Insurance adjusters have a wide variety of tools available to them to make the process of settling claims an easy and smooth process. However, one of the most underutilized options are claims reports. But what are they and how can adjusters utilize this data?

What is a Claims Report?

In order to understand how you can utilize this information, it is important to first understand what it is. Typically, there are two types of reports adjusters use: CLUE reports and ISO reports.

Similar to a credit report you might order, a CLUE (Comprehensive Loss Underwriting Exchange) report is a document that features consumer claims information for the past seven years. Generally, the information is specific to personal auto and personal property losses associated with a particular individual. It does not contain any credit or financial information—only the details of the claim. The Lexis-Nexis group is responsible for gathering the information and compiling the report based on data from insurance carriers.

ISO Claims Services is a program run by Verisk Analytics. Similar to CLUE, the report contains detailed information about past claims that insurers can use to analyze risk and evaluate new situations. The biggest difference with an ISO report is that it provides much more data—including information on third parties who have received payments from insurers as part of claims in the past.

#1: Detecting Insurance Fraud Amongst Insureds and Claimants

Insurance fraud is usually easy to detect if you have a copy of an individual’s CLUE report or an ISO report. Why? The information gathered in this type of report includes any claims a person has had over the last seven years.

One telltale indicator of a fraud is seeing several claims on the report matching a similar description. For example, an insured may call in an incident where he or she is hit from behind and the other car flees the scene. They will then report the same scenario happening weeks, months, or even a year or two after the initial incident as a new claim—usually after the person has switched to a new insurance carrier. Injuries, care providers, and vehicle damage may even be identical in each situation.

In fact, many large insurance fraud rings across the country have been stopped thanks to claims adjusters who took the time to review an ISO or CLUE report before continuing on with a case.

#2: Finding Out About Existing Damage

As an insurance adjuster, another way you can utilize claims reports is to find out about any existing damage on a vehicle or property.

Often, a physical damage adjuster will notice something during their inspection that points to damage happening prior to the reported incident. In this circumstance, using an ISO or CLUE report to see if something was reported in the past is a good way to tell whether the damage is actually new or was incurred during a previous claim.

In some cases, adjusters are even able to see claims reports that happened before the insured purchased the vehicle or property. This is usually more common in terms of homes and other buildings than with automobiles, but these reports can indicate whether a vehicle has had significant comprehensive damage or been considered a total loss at any time in the past.

#3: Discovering More Information About a Third Party

Most insurance adjusters will encounter situations in their careers where a claimant or insured just won’t provide complete information or is incredibly difficult to get in touch with.

This is where utilizing claims reports can help. Often, if you have just a bit of information about a party, you can look up these specific reports to find out more information. In some cases, this can mean the difference between getting facts of a loss and not being able to discern anything at all.

#4: Catching Medical Claims Fraud

While we like to think that most medical practitioners are honest, statistics show that fraud is a big business amongst doctors and other healthcare providers. Another way that adjusters can utilize claims reports is by looking to see the types of payouts made to a particular medical practice in the past.

Why is this relevant? For certain practitioners that prey upon victims of car accidents or job related injuries, over charging for services or billing for treatments that never occurred is often common—costing insurers millions of dollars each year. If a claims adjuster notices a trend when he or she looks at a claims report, they can often spot this type of scheme and help put it to rest by contacting their special investigation unit (SIU), who then puts together a report for local authorities.

#5: To Help Underwriters Determine Risk

Another great way claims adjusters can utilize CLUE and ISO reports is to help the underwriting team effectively assess risk. If an insured appears to have much more going on than your company seems to know about—such as using a vehicle for business use on a regular basis or more claims than they initially let on when applying for coverage—forwarding the data to underwriting is a good way to make sure your firm is accurately rating for that policyholder’s individual risk.

While these two types of reports are both great tools to use while working on a claim, they aren’t the only think you should use if you need more information or simply feel there are multiple fraud indicators. Talk with your supervisor or claims manager to find out what other tools your department utilizes to make the claims process much smoother.

Each year, millions of Americans set goals as the calendar changes to a new year. Are you one of them? Regardless if you’re trying to lose weight or give up a bad habit, there are many things you can do to ensure your work life over the next twelve months goes smoothly.

Here are a few tips that claims adjusters can use to start out 2016 right.

Tip #1: Take Inventory of Where Your Files Stand

Of all the things you can do at the start of the year, taking a solid inventory of where your case files stand is definitely an important one. While you probably already do this on a regular basis, taking a close look at the start of the year is a good way to see if there are any lingering files that simply require a few quick tasks to wrap up.

Review each one and jot down the next three things that need to be accomplished to take it to closure. Make a list of these tasks and start working on the easy ones, such as sending a letter or making a quick phone call. Repeat this process every few weeks throughout the year. You might be surprised how quickly the file closures happen by just taking this simple little step!

Tip #2: Put Together a Daily Routine

Another way to get your year started right is by putting together a daily routine. If possible, segment your day into different tasks to help keep things going as smoothly as possible. For example, maybe you decide to use an hour in the morning to answer emails or review files, and two hours in the afternoon to schedule recorded statements.

Of course, handling insurance claims files is never predictable for adjusters, so having flexibility in the schedule you choose is also important. If you have to change up things in a few weeks or months to accommodate what’s going on in your department, then that is perfectly fine. While it’s not always possible to stick to your new routine, it’s still healthy to have a general, predictable routine that you try for. It can definitely help break an overwhelming day up into something much more manageable.

Tip #3: Give Yourself Something to Look Forward To

The holidays are over and now it is time to get back to the grind. As claims adjusters, it is really easy to get caught up in the chaos of everyday file handling—contacting claimants, taking recorded statements, staring at a daunting caseload, or even just answering a phone that is ringing off the hook. At the start of the year, it is really important to give yourself something to look forward to. Maybe it’s as simple as rewarding yourself with a cup of your favorite java from the coffee shop around the corner, if you can just get through the next five subrogation demands. Perhaps it’s a few days off in the springtime to get out of the office and enjoy the weather. Everyone is different, do what works best for you. Make sure you set rewards for yourself throughout the year, as having something to look forward to is an excellent motivator.

Tip #4: Think About Where You Want Your Career to Go

Very few people decide in kindergarten that they want to be insurance claims adjusters. Usually, it is a job that you get into one way or another that doesn’t have to do with initial career aspirations—and that is totally okay. It’s a great career. But, now that you’re here, be thoughtful about what you’d like to achieve in your role. You have a multitude of different options to consider as you work your way up the ladder.

The beginning of the year is a good time to think about where you want your job as a claims adjuster to go. Are you hoping to rise into management? Or do you simply want to make a lateral move into special investigations, theft, or some other department? Take time at the start of the year to really think about where you want to be twelve months from now and make a list of everything that needs to happen in order to make this a reality. Review this list every month to make sure you’re making progress.

While these are just a few tips to consider, our team at Allegis Transcription wishes you a very happy 2016!

Insurance adjusters need to understand as much about the claims process as possible. Whether you actually handle arbitration or subrogation demands usually depends on your company’s departmental protocol, but learning about the process is critical in terms of how you handle a file and put together your claim notes.

Here are a few facts that every adjuster needs to know about Arbitration Forums.

What is Arbitration Forums?

Arbitration Forums, Inc. is a not-for-profit organization that handles disputes amongst its nearly five thousand members. These members agree to have specially appointed arbitrators hear their cases in lieu of taking the dispute to a court of law.

It is the largest arbitration and subrogation provider in the United States, and serves a vast majority of large insurance carriers. It also includes major self-insured companies, such as large trucking firms and corporations. Annually, the group hears around 619,000 arbitration cases.

How Do They Find Arbitrators?

One of the great aspects of Arbitration Forums is that it utilizes employees from its member companies to create a pool of arbitrators. These can range from adjusters to claims managers, but all are required to pass a series of tests and simulations about the claims industry before they are allowed to hear cases. Insurance arbitrators are never allowed to handle disputes that include the company they work for and are expected to remain neutral throughout the process as they evaluate the facts given.

How Does the Claims Industry Use Arbitration Forums?

The claims industry heavily utilizes Arbitration Forums, as it is far less expensive than taking a case against a fellow insurer to litigation. In addition, members are not charged an annual fee, but pay per case filed. Only the company that files case is charged, not the one answering the dispute. Those that file are also expected to use one of their arbitrators to hear a separate case in the future.

For many major insurers who have thousands of cases filed each year, this number can really add up. For smaller companies or commercial firms that self-insure and may only have a half dozen disputes per year, the total case charges are, of course, much less.

Why is Recorded Statement Transcription Important When Utilizing Arbitration Forums?

Recorded statement transcription is important in having a case go through the Arbitration Process. This is because the arbitrator that reviews the file and makes a decision cannot receive audio files. He or she only has text files and notes from the claims adjusters on both sides to go by.

A verbatim transcription file adds in an extra layer in terms of proving (or disproving) a case. Those who are trying to prove liability often opt to add many different transcripts from drivers, witnesses, and other accident experts. This can be a very important tool for both the adjuster filing the dispute and the one who is answering the demand.

Is an Arbitration Forums Decision Binding?

Decisions from Arbitration Forums are not legally binding. The decisions are more or less a “gentleman’s agreement” between the two carriers that they will follow through with the recommendations put forth by the arbitrator. However, companies that don’t follow the arbitrator’s decision could lose the privilege of having future cases heard through the process. For this reason, the vast majority opt to work in favor of the final decision.

Last Minute Recorded Statement Transcription and Allegis Transcription

This last little piece is one to know in case you ever find yourself in a situation where you have an arbitration dispute or answer to file, but are running out of time to get one done. One of the reasons why so many large insurers work with Allegis Transcription is that we offer four-hour turnaround time on rush transcription orders. This allows you to get the insurance transcription you need and still have plenty of time to complete your arb file. Please contact us for further details.

In short, Arbitration Forums is a very important tool for many insurers across the country. To learn more about how the process works, check out their website at Arbfile.org.

While working as a claims adjuster can be an interesting and rewarding experience, it can definitely be a bit wearing after a while. In fact, one of the top reasons why people leave the industry is due to job related stress.

So, how do you manage to get your work done right and still avoid burn out in such a fast paced industry? Here are five tips for insurance adjusters.

Tip #1: Ask for Help If You Need It

If you asked a group of claims adjusters what their biggest stressor at work was, many would tell you that they have too many files and not enough hours in the day to get them all handled. In fact, this is one of the biggest problems in the industry.

The easiest way to lessen the stress of this is by asking for help if you need it. Many claims managers understand this and have steps in place to help insurance adjusters handle an overflowing caseload. Sometimes this means transferring excess files to another member of the claims team or offering overtime to catch up. Either way, it is always a good idea to speak up to help keep stress levels to a minimum.

Tip #2: Know When to Step Away from Your Files

As all insurance claims adjusters know, sometimes the files that you handle are a little too personal. Maybe the accident involves the death of a small child around the same age as your own or some other factor hits too close to your own life. This is completely normal—after all, we’re all human.

Know when it is time to step away from your files. Go outside and take a break to deal with your thoughts temporarily. If it is a major issue, then talk to your management team about possibly having the file transferred to someone else. Or, simply remind yourself that the scenario you are dealing with isn’t your family and that you are grateful for that fact. (Gratitude for what you do have is always a great way to help reduce stress.)

Tip #3: Understand That It Isn’t Personal

One of the hardest things about working in claims is that the people you help are usually in crisis. Talking to you is not what they want to be doing, simply because they didn’t want to be involved in an accident in the first place. In some cases, someone they love has either been hurt or is now deceased. In other instances, they are the ones in pain—either physically, financially, or emotionally due to inconvenience. Their words can be sharp and they may even make threats or say things that are completely out of their normal character.*

To help avoid burnout as an insurance adjuster, it is important to really understand that none of it is personal. These people are mad at the situation and are choosing to take it out on the only person that they are able to put temporary blame on—you. The truth is that if you met most of these people under normal circumstances, things would be totally different. Keeping this perspective in mind can really help when you are dealing with a difficult insured or claimant.

*Any serious threats that involve the safety of yourself or your colleagues should always be reported to your manager and dealt with accordingly.

Tip #4: Utilize Company Stress Relief Resources

Most major insurance companies offer programs to help employees reduce stress and minimize burnout. This sometimes includes an on-site counselor or other mediator. Other companies offer access to health centers to allow employees to stay fit, which can also help minimize stress. No matter what it is, it is important to take advantage of these resources.

Tip #5: Take Steps to Make Your Job Easier

Taking steps to make your job easier is another way to help beat burn out. Here are a few suggestions.

• Utilize a company that handles recorded statement transcription. Reading a verbatim transcription sheet saves tons of time over having to listen to a recording for details and helps you have much more accurate claims files.
• Have a time management routine in place for each work day. Set aside a special time to just tackle emails or schedule a part of the afternoon when you return phone calls. Know exactly when it is time to review your new case files. By having a routine, you can help reduce stress and have a clear plan as to what your day entails.

Of course, taking a day off now and then isn’t a bad idea, either. Sometimes the stress of the job requires having something in your personal life to look forward to—even if it is just an afternoon on the couch watching a Netflix marathon. The key to beating burnout as an insurance adjuster lies with knowing your limit and making adjustments—including burning a day of vacation time—to recuperate.