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Claims Management/Control

The risks inherent in diminishing limit policies

“Diminishing limits policies create a host of potential problems for insurance company claim departments. As is well known the insurance industry has long been plagued with “nuisance” claims. While in some instances insurance companies make quick settlements of nuisance claims to avoid defense cost expenditures, in others, insurers will attempt to resist such claims to avoid setting a precedent, thereby sending a message to the plaintiff’s bar that nuisance claims will not be honored. Considering that defense costs are deducted from the policy’s aggregate limits, either course of action places an insurance company in a difficult position. … “

Claim Auditing

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.

“Ten Claim-Handling Lessons from `The Game of Thrones'”

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

Shinning A Light On Insurer Misconduct

A uniform law proposed by the National Association of Insurance Commissioners (NAIC) is currently working its way through state legislatures. The Corporate Governance Annual Disclosure Model Act[i] would require American insurers to disclose a wide range of information relating to their governance, performance evaluation systems, compensation and incentive plans, Enterprise Risk Management (“ERM”) plans and codes of ethics and conduct. This article will highlight some of the important features of the NAIC’s model act and illuminate how they are designed to cloak insurer disclosures in secrecy, but at the same time provide compelling evidence of information whose existence insurers have long denied. Discarding the secrecy mandated by the model act and allowing access to the disclosed information will help discourage insurer misconduct long hidden from the insuring public.

[i] http://www.naic.org/store/free/MDL-305.pdf.

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James J Moore

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies…

What The Plaintiffs’ Attorney May Be Missing In The Analysis Of His Clients Insurance Policy

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.

What The Attorney Hired By The Insurance Company Is Not

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

Addressing the Arbitrary in Subrogation Arbitration

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.

Insurance Company Cognitive Dissonance

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

James W. Greer

Jim Greer’s experience spans thirty-eight years in the insurance adjusting and claims administration industry, beginning with a variety of field and home office assignments with Aetna Life and Casualty’s P&C Claim division. After excelling as a claims professional in various field and home office management positions, he became a key participant in several business and…

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