"From Backlogged to Brilliant:

Transform Your Claims Operation in Ten Steps"

In the fast-paced world of claims, backlog is more than just an annoyance—it's a critical bottleneck slowing down operations and frustrating staff.

Imagine a world where you transform your claims workflow, tackle backlogs, and supercharge your claim unit’s productivity and morale.

This scenario isn’t a fantasy. It’s an achievable reality.

Whether you work remotely, at a TPA, within a claim department, or for a corporate self-insured unit, these ten strategies will reduce inefficiencies and drive your claim department to peak performance.

1. Detect and Deter "Drifters."

One key step towards optimizing productivity is minimizing the time adjusters spend away from their desks. If you notice excessive wandering, often pejoratively referred to as "Floaters," it might indicate too little work or poor time management. Encouraging adjusters to stay desk-bound unless necessary, without micromanaging their every move, is a balance that's vital for maintaining both efficiency and morale.

Recognize that periodic breaks to walk around or venture outside help knowledge workers stay productive and recharge mental batteries. (Apple's co-founder Steve Jobs was famous for his walking meetings. Jobs believed that walking boosted his creativity and problem-solving.) Monitoring "floaters" does NOT mean turning the claim department into an Orwellian Surveillance State.

2. Go Digital, Stay Productive.

Embrace digital transformation within your claims processing. By converting paper documents to digital files, adjusters don't need to leave their desks to retrieve information. Digital formats for company claim procedures, lists of approved vendors, and policy forms ensure that everything an adjuster needs is just a click away, dramatically reducing time wasted on physical document retrieval. Caveat: Recognize that there is still a need for and tremendous benefit from person-to-person real-time contact. Encourage eliminating much digital back-and-forth by picking up the phone, dialing someone, and asking, "Can we talk?"

3. Stationary Success: Equip to Empower.

Equip each adjuster's workstation with all necessary tools and information to minimize the need for physical movement. Provide printer access, digital document retrieval systems, and comprehensive online resources. Each workstation should be a self-sufficient hub that enables adjusters to handle most tasks without stepping away.

Again, recognize the legitimate need for periodic breaks. These are not necessarily signs of slackers but help mentally and physically recharge to optimize the cognitive effort needed for successful claim-handling.

4. Provide Immediate Information Access.

Make all relevant information readily available at adjusters' fingertips. Scan in policy forms, endorsements, and reference materials. Upload them to your office's Intranet or claim handling system. Similarly, digitize statutes of limitations, state-specific claim handling practice regulations, and details on coverage for punitive damages to streamline analyses and decision-making processes.

5. Communicate with a Button-Click.

Improve communication efficiency by organizing contact lists and setting up speed dial for frequently called numbers. Doing so saves time and keeps adjusters focused on core tasks without disruptive searches for addresses, emails, or phone numbers.

6. Enable Desk-Based Documentation Access.

Let adjusters manage documentation directly from their desks. Provide dedicated printers for each workstation and use paperless filing systems that adjusters can access electronically. Documents should be printable, email-able, and manageable from the desk, ensuring seamless and efficient communication with insureds and coordination with attorneys or doctors.

7. Use Time-Tracking Technologies.

Employ technology to keep digital tabs on backlogs. By electronically tracking each document and task, managers can easily identify bottlenecks and uneven work distribution. This enables proactive workload management and ensures no adjuster is overwhelmed or idle.

8. Monitor and Balance Workloads for Better Outcomes.

Review and balance the distribution of files among adjusters regularly. This prevents inefficiency and ensures that all team members are productively engaged, with manageable workloads that optimize their potential without leading to burnout.

This tip doesn't mean every adjuster must have identical workloads. Savvy managers customize workloads to claim representatives based on a blend of their experience, expertise, specialization, work habits, and key client relations.

9. Harness Tech to Tackle Tasks.

Invest in technology that automates repetitive tasks, improves accuracy, and enhances overall claim efficiency. This accelerates claim processes and causes claim representatives to focus on more complex claim-handling tasks. The advent of large language models and generative AI will create new risks and opportunities for optimizing claim operations while retaining the needed human element (a topic for a future column).

10. Continually Monitor for Ongoing Improvement.

Monitor and review your claims processing workflows. This helps identify existing inefficiencies and fosters a culture of continuous improvement and adaptation in the face of evolving industry standards and technologies.

By implementing these strategies, your claims operation can improve its efficiency and transform its workflow into a productivity and effectiveness model in the insurance industry.

Accelerate Toward Excellence

Embracing these strategies heralds a new era of claims management. By optimizing each step of your department’s workflow, you not only minimize backlogs but also unlock unprecedented levels of efficiency and customer service. Imagine a department where every claim is smooth sailing and files close swiftly! Claim representatives feel empowered to perform at their best.

The preceding picture isn't a mere vision—it's an attainable reality. Adopt these practices and watch your claim operation strive toward excellence. Leave inefficiency in the past and step into a future where your claim processes set a new standard for success!

Kevin Quinley, CPCU, AIC, ARM, is the Principal at Quinley Risk Associates LLC. He has 47 years of claims experience and serves as a nationwide expert in over 150 cases in state and federal courts. He helps clients improve outcomes through expert evaluation and testimony in high-stakes insurance claim disputes. Kevin has written over 770 articles and ten books on claims, litigation, and risk management.

Visit Archived Posts

"Decoding the Coverage Enigma:

A Deep Dive into Claims-Made Policies"

Reviewed by Kevin Quinley CPCU, AIC, ARM

Claims-Made Insurance - The Policy That Changed the Industry by Frederick J. Fisher, Wells Media Group Inc., 2024, 190 pp., $29.99 PB.

In his new book, "Claims-Made Insurance - The Policy That Changed the Industry," Frederick J. Fisher provides a comprehensive and engaging exploration of claims-made insurance policies.

This compact yet thorough book is not just a guide but a treasure trove of practical knowledge for brokers, agents, underwriters, and claim adjusters. It offers valuable insights into the evolution and impact of these policies on the coverage landscape, empowering readers with a deep understanding of the subject and practical applications in their professional roles. Fisher's comprehensive analysis ensures that readers are well-informed and knowledgeable about claims-made policies, instilling a sense of confidence in their understanding.

(Full disclosure: I know Fred Fisher. I consider him a professional colleague, if not a friend. However, these ties do not bias me toward or against the book’s conclusions and analysis.)

Fisher expertly traces the historical development of claims-made policies, starting with their 1960s innovation to solve the "long tail problem" inherent in occurrence-based policies. This historical perspective enlightens readers about the industry's evolution, making them feel more aware and enlightened, and better equipped to navigate the current insurance landscape. He skillfully explains how these policies aimed to provide greater actuarial certainty for insurance companies and policyholders.

His deep industry knowledge shines as he examines the expansion of claims-made policies beyond professional liability and into other areas, leading to the emergence of two distinct branches with different triggers.

One of the book's strengths lies in its exploration of the complexities arising in claims-made policies over time. Fisher delves into the early challenges of defining a "claim" and how multiple conditions are now requisites for coverage. He astutely points out an irony: while claims-made policies initially aimed to simplify coverage determinations, adding myriad clauses and requirements, leading to increasing complexity, nearly rivaling the intricacies of occurrence policies.

Throughout the book, Fisher underscores the pivotal role of insurance brokers in not just selling policies but ensuring that policyholders thoroughly grasp the nuances and potential pitfalls of claims-made coverage. He provides practical checklists and advice for brokers and policyholders to avoid coverage gaps and denials, equipping them with the necessary tools to navigate the complexities of claims-made insurance. This aspect makes the book an indispensable risk management resource.

Fisher's engaging writing style reveals a sardonic sense of humor that subtly permeates the text, making what could be a dry subject rivaling Ambien, accessible and entertaining. This may be one of the most well-written insurance books I have ever read, striking a perfect balance between informative content and engaging prose.

Fisher doesn't shy away from critiquing certain industry trends, including the shift towards profit-oriented practices that can degrade insurance's original intent as a means of shared protection. While maintaining a balanced perspective, Fisher advocates for policyholder rights and broker vigilance without being dogmatic.

"Claims-Made Insurance" is not just for industry veterans; it also serves as an excellent primer for newcomers to the field. Kudos to the publisher, Wells Media Group, for the book’s reader-friendly format, with double-spaced pages and generous margins, enhancing readability. However, adding an Index or Glossary would have been a welcome enhancement.

Fisher's wealth of information and insights is so compelling that readers may find themselves highlighting passage after passage. I found myself highlighting the pages so much that, when I finished, the book looked like it had a case of jaundice. This underscores the book's value and the abundance of practical content.

Fred Fisher's "Claims-Made Insurance” is a must-read for anyone involved in professional liability insurance. It offers a wealth of knowledge, practical advice, and historical context that will prove invaluable in navigating the complexities of claims-made policies. This book significantly contributes to insurance literature, fostering greater understanding and transparency in an ever-evolving industry.

Fisher's "Claims-Made Insurance" is more than just a book—it's a vital tool for navigating the complex world of modern insurance. Whether you're a seasoned professional or new to the industry, it offers invaluable insights that could prevent costly mistakes and enhance your understanding of claims-made policies.

Don't wait for a coverage dispute to learn these lessons the hard way. Get your copy today. Arm yourself with the knowledge to protect yourself, your clients and your business in today’s ever-evolving insurance landscape.

March 03, 2024

"Michael Clayton" and the Tao of Product Liability Defense

March 03, 2024/ Kevin Quinley

Inflatable penile implants started it all.

After nine years of working for a ginormous third-party claim administrator, I eagerly sought career advancement and change. Handling medical malpractice claims for a teaching hospital system in the Washington DC area gave me an intoxicating taste for liability claims against hospitals and healthcare providers. Plotting my escape from TPA Land, I interviewed for a Claims Manager job at a specialty "captive" insurer who wrote product liability coverage for medical device manufacturers. It needed help.

The captive’s fronting insurer had bungled claim files for years, contesting legit claims and paying spurious ones. Courthouse step surprises abounded. Defense firms complained about slow payments. Reserves oscillated like an EKG strip, with no rhyme or reason. Hence, this specialty carrier, a Bermuda captive, needed a full-time claim professional to right the ship. I was looking for a medmal claim position, but this job involved medical equipment and technology. Close enough!

Diving Into Mass Tort Product Liability – A Stiff Challenge

The biggest claim problem this specialty carrier had was — no joke — over 100 claims around the country with plaintiffs suing a manufacturer of inflatable penile prostheses. (This time frame was pre-Viagra.) I was offered the job and took it, which involved coordinating claims-handling and litigation defense with the product's manufacturer. I later joked privately that "The Pump" technology was better suited to Reebok basketball shoes than urological applications.

Penile implant mass torts were just the beginning. Over the next two-plus decades, I handled and managed mass tort claims involving breast implants, TMJ jaw implants, latex gloves, electro-surgical devices, hip implants, stents, and implantable mesh graphs. Class actions and mass tort cases became my bread and butter.

So, not surprisingly, I did a double-take when recently re-watching "Michael Clayton," a 2007 underrated film and one of my top-10 all-time favorites. If you haven't seen it, I encourage you to do so, whether you are in the insurance and claims business or not. It is an under-the-radar classic. My background in product liability claims quickly tuned me into this movie's narrative.

Cinematic Parallel

When I settled in to watch "Michael Clayton." I didn't know that the movie centers on a product liability case, a class action involving a weed killer and a mythical Nebraska-based company called U-North.

Highlights of the plot that may interest claim folks:

· (SPOILER ALERT) Bad corporate documents sink a defense (though how did these stay suppressed and secret for so long?)

· During a plaintiff's deposition, the lead defense counsel strips down to his tidy whities, adding a new meaning to the term "legal briefs." Also, why did Tim Wilkinson play the lead defense counsel instead of, say, Charlize Theron?

· A partner at Kenner, Bach & Ledeen dances a celebratory jig when the firm hits 30,000 billable hours in defending the weed killer. Yippee!

OK, it's Hollywood. I get it. Nevertheless, if you work in product liability defense, you may get a hoot from "Michael Clayton." Step into the shoes of a jaded "fixer" for a powerful Big Law firm as he navigates the murky waters of product liability and mass torts.

Legal Drama

George Clooney's masterful performance dramatizes high-octane product liability battles, where "smoking gun" documents can make or break a case. Explore the nuanced portrayal of the immense pressures, ethical crossroads, and the often-overlooked human element within the behemoth that is the legal industry.

At the heart of managing mass tort product liability claims lies the pivotal role of critical documents. These are the foundations on which defendants craft legal strategies. Corporations win or lose cases based on whether documents are exonerating or incriminating. In "Michael Clayton," a newly disclosed memo reveals upper management's long-ago knowledge of the carcinogenic health dangers of U-North's herbicide. The memo's discovery shows how a single document can tip the scales and crater product liability defenses.

Sink or Swim Through Discovery

Moreover, the "smoking gun" document takes center stage in the film, highlighting its critical nature in proving liability. When concealed or manipulated by corporations, these documents possess the power to expose negligence or deliberate wrongdoing. Uncovering such evidence becomes a plaintiff's relentless quest, as depicted by Clayton's dogged investigation to unearth the truth behind U-North's actions. The film underscores the high stakes in obtaining these documents and the lengths parties will go to in order to suppress or destroy them. It does not, however, explain how the discovery process and document production failed to unearth a damning memo after years of litigation.

Clayton finds himself part of a law firm complicit in defending corporate interests at any cost, including manipulating legal proceedings and exploiting loopholes. The film critiques the inherent conflict of interest within the legal system, where financial gain predominates over pursuing justice.

Hollywood Drama

Yet, while the film accurately portrays certain aspects of the legal landscape, it also tends to exaggerate and sensationalize certain elements. "Michael Clayton" portrays large corporations as nefarious entities willing to resort to covert operations to limit their legal liability exposure. While corporate malfeasance certainly exists, the movie's depiction overdramatizes the complexities of corporate behavior and legal proceedings.

Further, the film's cloak-and-dagger operations stray into the realm of fiction, painting an unrealistic picture of the legal world. While intrigue and drama are inherent in high-stakes litigation, the extent to which "Michael Clayton" portrays covert activities is sensationalistic.

"Michael Clayton" offers a compelling exploration of the challenges of managing mass tort product liability claims. It underscores the importance of crucial documents and pursuing "smoking gun" evidence while highlighting the suppression of harmful documents. We should view "Michael Clayton's" tendency to villainize large corporations and depict unrealistic cloak-and-dagger operations with a critical eye. While the movie dramatically portrays the legal arena, it is essential to separate fact from fiction when depicting mass tort litigation.

Claims Coach Blog

Quinley Risk Associates