American Association of Insurance Management Consultants

Library of Articles

MANDY CONNELL: We are dealing with significant brush fires, we’re going to have a really bad fire season, we have that here in Colorado and I thought it would be timely to bring someone on to talk about what a homeowner should do before the possibility of disaster strikes because we’re in a situation if a brush fire pops up near your home when you are at work you may not be able to go home again depending on the severity of the fire and its movements and things of that nature, so what kind of guidance can you give us in terms of preparing for a natural disaster before it happens? DAVID STEGALL: The best thing to do is it go through your mind and imagine that it’s already happening. You want to have a plan before you have to deal with it, and the Colorado authorities, the national forest service and there is a number of things, has all sorts of things on their websites as to the best way to protect your property from a physical standpoint, but the best thing to do from an insurance standpoint is to make sure you’re “insured to value” which means that you have enough insurance on your house to pay for it when it burns down and this is a serious problem, this is where more of acrimony between policyholders and insurance companies happen on any other issue, it’s the value of the dwelling and a lot of people are confused on this issue. They think “oh well the mortgage company told me I have a mortgage of a $180,000 and so that’s what I want the insurance for.

David L. Stegall

Principal Consultant

Risk Consulting & Expert Services

Dad Faith: Breaching the usual and customary practices of, and/or failing to maintain the standards of care required by, the insurance (and Risk Management) industry based on the concept of “Utmost Good-Faith”

David L. Stegall

Principal Consultant

Risk Consulting & Expert Services

Maintaining client relationships is critical for insurance brokers and agencies, especially given the fact that developing new commercial clients involves a significant time investment to understand the client’s business and risks and to implement solutions for risk transfer. Once insurance coverage is in place and policies are issued, the focus of the agency switches to servicing the account. The agency is happy. The client is happy. But what happens when your client experiences a significant property loss?

Scott E. Bushnell

Principal Owner – Executive Forensic Accountant

Business Interruption Consulting

Preparing business interruption claims takes thoughtful planning and insightful analysis, clearly communicated to all of the parties involved in the claims process. One of the most important factors is the breadth and depth of analyzing relevant financial information related to interrupted business operations. Although this may seem like an intuitive step, there is often a gap between the internally prepared financial information and the analysis to determine lost profits. Application of due diligence results in a smooth claim process, quicker payment from the insurer and a fair and equitable recovery.

Scott E. Bushnell

Principal Owner – Executive Forensic Accountant

Business Interruption Consulting

THE CLAIMS JOURNAL interviewed AAIMCo member Kevin Quinley on claim ramifications of the 2018 Keodalah v. Allstate decision, allowing adjusters to be added as individual defendants in bad faith lawsuits.

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Kevin Quinley

CEO

Quinley Risk Associates LLC

“To the uninformed, “a claim is a claim is a claim.” To some extent this is true. Any type of liability claim requires proof that the insured owed a duty to another person or entity, that the insured breached this duty, and that the breach was the proximate cause of quantitatively measurable damages suffered by the person or entity to whom the duty was owed. Thereafter, it becomes a matter of determining whether or not there are any defenses such as comparative or contributory negligence on the part of the claimant. Finally, there is the question of coverage—the issue of whether or not the policy will respond to the claim. …. There are significant differences between managing professional liability claims, compared to those arising out of more standardized coverages. …”

Frederick J Fisher

President

Fisher Consulting Group, Inc.

The claims audit is the anathema of day-to-day claim operations. Nothing is more disruptive. Yet, if properly defined, nothing is more informative and helpful in improving a claim management program. This article will examine the need for a regular auditing program and provide a recipe for a three-dimensional approach to the process in order to maximize the accuracy of the audit results. The need to conduct regular claims audits has already been widely discussed. With the magnitude of self-insured claims programs (including self-funded programs) and the millions of dollars spent on claim administration fees, what better way to verify whether the money spent has been justified or wasted? In essence, an audit of closed and open claims should accomplish several things.

Frederick J Fisher

President

Fisher Consulting Group, Inc.

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Akos Swierkiewicz

Principal

Insurance & Reinsurance Consulting & Outsourcing Services (“IRCOS, LLC”)

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Akos Swierkiewicz

Principal

Insurance & Reinsurance Consulting & Outsourcing Services (“IRCOS, LLC”)

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Akos Swierkiewicz

Principal

Insurance & Reinsurance Consulting & Outsourcing Services (“IRCOS, LLC”)

Kevin extracts insights from HBO’s popular series and sees implications for how claim professionals approach the challenges in their work.

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Kevin Quinley

CEO

Quinley Risk Associates LLC

I was often amazed at what I could only discern as an argument by a Plaintiff’s attorney concerning an insurance claim where he had never bothered to read the policy or have a true of understanding of insurance.

Bruce Heffner, Esq.

Independent Company Legal Consulting / Attorney at Law

Boomerang Recoveries, LLC & Law Office of Bruce P. Heffner,

Corporate Counsel is not properly the attorney to specifically respond for the Insurance Company to a suit against the Insurance Company.

Bruce Heffner, Esq.

Independent Company Legal Consulting / Attorney at Law

Boomerang Recoveries, LLC & Law Office of Bruce P. Heffner,

If learning is not part of the process, and all that an insurance company is interested in is a decision, any decision, no matter how subjective, then insurers need to have an intercompany coin toss agreement.

Bruce Heffner, Esq.

Independent Company Legal Consulting / Attorney at Law

Boomerang Recoveries, LLC & Law Office of Bruce P. Heffner,

On the one hand Insurance Companies invest a lot of money parcing court dicta to discover what the policy might have said in order to change the outcome of the decision, yet on the other hand believes the trial is some sort of Wild West side show and must be avoided at all costs

Bruce Heffner, Esq.

Independent Company Legal Consulting / Attorney at Law

Boomerang Recoveries, LLC & Law Office of Bruce P. Heffner,

It appears that the recent change in The State of Michigan workers compensation act extends Michigan’s jurisdiction to all Michigan Residents no matter where in the US (or the World) the resident is hired, works or is injured.

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Lee Hoffman

President

Lee M. Hoffman & Associates, LLC

For plaintiff lawyers, discovering what reinsurance has been purchased will not get you directly into the pocket of the reinsurer, but it will give you insights into what the insurance company was thinking as it handled your client’s claim.

Bruce Heffner, Esq.

Independent Company Legal Consulting / Attorney at Law

Boomerang Recoveries, LLC & Law Office of Bruce P. Heffner,