Thursday, September 4. 2008
An Example of Excellence
Although I’m not much of an “Olympics guy”, I couldn’t help but watch the swimming events, especially the accomplishments of Michael Phelps and Dara Torres. I was in awe of their commitment to accomplishing their goals even though both are on opposite ends of their careers (although I wouldn’t count Torres out too soon). Both knew that in order to reach their goal, they would need to not only have a plan, but be committed to implementing it and staying with it for the long-run. It obviously wasn’t easy, but they stuck with it and became the best they could be. If you think they accomplished this by themselves, think again. They had coaches, nutritionists, and a number of other individuals to keep them limber and motivate them towards their goal. It is the classic example of personal accountability with a team effort. I know each of their team members were also striving to be the best they could be and to reach their goals. Keep in mind, if it wasn’t for one of Phelps’ team-mates swimming a phenomenal leg, Phelps would have had 7 golds and 1 silver! Still not bad, but due to this team-mate’s efforts, Phelps now holds a record 8 gold medals. Same applies for Torres (who was swimming in her first Olympics the year before Phelps was born). She has 12 medals over her career beginning with the 1984 Olympics!
There are a number of lessons we can take from Phelps and Torres:
1. The drive to excel comes from within:
- We will not accomplish our goals unless we are passionate about reaching the end result.
2. Planning is essential :
- We need to know how we will get from Point A to Point B.
3. Hard work is part of the process:
- We can’t rely on someone else to accomplish our own goals.
4. Personal accountability is essential:
- Excuses don’t cut it.
5. Teamwork is imperative:
- Our team is there to encourage us and lift us up when we struggle. They are there to keep us pushing towards the goal.
6. Celebrate the Successes:
- Enjoy the fruits of your labor. Celebrate when you reach the mark and then go set the next mark higher!
We each have a choice when we put our feet on the floor in morning as to how our day is going to go. This doesn’t mean we will enjoy each issue we face, but it does mean we have a choice as to how we deal with them. Live your day passionately and celebrate YOUR “Olympic successes”!
Friday, March 7. 2008
Goals
I can't help but look back over the last two months and wonder "where has this year gone already?". If any of you are like me, I'm tired of winter and am looking forward to some warm weather. However, as much as I'm planning on enjoying the warmth, I know there isn't a lot (ie absolutely nothing) I can control as it relates to controlling the weather. However, that is different in planning for a new year. We set our subro recovery goals (both internally and for our clients) at the beginning of the year giving us our destination. Granted, there will be roadblocks, potholes, and the unexpected as we travel this road, but it's all about setting the course and preparing for those "bumps in the road". It's so important for all of us to be able to see the goal and then be able to plan the route to accomplish them. For me, it is a daily evaluation of what has been accomplished and what I need to do today to keep moving forward. Subrogation is not only recovery focused, but as equally important focused on delivering on the promise to take care of our/your clients in the event of a loss. I believe too many times we are focused only on the bottom dollar (very important!) and forget about the person waiting for the deductible. My challenge to all of you is to plan your day so you take the steps necessary to deliver on "the promise" and to maximize recoveries. Might be as simple as staying up on your "diaries", returning calls, or getting those arbs written. Whatever it is, keep moving forward and don't forget those we serve....
Subrogation: Live it! Breathe it! Share it!
Friday, February 8. 2008
Q&A
Question:
"If you insured several tenants in a apartment complex and one of your
insured's caused the fire and your other tenants had damaged and we paid a
claim for damages.
Can you subrogate against your own company for the tenant that caused the
fire ?
Another factor in all of this is that the loss is greater then the policy
limit. We have tenants that are insured with us and other tenants that are
insured with other carriers and also damage to the apartment itself.
Would the other carriers frown upon pro-rating the loss with us being added
as a claimant ? or would it be best to just refund the insured's back there
deductible based on the loss ratio ?"
Answer:
I have dealt with a situation such as this before, and it does cause several issues. Ultimately, you have to look at the best representation of the insured in either situation. So for you as the subrogation adjuster, I would look to pursue to the fullest extent possible especially if you consider what affect that loss may have on your insured's underwriting even if you absorb the deductible. Yes you will probably get some push back from the other carriers involved with regard to your pro rata participation, but it's an argument I have won on a few occasions.
An issue to consider is what is the financial impact of the case, and from an overall handling standpoint, is it cost effective to proceed. In a case such as this you will have to have your own counsel to proceed in the pro rata and protect your lien.
One pitfall to avoid is representing your insured out of pocket damages without a signed handling agreement outside of your policy. One such situation led to the carrier being barred from dropping the litigation even though it was not cost effective, as early in the file they agreed to rep the insured's OOP interest without a litigation agreement.
Friday, January 18. 2008
National Health Care 2008/Entitlement Mentality
Is this the year the American public demands universal health care? Do the special interests control one sixth of our gross domestic product? If there was ever a topic that provided heated debates- both health care and subrogation fit this bill.
I read with interest a recent Pennsylvania Supreme Court case that reversed a lower court ruling and allowed a worker's comp carrier to assert a subrogation claim against wrongful death proceeds. Let's be honest: the situation in the instant case is tragic. Who does not want the surviving kids to receive as much money as possible when their parent was not at fault. I guess in the end, as a society, we have gotten way off track with personal responsibility and accepting what reality is and then trying to justify a way to get around it. Frankly, the folks involved in this case should be pleased there was insurance in place. I understand that perhaps the amount of insurance was insufficient but by the same token, don't we agree that people who do not carry adequate insurance run other, more devastating risks?
I am open for comments.
Wednesday, December 5. 2007
Wal-Mart or bust
Most folks do not think of Wal-Mart as providing coverage and assuming the risk for payment of medical claims for its hundred's of thousands of employees. Well, they do and in my view, received some adverse publicity last week when the parent organization sought reimbursement from one of its insured's in an amount of approximately $400,000. The reality is nobody wants to have an open and honest conversation about what occurred and who the winners and losers were in this most tragic of accidents. As in most tabloid journalism, the Wall Street Journal reported that Wal-Mart despite its massive profits and reputation for short changing its labor force, extracted approximately $400,000 from a personal injury settlement that should have rightfully gone to its injured employee. David v. Goliath? Corporate greed? Let's at least consider some additional ideas: 1) did the WSJ report that the plaintiff's fee in this instance was 40% and that maybe, just maybe, plaintiff's counsel should have cautioned his client BEFORE taking this case? Did anybody bother to look at the settlement sheet to see the breakdown of fees? My bet is plaintiff's counsel took home a pirate's ransom while the naive, unsophisticated former Wal-Mart employee sucked the exhaust from counsel's new BMW. Was this really even a contingent case worth 40% of the total recovery? I could on and on. Let's switch gears and take on the medical establishment.
Having spent the past ten years in provider sponsored HMO's, not once did I hear how happy physicians were to accept the low rates health plans want to pay for their over inflated services. It is no secret that when a patient walks (rather is carried into) the ER with significant injuries stemming from an auto accident, the feeding frenzy commences at the provider's billed rates. Did anybody bother to consider that $400,000 is a tremendous amount of medical services? I am not discounting the severity of the Wal- Mart employees injuries. Rather, I would be interested in knowing the medical necessity of the services provided. I am reminded of the Capitol One commercial and instead of a barbarian inquiring " what is in your wallet?" it is a surgeon who is ready to perform surgery.
Gordon Gecko in Wall Street famously quipped, "greed is good." That is what really drives cases like the one discussed above.
Monday, November 19. 2007
Small Appliance Fire Handling Tips
All too often, small fire losses, especially appliance fires are swept under the rug as far as subrogation investigation is concerned. This is most commonly a result of the impression that all of them have no value due to the expense for using cause and origin and engineering experts to prove the case. These are some methods to work with your subrogation teams and field staff on that may assist you.
- Put a plan in place with your field staff, that when you have a small appliance fire, to overly photograph the entire area of the origin of the fire. This is not difficult, as in these cases the smoke and fire damage point directly to the origin as opposed to larger fires with massive damage.
- As long as it is apparent that the appliance in question is the only possible ignition source of the fire, have them secure the evidence, as in all probability, claims will have insured proceed with repairs to avoid ale, and the manufacturer will not visit the fire scene due to the low potential expense exposure. In securing the evidence, the claims staff should have an evidence receipt form in which they document the securing and possession of the evidence as it changes hands, i.e. insured to adjuster to subrogation adjuster etc.
- As soon as an appliance or other piece of evidence is secured, have notice of the evidence sent to the subrogation team so that they can assist in coordination of any further investigation as needed. Make it part of the process to have the adjuster secure all manufacturer, model, serial number, place and date of purchase information on the evidence form, and obtain and or copy any manuals receipts etc.
- The manufacturers will request the item be shipped to them for testing. Get a written agreement up front which lays out the shipping of the evidence, including the tracking of the shipment, and the responsibility of the manufacturer of the evidence once it is in their possession. A full payment of submitted claim in the event of loss or spoliation of evidence usually does the trick, but make sure it is signed and secured before shipping the evidence.
- If the evidence is questionable, or you have concerns about confirming cause before sending to manufacturer, contact an expert local to where the evidence will be stored, and have them do a short once over of the evidence and the file materials. Other alternatives include locating a appliance repair facility that may be able to give you some opinions or guidance, or local a mail in evidence program that meets your company’s guidelines.
Tuesday, November 13. 2007
NASP
All --
It is always a great time to reconnect with old friends and associates at the NASP conference. As a board member, I enjoy meeting with the first time attendees and seeing how excited they are to have the opportunity to network with other subro professionals along with attending the educational sessions.
In our role as a partner to the insurance industry, our team enjoyed the opportunity to share how both the Acclaim and Recclaim services can impact their operations. It's always a good opportunity for the insurance communtiy to see the different types of services available to enhance their operations. It's also good to see the breadth of services available dedicated to the subro field. Who would have thought 9 years ago when there were only 440 attending the first show that we would be where we are today? Can't wait to see everyone again in Hollywood next year.
Wednesday, October 31. 2007
On the road again
Well the team is headed to New Orleans this week for the National Association of Subrogation Professionals National Conference. Should be a great time to meet our peers and our clients. If you are there stop by our booth and say hi. Just look for the Harley!
By the way, have a safe and happy Halloween.
Tuesday, October 16. 2007
Health Care
I want to know how many plaintiff’s attorneys, when settling a worker’s comp claim, attempt to pass the risk back to the health plan if at all possible? I would also like to hear any comments from attorneys and how they deal with liens when an employer who is both self funded on the health and work comp side and nobody wants the hot potato.
Let’s also open the floor to resolving medical malpractice claims in provider sponsored HMO’s when a shareholder/owner commits malpractice and the malpractice carrier is a self insured entity owned by the same physicians that own the health plan. Cocktail conversation it is not.
Monday, October 15. 2007
Customer Service
Over the past few weeks I have been working with a client on a equipement loss. Their insured had attempted through their service company to resolve a fire where only the product was damaged, and had just run under the warranty. We went to work and got everyone on notice and began the process of inspection. Oddly enough, at the first inspection the manufacturer sent a general c&o and not an engineer to look at their product. as such we had to reschedule to actually secure the unit so that the manufacturer's enginner could look at it in place. Upon contacting the manufacturers rep and relaying what was going on, they realized that the product did not meet their standards based on the information we provided, and agreed to fix the unit at no charge. The client contacted me with the news and was appologetic due to the work we had put into the file since officially it was being shut down with no recovery nor fee. I stopped them however and advised that the ultimate goal had been reached in taking care of their client, and that is what we are in business for.
Yes we are in business to earn a profit, but it will not be at the detriment of our clients, and it is what has and will set us appart from our competition.
Monday, October 15. 2007
Don't cut investigative corners
Well I was sitting in arb today in a 3 personal panel for an interesting claim. A fire truck crossed a homeowner’s bridge which collapsed almost totaling the fire truck. $100k loss in which neither side had good evidence or investigation, and in which neither provided readily available evidence that could have changed the outcome. Oddly enough both parties actually have personal representatives there, both of whom seemed very shocked when I and my fellow panelist pointed out the problems with each party’s contentions and evidence. I must say it’s a sad state of affairs when carriers cut corners on investigations in 100k plus claims!
Monday, October 15. 2007
See you in New Orleans
I’m going to put my NASP hat on for today’s commentary… Our National Conference is coming up in just three weeks and promises to once again be the premier subrogation training opportunity of the year! I encourage everyone, if not yet registered, to do so now. Not only will you have over 60 subrogation classes to chose from, but you will be able to network and meet your peers (probably some that you have spoken with over the years and have never met). We also have the opportunity to “give back” to the New Orleans community with a volunteer effort on Sunday morning. Hopefully we will see you there. Stop by our booth (#608-610) to say hi. See you in New Orleans.
Tuesday, October 9. 2007
Health Care Blog Part II
Good morning all:
For those of that follow politics, does anybody believe the US economy (read: employers) can continue to absorb the double digit rate increases for health insurance? Why should they? Has anybody figured out that the incentives in the health care system are misaligned and who bears the costs for paying for medical services is a game of hot potato? Can anybody have an intellectually honest conversation and address these issues head-on? Does anybody want to?
I have spent the better part of the past ten years inside provider sponsored HMO’s. Is anybody out there familiar with these entities and know how they work? I am curious to see what kind of investments other plans have made in technology and efforts made to understand and maximize profits without compromising the quality of care. What processes are done manually? Is the subrogation department outsourced? If so, who is handling the account? I am more interested in knowing who has kept the subrogation component in house and what are you doing to process the claims? Do you scrub the claims? Or, do you rely on sending a questionnaire and hope the member responds? Are any TPA’s out there that believe they do a good job for their groups? Are any providers out there doing subrogation?
I look forward to any thoughts you may have.
In blog we trust,
Doug
Tuesday, October 9. 2007
In agreement with the Lost art of the statement
I completely agree with the comments made under “The lost art of the statement.” I wanted to comment on the importance of taking a Recorded Statement in general. As I have sat in the desk of a front line claim handler and am now sitting on the other side (Subrogation), I truly do understand how important it is to take Recorded Statements and ensure they are done in a timely manner.
When handling a claim, the sooner you can interview all the parties involved the better off you are going to be in the long run. Too many times I see that the claim handler did not take a statement or waited to take a statement because they felt liability was clear. Once the file is being argued for potential recovery dollars though, it might be that two companies do not see eye-to-eye. Now figure how much time has gone by. We are all human and we all like to talk about what goes on in our life. Therefore, the more time an individual is given, the more people they talk to about their accident, the more advice they receive as to how to handle their claim on a personal level. The story has now changed 10 times. This does not make for good evidence when all is said and done.
Monday, October 8. 2007
Subrogation Goals
I like numbers. Anybody that knows me will confirm that statement. As I look at the effect subrogation has for a carrier, I like to look at what would have to occur in other areas of the company to have an increase of 10% to the bottom line. How many policies would have to be sold? How many positions would you have to reduce? What about your investments – what would you have to do in the market to obtain this increase? Increasing subrogation recoveries by 10% (or more) can be done. This also begs the question as to how companies set subrogation goals for their areas? I’d be interested in hearing other’s thoughts on this.