— Quinley Risk Associates

"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.

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"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.

December 18, 2024 December 18, 2024/ Kevin Quinley

Protecting the C-Suite: A New Era in Corporate Risk Management"

“By Kevin Quinley, CPCU, ARM, AIC

Is your CEO safe? The assassination of UnitedHealthcare's Brian Thompson exposed a chilling gap in corporate security and sent shockwaves through the business world. His tragic death raises critical questions about how companies protect one of their most valuable assets – their leaders.

UnitedHealthcare's shareholder value has reportedly plummeted by $45 billion since Thompson's killing. This staggering financial loss tragically quantifies the importance of protecting key executives integral to a company's success and market valuation.

In stark contrast to UnitedHealthcare's apparent lack of security for its CEO, other major corporations invest heavily in executive protection:

Meta (formerly Facebook) spent $24.4 million on security for Mark Zuckerberg and other top executives in 2023.

Alphabet (Google's parent company) allocated $6.8 million for personal security services for CEO Sundar Pichai in 2023.

While UnitedHealthcare's security spending remains undisclosed, the fact that Thompson was walking alone in Manhattan suggests a significant disparity in security measures compared to other large corporations. This killing raises serious concerns about whether UHS adequately assessed and mitigated the potential risks to its CEO, especially given the controversies surrounding the healthcare industry, from drug pricing to insurance coverage disputes.

Potential D&O Liability Exposure

Shareholders and stakeholders could view Thompson's lack of apparent security measures as a breach of reasonable care by UnitedHealthcare's directors and officers. They may argue that:

Failure to Protect a Key Asset: The Board failed to adequately protect the CEO, who is crucial to UHS's performance and shareholder value. This perceived failure could breach a fiduciary duty to act in the Company's best interests.
Negligent Risk Assessment: The Board failed to adequately assess and mitigate potential risks to executive safety, especially given the high-profile nature of the healthcare industry and the potential for targeted violence against its leaders.
Deficient Corporate Governance: The Directors and Officers failed to align security practices with industry norms set by other major corporations, demonstrating a lack of due diligence and oversight in a critical area of risk management.

These claims could find support in legal precedents], where courts have held directors and officers liable for failing to exercise reasonable care in protecting company assets and mitigating foreseeable risks. (Caveat: I am a risk management commentator, not an attorney.)

Implications for Corporate Governance

This tragic event should serve as a wake-up call for boardrooms across all industries, particularly for publicly held companies:

Increased Security Budgets: Companies may significantly increase their executive security budgets to mitigate risks and potential liability. Budgets could include investments in personal security personnel, advanced security technology, and comprehensive security training.
Robust Risk Assessment Protocols: Boards must implement more robust risk assessment protocols addressing executive safety. These protocols should consider the specific threats faced by executives in their industry, including potential threats related to their public profile, controversial business decisions, and the overall security environment.
Security as a Central Governance Issue: Executive protection must become a key corporate governance consideration, integrated into overall risk management strategies. Boards should regularly review security protocols and ensure they align with best practices and evolving threats.
Meeting Shareholder Expectations: Investors may begin scrutinizing companies' executive security measures as part of their due diligence process. Companies should prepare to disclose their security policies and demonstrate their commitment to executive protection.
Insurance Considerations: D&O insurance policies may see changes in coverage and premiums related to executive security risks. Companies should review their insurance policies to ensure adequate coverage for potential liabilities arising from security breaches or incidents.

Beyond Bodyguards: A Holistic Approach to Security

Effective executive protection goes beyond simply hiring bodyguards. Companies must adopt a holistic approach to security that encompasses:

Cybersecurity: Protecting executives from online threats, including harassment, doxing, and data breaches.
Travel Security: Ensuring safe travel arrangements and providing security measures domestically and internationally during travel.
Home Security: Assessing and enhancing security measures at executives' residences.
Crisis Management: Developing and regularly practicing plans to respond to potential security incidents.

Call to Action

Brian Thompson's assassination is a stark reminder of the vulnerabilities facing high-profile executives. Boards and management teams must reassess their executive protection approach to safeguard their leadership and shareholder value in an increasingly unpredictable world. Prudent executive security consciousness merits a proactive, comprehensive, and well-funded approach to security that prioritizes the safety and well-being of company leaders.

Claims Coach Blog

Quinley Risk Associates