Adjuster Consistency Seen Needing Help

By Daniel Hays

NU Online News Service, May 27, 2:34p.m. EDT?There is no consistency in the damage figuresthat different adjusters come up with for the same bodily injuries,according to field tests by a claims management system company.

When groups of adjusters are asked to evaluate the same casefile any two adjusters were found to have 60 percent or greaterchance of being 100 percent apart in their evaluation, said LeeFogle, vice president of ISO Claim Services in Columbia, S.C.

ISO Claim Services, a division of Insurance Services Office inJersey City, markets the Claims Outcome Advisor system. Inanalyzing how different adjusters rate the same closed case, hesaid, "We find them to be all over the board."

Mr. Fogle said ISO Claim Services has run such tests at morethan a dozen companies to demonstrate a problem, which the ClaimsOutcome Advisor is designed to fix.

He said at one company a check of 10 adjusters found them torange from $15,000 to $200,000 for the same claim.

Frank Marx, the president of the National Association ofIndependent Insurance Adjusters in Geneva Ill. said the currentproblems with adjusters at large companies is that their firm'sfail to give them enough training.

"Thirty years ago adjusters were trained as multiple lienadjusters. Today, people are pigeonholed. You're trained as just aPIP adjuster," he said.

Adjusters assessing the value of a claim "should be within thesame ballpark. That's not happening because of a lack oftraining.

Mr. Marx's firm, The Curley Adjustment Bureau in Philadelphia,does work for a lot of insurers and he said "they are all in thesame boat with cutbacks in budgets. The training provided 20 yearsago isn't there today."

Mr. Marx said his firm's adjusters do not use software likeClaims Outcome Advisor or COLOSSUS, licensed by El Segundo,Calif.-based Computer Sciences Corporation, but more and more largeinsurers do.

Mr. Fogle said the Claims Outcome Advisor as part of its systemallows adjusters to point and click on a model of the human body toget an assessment. The system's mathematical model has programmedinto it 14,000 injuries, and treatments and prognosis includinginformation that factors in pre-existing conditions, he said.

Testing of adjusters who are schooled in the ISO system, hesaid, reveals they rate claims with a high degree ofconsistency.

Mr. Fogle said the ISO system also provides for tracking ofclaims to see if certain geographic or medical provider trendsemerge. Hypothetically, he said, it could find a company wasencountering more head injuries in a certain location or thatdoctors were continually diagnosing the same malady.