section 1 - PLANS

“If you don’t know where you’re going, any road will get you there.”

- Lewis Carroll

“If you don’t know where you are going, you will wind up somewhere else.”

- Yogi Berra

PLANS

What do you and your members expect out of the pool?

Cost-effective coverageProfessional claims management that

controls claims costs and expensesAdditional services – e.g., loss control,

trainingOthers?

PLANS

Develop plans based on Expectations Program administration requirementsExecution needed to reach the desired

level of quality, professionalism, and cost controls

PLANS

FOCUS ON CLAIMS ADMINSTRATIONWho will manage the claims?

Self-administration?Third Party Administration?

will you hire (responsibilities, functions, expertise, experience) as claims managers and for ancillary services?

PLANS

What growth plans do you have?type of claims will you manage (now and

in the future)?claims system will you use?guidance and training will you give to

claims staff and to the members?

PLANS

Whenwill you be “up and running”will you add personnel?will you feel comfortable to grow the

program and/or offer additional lines?

PLANS

Where will you locate the claims personnel? All at one site?Field based?Combination?

PLANS

Howwill you measure results?will you deliver training to the members?will you provide regular updates/progress

reports to the members?can you be sure your program attains

leading industry practices?

PLANS

Develop a Business PlanAnswer the WHO, WHAT, WHEN,

WHERE, and HOW questions and address other issues that arise

Review periodically (e.g., semi-annually)Clearly define roles and responsibilities

Section 2 - PROTOCOLS

“When you come to a fork in the road, take it!” -Yogi Berra

“Let‘s get this straight. The police don’t cause disorder. The police are here to preserve disorder.”

-Mayor Richard Daley

PROTOCOLS

For purposes of this discussion, protocols are also known as

ProceduresProcesses

PROTOCOLS

Addresscontrols and authority levels/needsguidelines necessary to achieve leading

industry practicesmetrics needed to measure your

program’s success

PROTOCOLS

Should you document your protocols fully?Yes – to improve adherence to standards

and required practices and to improve and maintain consistency.

No – I have a concern about “discoverability” of the procedures that might work against us.

PROTOCOLS

These should include:“TO DOs““TO DON’Ts”

PROTOCOLS

What should they include?High level plans, philosophies, goalsProgram characteristics

Organizational Structure Staffing and pending workloads –

supervisors/managers and adjusters Supervisory span of control Field personnel or use of independent adjusters

and other partners

PROTOCOLS

Program characteristics (continued)Claims system and documentation

Hardcopy files? Paperless processing? A combination?

How much should I document the individual claim files?

PROTOCOLS

Program characteristics (continued)Communications with claims staff and

members Training “Roundtables” Frequency and type of reports to claims staff and

members Dealing with non-compliant members

PROTOCOLS

Program characteristics (continued)Procedural documentation

Claims procedures manuals with DATED updates when needed

Coordinating internal procedures with system steps and fields

Documentation for partners

PROTOCOLS

Claims Management File documentation Claim intake, set-up,

and assignment Coverage analysis Contact (initial and

ongoing) Investigation and

Inspection

Liability assessment Damage appraisals Damages

documentation Fraud Investigation Payments and

supporting documentation

PROTOCOLS

Claims Management (continued) Reserving Settlement valuations

and negotiations Litigation / hearing

management Potential recoveries

Potential recoveries (subrogation, salvage, risk transfer, excess insurance reporting)

Manager/supervisor control / involvement

File closure

PROTOCOLS

Metrics

“If you don’t know where you’re going, you can’t tell when you’ve arrived.”

-Anonymous

METRICS

Know when you arriveDevelop specific protocolsCreate fields to capture the needed

information to measure compliancePerform regular and objective measurementsCommunicate results objectively and promptlyDevelop corrective action plans when neededFollow up

Section 3 - PARTNERSHIPS

“A Good Ball Club” – on what it takes to make a good manager

-Yogi Berra

PARTNERSHIPS

InternalMembersSafety / Loss ControlRisk ManagementRoad DepartmentMaintenanceSheriff / PoliceOthers

PARTNERSHIPS

External – COMPETITION IS HEALTHYIndependent adjustersAppraisers (auto and property)

Buildings Standard vehicles Heavy equipment / unusual vehicles

Mitigation specialistsSurveillance specialistsDefense counsel

PARTNERSHIPS

Clarify roles and responsibilities“TO DOs”

Specifically inform them the services they are to provide, including time requirements, reports, forms to use, etc.

“TO DON’Ts” We will not pay for services you perform that

exceed our instructions We will remove you from our panel if you do not

meet our standards

PARTNERSHIPS

Clarify your expectations in writing and tell them how they will be measuredAsk them to provide accomplishment reportsProvide regular reports to them based on the

pool’s measurementsReview contract and service requirements at

least annuallyRemove non-compliant vendors promptly and

transfer to compliant vendors

CONCLUSION“It ain’t over ‘til it’s over.”

-Yogi Berra

DISCUSSION / QUESTIONSGary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLA

Principal, Strategic Claims Direction LLCGary.Jennings@StrategicClaimsDirection.com

www.StrategicClaimsDirection.com678.520.3739