The Art of Adjusting® Podcast

Episode #79 - Experts in Claims — When & Why to Call Them

William Auten & Chantal Roberts Season 3 Episode 79

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🏈 Adjusters can’t do it all — sometimes you need to call in the experts.


Heather and Chantal dig into the world of experts in claims. From engineers and origin-and-cause investigators to claims handling experts, we explore:

  • When adjusters should bring in specialized help (and when not to).
  • Why “being an expert” takes more than Google or self-proclamation.
  • How early expert involvement can save costs, reduce disputes, and even prevent bad faith.
  • The challenges (and humor) of expert testimony in court.

Think of it like football: adjusters may be the quarterbacks, but sometimes you need that skilled player to step in. Or in classic film noir terms (yes, Double Indemnity gets a mention) — adjusters are the Renaissance folks of insurance, but even Renaissance folks know when to call backup.

Listen in for practical takeaways, ethical insights, and a few laughs about what it really means to be an “expert” in claims.

#Insurance #Claims #Experts #Adjusting #TheArtOfAdjustingPodcast


For more insights, you might consider a career in liability adjusting or if you're searching for reliable adjusting services, visit Auten Claims Management.

To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting.

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SPEAKER_00:

I'm Bill Auten of Auten Claims Management.

SPEAKER_01:

I'm Chantelle Roberts of CMR Consulting, and welcome to the Art of Adjusting Podcast.

SPEAKER_00:

Today we're going to talk about life as an insurance adjuster from the perspective of property, auto, liability, or workers' compensation adjusters. Our goal is to bring interesting topics in the world of claims adjusting to people who are working as an adjuster now and to people who are considering a career as a claims adjuster.

SPEAKER_01:

Good morning, Heather. Good morning. How are you? You're like all sunny and everything. I know shining on you.

SPEAKER_02:

I have this gorgeous new window in front of where my desk is at in our new house. And of course, about this time of day, I can open the curtains. Otherwise, the sun's like my face, and I can't even see my computer screen. But right now, perfect time.

SPEAKER_01:

So, did I tell you about this prank that I pulled on my husband that ended up backfiring on me, which is usually what happens to all of my pranks, right? So I don't know what got into me, but he well, his office is down in the basement and it happens to face east. And usually what he'll do is he'll put up a piece of cardboard box, kind of like what you do with the with the blinds, and or until the sun happens to pass over. Well, all of I in the spring, I just decided, you know, with this window well, I'm going to plant a little garden. And and he's just gonna hate that, but I'm gonna do it, right? And it's gonna die in the winter because it's not that deep underground and blah, blah, blah. And so I I did it, and I swear it has like taken off. Well, he has two windows, the one that fits the the sun, which is now completely covering the window, and the other one, which is off to the side, which is in the shade, and he says to me, Can you go get some more plants and like plant the more things there? I'm like, What? It's it was supposed to annoy you. I was gonna put fairy lights in there and little gnomes and everything. And he goes, No, I actually really like it. Oh my gosh, that is that's fantastic.

SPEAKER_02:

I know, right? I'm living in a place that doesn't have basements anymore. So but I do have gorgeous sun coming through the window.

SPEAKER_01:

Well, that's good. So nothing to do with claims or what we're gonna be talking about today, which is experts. Uh so uh, but I just uh you said sun and that that's it reminded me. Yeah. It reminded me. Oh, experts, experts.

SPEAKER_02:

What are we gonna be what are we gonna chat on about experts? Because, you know, I think we're we're kind of all we're we're experts, right?

SPEAKER_01:

We are experts, like we are such experts right now. I mean, like we don't even we just should talk about ourselves all day long, which is so hard for me. I mean, amen. Uh but what I was thinking of is specifically those people who uh maybe have some kind of specialized knowledge or additional education. And I actually read this, and I'm not gonna be able to say it verbatim, but I thought it was a pretty a pretty good observation. And it was something to the effect of nowadays, everybody thinks that they are experts because they can do just a little bit of of research, and we actually need to realize that we aren't experts. For example, I am not an expert in uh microbiology. I can read an article about it, but that doesn't mean that I'm an expert in microbiology. I need to defer to people who have gone to school and majored in biology and then, you know, minored in microbiology and then gotten their master's degree in chemistry or something like that, and then gotten a PhD and yada, yada, yada. I need to defer to those people. And those are going to be the experts. Now I can then take what they say and apply it to my case, whatever that case may be, like, oh, I'm not gonna eat cheese now or whatever. But that's what we that's how we use experts. And and I think that's the best way that I can describe what an expert is, is someone with some kind of superior knowledge in something that we use.

SPEAKER_02:

Definitely. Um, you know, I always thought like it was like YouTube and TikTok videos and all of that. Like, even if you just read X, like you should be an expert, right? Right.

SPEAKER_01:

I mean, because if it's if it's on the internets, it's true.

SPEAKER_02:

On the internets, it's true. If it's on the internets, it is true. Abraham Lincoln said it there. You know, exactly. So no, I I have always thought of when I when I live in the claims world, I always thought of like I have a football analogy because it's almost, you know, it's football season right now. And I'm way into college football. But the experts that you may be bringing alongside are like somebody that you might be handing the ball off to. Like they're like the running back or like they're the receiver at some point in the game of football. Um, because you're handing it to them for a moment, but then they're gonna eventually hand it back to you because you're the quarterback of that game, right? You're the quarterback. If you're the claim handler, you're the quarterback of the game. I love that. So you they are somebody that you're gonna hand it off to and they're gonna make some progress with it, and then they're gonna bring that back to you so that you can move everything forward. But they have specialized training, specialized expertise in being that said receiver or running back or fullback or tight end or whatever that they are when it comes to the players within the football game. They have spent time, effort, training, education to be able to become what they are in that role that they're playing. So giving it to them for that moment is an assist for you to be able to move that the playing field forward when it comes to your game. So I think that was a pretty profound analogy there.

SPEAKER_01:

What do you love it? I actually love it. I think that makes a great deal of sense because as much as I do love Barton Keys, if you've if you've never seen if uh uh Double Indemnity, it's it's a film noir. Uh the main character is a sales agent, but the I guess one of the supporting characters is Barton Keys. He's the claims manager and actually the only adjuster. But he has this great little monologue about what a claims adjuster is. You know, we're the father confessor, we're the surgeon, we're the scapel, we're the we are basically everything we have to know a little bit. And I call that the Renaissance Man kind of deal where we have to know a little bit of everything to be able to do our job, but we can't know everything, can we? And that's why we do have to hand it off. And if you think about it, this is very normal in claims handling. If we're a desk adjuster, we often hand it off to a field adjuster to do the inspection, or the field adjuster to maybe do a locus investigation or the SIU department to to to research fraud. Maybe we'd uh have someone doing the uh medpay if we're doing auto or or something to that effect. So it's very normal for us uh in claims to hand things off, but then it comes back to the main adjuster who's handling all of it. So I loved that. I it's it's it's very good. Um and and why would you say, well, I guess we just did that the experts exist in claims.

SPEAKER_02:

You know, claims are 100% about like applying a set of facts or determining a set of circumstances that have happened to someone, but sometimes those facts need interpretation that's beyond your area of expertise. You know, and and just like you said, like you have to know a lot to be a claims professional. You have to have a lot of different hats that you put on, but you also have to know what when you don't know something and don't try to make like just educated what you're calling an educated guess about things to be able to uh to to influence your ability to know when there's that moment, like I don't have the expertise to be able to determine the causation of this loss. I I don't have it, and I can't figure it out just by all the facts that are in front of me right now, and that's where you're gonna call in that assist. That's the moment where you might bring somebody to the table. What are some other times that you know that you've had to call in some of those types of experts?

SPEAKER_01:

I think, yeah, the the the main ones that I see, even as a as a claims handling expert witness kind of deal. Of course, I'm getting called in when there's a bad faith claim to sit there and look at a claim and say, yes, it's been handled within the Unfair Claims Settlement Practice Act, which we both talked about, you and I, or no, it hasn't, y'all need to settle. Y'all need to, y'all need to settle or uh or you know, they did a good job and you need to to drop the suit, depending on on who's retained me. It's not always the defense counsel who's retained me. But the when I was when I was an adjuster, when I would normally see this uh or or want to retain an expert would be, of course, when there's a fire over like perhaps a certain amount,$100,000 something dollars or suspicious fire, uh, you know, all of a sudden the the fire burst out in the middle of the floor where there's no electrical, you know, uh and the electricity is off and we don't know how the fire started or um and they're behind on the mortgage payments. Well, you know, I'm probably gonna want to get an origin and cause expert out on that. But honestly, I think some of the most frequently used ones are the like the engineers. How did this how did this pipe burst? Uh what do you think the cause of loss is? Uh the insured public adjuster says it's XYZ. I think, or my independent adjuster or my independent or my field adjuster, even if it's not independent, says that it's ABC, not XYZ. So can you tell me which one it is? Because look, I don't care. I just want to pay the claim and get it closed. Yeah. Or I need to deny the claim and get it closed. I mean, it uh it sometimes we don't settle or we don't pay things, unfortunately, which is not always what the insured wants to hear. But so I think those are the main times that I saw something is is when I said that it was something and the insured would say, No, that's not right. I think it's something else. And I would send someone with a slightly higher degree of education than I in to give me this is what I think, one way or another.

SPEAKER_02:

And I will tell you like one of the pitfalls that I always saw some people fall into a lot is like we're gonna get into a dispute and not recognizing proactively that you really need that expertise. And that often leads to the dispute, right? Is not knowing. So I think there's you have to know that there's a big difference in between the judgment that you have as an adjuster and that moment that you need the specialized expertise that can help, and isn't just there to help you to to like bail you out when you've suddenly came to the tension point of we're fighting about something in the claim or there's some adversarial stuff that's going on. Um, because I can tell you, you and this is just from what I've heard from experts and what I've heard from other people, that puts them behind the eight ball and and also is very difficult for them as a professional. And it's automatically like they're just called in on the dispute side of it, versus we're we're trying to proactively figure this out and we recognize the need for the expert at the right moment. And I know that's hard. Like it's hard to know that exact right moment to bring them in.

SPEAKER_01:

It is hard. And I would say nine times out of ten, it experts are always brought in when there's a dispute. Yeah, yeah. Now, I I would say this to any adjusters that are listening, and even if there's an agent or two that are listening, maybe gently suggest it to your agent or to your adjuster that if if tensions are rising, this might be a good time to get an expert. And because it might be a face-saving way for you as the adjuster to either say, see, I was I was right, there's someone else who believes me, or oh my gosh, I'm wrong. Thank you for pointing this out, which I mean a lot of people don't do, but it could be a very face-saving method. I I'll give you a little story. Uh it I have had so many claims go to mediation where the plaintiff attorney may have oversold the case to the claimant. This is third-party claimant, you know, a liability claim or something like that, or simply the the third or the the plaintiff attorney doesn't have control over her client and they think they're going to get$50 billion for, you know, a rear-end accident uh that has property damage of$500 or something like that. And it helps to have that third party, that mediator, spend some time with the layperson or the consumer and and say, hey, this is really what's going on, and this is what you need to expect, and and blah, blah, blah. And I know that's not what necessarily the the expert does uh the for if they were on the roof or anything like that. But I also guy uh ladies and gentlemen, I will tell you this side note give the expert report. I it look, it may not be your company's uh uh procedure to do that. Uh I would talk to your boss naturally, but I'm going to tell you they're going to get it in in Discovery. So you might as well do it, you know, and that's your argument. We might as well do it because if they sue us, they're gonna get it. So just give it. But anyway, my my point is that uh this might be a nice way for you to resolve the issue and not get entrenched in because what happens if you're wrong? You just I mean, what what's the worst that can happen? You're embarrassed. You know what? If you're gonna do this every time you're embarrassed, seriously, I mean you're I mean, you don't even need to be leaving the house. No, which I guess we should, none of us are nowadays. We're working from home, but but you know what I mean.

SPEAKER_02:

Yeah, set the ego aside when it comes to that, because like again, uh like we said just a moment ago, you don't know everything as an adjuster, and that's okay that you don't, right? Yes, but what you need to have is a keen eye for the moments when you need to have some outside expertise. Also, they have a different set of eyes than you, and they have a different set of skill sets than you have as as a professional. And you might have seen, I don't I don't care how long you've been in the street, if you've been in the industry for 25 years, there are still probably things that you have not seen because we're talking about human error and issues that happen.

SPEAKER_01:

Yes.

SPEAKER_02:

So be aware of those, the right moments and the really savvy adjusters that are out there are the ones that can sit down and go, Yeah, I know. Like here, I'm looking at this file and I'm already thinking about there's a need for me to have these types of people potentially involved because there is a set of disputed facts on causation, or something comes in the door where you're going, well, I'm not quite sure what actually happened here just by looking at this or my eyeball for the moment on it. Um, that's that whole differentiation between your judgment capabilities and needing the specialized expertise that's beyond the knowledge that you have.

SPEAKER_01:

And I love what you're saying is that you're you're seeing things at the beginning of the of the claim. And I think that sometimes this is what is going to separate the good adjusters, the ones that get promoted, the ones that uh make the climb up into the system. And I'm still looking for that CEO that's a claims adjuster who actually knows what a claim is, other than when their Lamborghini gets keyed or whatever. Um, not that I'm better. But um, yeah, no, not an MBA. Uh as Heather is an MBA, but whatever. I digress. I digress. But no, you're you're absolutely right, knowing that, and and of course, it does come with time and everything. And I think that there are, again, certain things that you can look at when you are looking at a first notice of loss. For example, fire started in the middle of the living room, the electricity is off, the house is vacant. Well, if you don't have squatters, you uh you know, um, and you right now you are or meth cookers, or meth cookers. You know, and and and you right now you don't know that the insured is behind because that's gonna be a recorded statement. You know, that's gonna be a recorded statement that you find that out. This is where you probably want to go ahead and have your field adjuster and an origin and cause expert go out there at the same time and do a little, you know, investigation on on things. Uh so maybe that's that's what you want to do. Um then same thing with with, I don't know, your medical. If if we're talking about um a low impact claim, and now the uh first notice of loss and the claimant is like, oh my gosh, I went to the hospital, I've had three MRIs already, and we're three days into the into the loss, um, there might be something that we wanna we wanna take a look at.

SPEAKER_02:

Yeah, and you you are not an expert. I mean, you you've probably gotten some training. There's this there's this word out there in the field for bodily injury, like biomechanics of motor vehicle accidents and like how they happen and what happens to the body. And there's probably a ton of training that you get if you sit in that role because you're charged with evaluating bodily injury claims and compensation for that. But you're not 100% an expert in how the biophysics and biomechanical physics of the body operates. So you probably need some help figuring that out so that you can make sure that you're paying the right amount for the claim. It's not about like you set out with the mindset always, especially when you're talking about unfair claim settlement practices, which I know we've harped and preached on this. You're not setting out with the mindset to deny the claim. You're setting out to deny with the mindset of let me find the coverage that's necessary and let me find the right evaluation for this loss.

SPEAKER_01:

And you know, you mentioned something that's really, really interesting. I'm gonna tell you, medical doctors aren't even the quote expert in quote for biomechanics. Yeah, they are experts for whatever field they're in, emergency medicine, general practice, uh neurology, cancer doctors, all this, all of these kind of things. Uh you know, and so they do they all go to the same four years before they go on to the same, you know, to their own uh expert. Yeah, absolutely. It's kind of like when we all go to college. Do we all have the same two years, the first two years? Do we all take English lit, American-lit, you know, intro to calculus, blah, blah, blah? Not me, because I went to Baylor and they allowed liberal arts majors to take logic rather than math. And I signed up for that because I didn't want to do anything with math. Um, but it was a lot of fun, regardless. Um, I digress again. Anyway, but yes, you see what I'm saying. It's like we all have the same kind of education, but that doesn't mean that I'm a mathematician because I can't add eight plus seven. Okay, great. I'm gonna assign these things over when we're talking about uh like a business interruption loss to someone like Scott Margraves, or uh, because he's uh he's an expert um in that. Isn't he? No, I just got his name. He's the COI, he's the um certificate of insurance guy. Sorry. Um, but anyway, I'm gonna assign it over to an expert for um Scott Bushnell. That's his name. There we go. That's the one or Scott. It's a it's just a Scott, okay. Just look, find a Scott, Google Scott, and I mean, there you go. That's you'll have it, whatever. You know what I mean. Anyway, that um I I I really like that idea. I love what you had said about that. That's very good.

unknown:

Yeah.

SPEAKER_02:

And I mean, there's a lot of different types of experts that you might routinely interact with at in your adjuster role. And so that's why I think it's very important because we are living in this world where there's so much more virtual handling of claims. That doesn't mean that there aren't still adjusters who go out and physically inspect properties or physically inspect injury sites and injury locations that happen, but that is less and less frequent with the advent of technology. So knowing the types of experts that are out there that you can reach back into and get assistance with is really important. And it's also very important if that you know what experts go with, maybe the type of line of business that you work, because personal lines might be a little bit different than commercial lines and some of the specialty lines that are out there and excess and surplus as well, because there's people that work claims all the way across, like all those different types of things, and then there's people who are very specialized. But if you're a typical property person, like you handle property day in and day out, you might have interactions with engineers regularly. Why? Because you need to know causation, like we talked about code issues, codes are always really big. Um become even more of an issue, I think, lately as well, because the building codes are trying to evolve and adapt because many of them are very outdated, unless you're Florida.

SPEAKER_01:

Um well, I mean, this is a very, very good point because I'm gonna tell you right now, adjusters, just FYI, you may want to go ahead and get an expert or at least talk to your county code people because I am in a couple of lawsuits as the expert witness, and the code upgrades are really creating a lot of increase in the estimate because uh it's like out in California with the wildfires or whatever, and and so it's like, well, now we need to do more of this kind of of rebuilding or whatever. And as an adjuster, look, I'll be honest with you, I used to forget it there, but there is extra, you know, coverage for that up to$25,000 or$50,000 or 25% of blah blah blah. I mean, you have to read it, but you know, don't just not give that because of course that's when you're gonna trigger Unfair Claims Practices Act, too.

SPEAKER_02:

And and thinking in advance about that and maybe attaching the types of experts that you might need to use in a claim file to like the coverage, like the coverage figure out that's your responsibility 100%. Because your experts are not gonna sit in the space of determining the coverage, they're in the space of t of helping you to understand the facts and circumstances or the causation of what happens so that you who sit in the quarterback role get to make that decision about coverage, they're feeding you more information from their area of expertise. Right.

SPEAKER_01:

We were talking about um what kind of experts uh with with the codes and and all of that. And and one of the things that I thought was brilliant about you talking about these sorts of things is that uh as an adjuster, you do need to start thinking about this early and often. And uh I almost feel one of the things that kind of trips a trigger with insureds is that they feel like we're not paying attention to that kind of stuff because the policy says that it has to be incurred. And there is this whole debate right now in insurance. What does incurred mean? Of course, the insurers, the carriers, think that it means we reimburse you, you know, like you pay for it and send us in. So you incur the cost. Uh most plaintiff attorneys and public adjusters believe incurred means you suffer the loss. You know, like the insured has suffered the loss of the building burning down. That means they're going to have to have the building code upgrades. Therefore, that's why in these kind of public adjuster estimates and everything, you will see the coverage for or the cost for building code upgrades, and but you won't on the the insurer side.

SPEAKER_02:

And wait a minute, wait a minute, wait a minute. So you're telling me that like in insurance claims, like there's disputes about interpretations of words. Oh my god.

SPEAKER_01:

Oh my gosh. And a coverage attorney could also be your expert, by the way. Oh yeah. You know, a coverage attorney could be your expert, but uh these qu these kind of things, uh, this is something that you would want just kind of off off to the side a little bit, adjusters, it to think about. And I always thought it would be a good idea. I don't write estimates, I'm a desk adjuster, but if we did not put this thing that says uh, you know, code upgrade TVD to be determined, because I want my insured to see that I'm considering it, I just can't pay it right now because I I'm the carrier and I uh will make you pay it first and then I'm reimbursing you. And that's the difference for the estimates, because I feel sometimes the insured looks at their public adjuster estimate, which may have that charge, and our estimate, and and they go, Oh, they really are low-balling me. Not necessarily. But any, but you were talking about, you know, again, the engineers. One of the things that's really important to understand is that again, your your engineers, your origin and cause, even I guess coverage attorney, weather experts. I don't think these are used often enough, these weather experts, medical experts. None of these people can determine coverage, they can't speak to coverage. No, and that is something that you, as the quarterback, you're you're you're making the calls. So basically, it's like the coach is running up to you saying, Here's the playbook, which one do you want to do? Of course, the coach wouldn't be doing that, but you know, maybe second stringer. I have no idea. I don't watch football, I'm more of a basketball person. So leave me alone.

SPEAKER_02:

No, I would definitely just say the I mean, there's such a wide variety of people who have established themselves as subject matter experts because of their background, their training, their technical expertise, and their and and what they what they went to school for, but also just like the day to day of what they have done for years and years in the job role that they have. But those those types of experts. Your expertise needs to lie in. And I think I've said this like a million times already. When do I know that I need to call these people in? You know, we we we haven't mentioned financial experts yet. No. You know, in the financial expert world, like if you're in that world of handling commercial losses, you probably need to know and understand the moments where you might need to do an evaluation of business interruption damages that someone has suffered, because that is a holistically nuanced type of expertise that involves a lot of math that you and me probably don't like doing.

SPEAKER_01:

No, no, but I'll tell you this like this is something that is so completely foreign to me, but it it, you know, it's something that is in the financial expert kind of deal, is a business can be losing money, it cannot be profitable, but it still has a business interruption claim. And I'm like, what? What does that make any sense? But I mean, so even though uh the insured maybe like, I don't, I, you know, I'm I'm I'm negative or whatever, you know, go ahead and send it over to your CPA, uh, the insurer's financial person uh to take a look at it. And I'm gonna tell you, these commercial claims are usually where you're going to see a lot more of the experts because you've got these huge, I don't know, warehouses or whatever, uh you know, high rises or what have you. And that's when you need to get a construction expert in. Uh that construction expert may need to work with the field adjuster to write the estimate because it's so complicated.

SPEAKER_03:

Yeah.

SPEAKER_01:

And I will also say you cannot remember your Unfair Claims Settlement Practices Act. You cannot assign it and forget it. You've got to maintain momentum. So assign it, of course, let your insured know what's going on, and then follow up in a couple of uh maybe a week, seven days, you know, something like that. Like, hey, have you seen it? I know you're writing a report because these guys they're gals do. Yeah, they're technical. It takes them, you know, two or three weeks to write a report. Yeah.

SPEAKER_02:

And then I'd like to give a huge shout out to like all those in what I call like an unsung hero field of insurance, which is those subrogation adjusters out there. Or if you happen to be the day-to-day adjuster who's just handling subrogation as part of the full claim file that you handle for your company. Um folks, subrogation is the moment where we make sure that the right person is paying for the loss because they contributed to, or they had, or they were 100% responsible for paying, you know, for causing the problem that happened, especially in property damage claims. Um, but it's it's big time in the in the injury world as well. Subrogation adjusters you have a regular familiarity and knowledge of causation experts or failure analysis experts, and those people who can determine like, why in the world did this one electrical component inside of this gigantic generator system that is connected to five others actually fail? And they can point you to the reasoning why and give you the right details so that you can go, okay, yeah, this was a manufacture defect, or this was a product failure, or this was something else that contributed to the loss. But they help you to make sure that the dollars that need to come back that have been paid out the door, because let's face it, claims, what do you do? You're handing the money out the door. They're bringing, they can bring that recovery back and also help to indemnify that insured for their deductible as well, which in the commercial world, especially, those are sometimes gigantic orbit. Absolutely.

SPEAKER_01:

Subrocks, I I have your back. Absolutely. And and again, uh all of these things, it is easier and better to get your experts in earlier rather than later. And even that goes with the sub row people because I'm gonna tell you this too. The subro people can point you to the right people. But when you have a potential subrogation issue and you send your expert out there, your sub row people are gonna want to put the at fault or the possible at fault people on notice because maybe there's destructive testing, or maybe that the other, the at fault carrier needs to assign an expert and they need to have joint inspections. One of the things that I was, I'm particularly thinking of as a case that I was working on. It was unfortunately a fatality with a bicyclist and he was hit by a car. His he was right, he had a helmet on. My first thought was, of course, as an adjuster rather than a clean, rather than a standards, practices, and procedures, because it's hard to shake these these thoughts once you get into that kind of mentality. Is have we put the manufacturer of the bike helmet on notice because that right there could be the reason why our insured died? Yeah, yeah.

SPEAKER_02:

Is because the helmet wasn't yeah, you don't know that just by looking at the facts or even doing your investigation. There has to be much more detailed analysis of all the factors to even determine like how much did someone contribute to this loss. Exactly. And when the exposure's high, it's always a good idea to be thinking about that on the front end versus oh, I'm halfway through the claim. Oh, wait a minute, where's the evidence? Right of how this happened.

SPEAKER_01:

Yes. Oh man, we just lost out on yes, because that is going to just destroy you in court and and all of all of this kind of thing.

SPEAKER_02:

Um word called spoiliation, yeah, spoiliation.

SPEAKER_01:

And by the way, there's not like there's I always think there's extra eyes in there somewhere, but it there's not. Yeah. Um, so there's gonna be a spelling B at the end of uh today's podcast where we're going to have the word of the day is spoiliation. So anywho. Thank God, no, because I wouldn't, I would not, I would end the podcast early if we had math problems. But uh look, I cannot tell you how many times as an expert witness for claims handling I get called in late. And I know the reason why. And so I this is where I need to speak with the adjusters because I know there's no C-suites people listening on this, because if there were, everything would be changing. But I need you to explain to the to the bosses that I know everybody's trying to lower the loss adjustment expenses, the LAEs, not to be confused with additional living expenses, A L E, but L A E, loss adjustment expenses, which is why you don't want to call in your experts, either for origin and cause or financial business interruption or engineers or even me. You want the in you want the claims handler to be the expert, but you can't be the expert because you're kind of blinded by the trees in the forest. Like you can't see the trees because of the forest. You know, you're seeing the forest. Whereas I'm going down and going like, oh yeah, you probably you didn't do this, this, and this, or oh, you're fine, you did that, that, and that, you're good. It's always better to have your experts in earlier rather than later.

SPEAKER_02:

And I just think it's also uh I think you cripple your adjusters by having that expectation of them to always sit in that in that space because they honestly they don't have the training and they don't have the expertise. They have training and expertise in a lot of of other things that but recognizing that and realizing that loss adjustment expenses that are spent towards things that will help to make sure that you're paying the right amount at the right time helps you to avoid the bad faith lawsuits, helps you to avoid the the the whole idea of you know, we're called being called in for a market conduct exam because we're flame handling that just seems to be sloppy or using things at the wrong time or not investigating the way that we should. Um they're expensive, I get it, okay? But you would rather be expense on the back end to brand, reputation, but also like your ability to be able to write insurance in a particular area because like they're you're you're putting your adjuster in a place where they shouldn't be. Yes.

SPEAKER_01:

Trust me on this for any C-suite that's in that's listening, which is absolutely nobody, but you would rather spend five thousand dollars on me or some other engineer or medical professional or whatever looking at this file than I in one file, I have already billed$55,000. I mean, look, I would love to put myself out of business. And that's actively what I'm trying to do here with this podcast. I am trying to put myself out of business. So also, I mean, for the adjusters, this is this is why you need to be paying attention and trying to get the the engineers involved or the experts involved early and often whenever you see that you have some kind of of problem.

SPEAKER_02:

Yeah.

SPEAKER_01:

It is always going to be worth it.

SPEAKER_02:

Well, and the the proactive piece of it just can't be stressed enough because not only do you like cripple the case and capability to be able to carry everything out, you cripple the expert when you bring them in too late.

SPEAKER_01:

You know? Um very true. You know, if we're under the gun, I can't do a good review.

SPEAKER_02:

Yeah, it's difficult to be able to be feel that pressure of that. And so again, you know, experts are often involved in dispute situations, even though I said try to get them in before the dispute happens. They're often they're often going to always be involved of the time in those major dispute situations. Um, how do courts like look at expert testimony? Because I know you sit in that space and tell us all about it.

SPEAKER_01:

So tell us all about it. Um, you know, it's uh the courts will make sure that your expert is good. I there's other words, but you know, just to break it down, good in that particular field. Like, you know, they've got the education, they've got the uh, and and it's not just education. I mean, could have they been writing in it? Um, do they teach in that field? It because it doesn't necessarily even have to be the education, it could be the experience. For example, I've never uh I don't have a master's degree in insurance, I don't have a PhD in insurance or risk management or whatever, but I've been handling claims for 20 some odd years. So that breadth of experience, as well as my teaching, as well as my authorships, gives me the expertise according to the you know, courts. Okay, great. Uh so there is that. What we have to be very careful about, and this is one of the reasons why I say your claims adjuster can't necessarily be the expert on claims handling, is because even though they may have the same degrees that I do, or the same education, or the same background, or the same learning experience that I do, is that I have been trained on what I can and can't say. For example, this is and this is still completely bizarre to me, and I will argue it to my dying breath in a courtroom on record, like I am right now, being recorded, is that you according to attorneys and and the judge, adjusters cannot interpret coverage. Like we can't make a coverage determination. And I'm like, that is literally our job. Literally the job. Literally our job is to take the facts, apply coverage, and interpret how coverage is going to literally, but I have to be very careful the way that I say it, especially when I'm writing it. And sometimes it's really hard when you're writing the report, but I I cannot say the adjuster did the coverage interpretation correctly, or I'm interpreting this thing correctly, blah, blah, blah. I uh and and as another little side story, I wrote a report and I was referencing, it happened to be Colorado, I was referencing the Colorado uh Unfair Claim Settlement Practices Act. And I and I said, well, the insurer violated this particular law. Well, that was a quote, legal opinion, end quote. And since I'm not an attorney, half of my uh report got thrown out, yeah, even though it deals with claims, and and that's literally, I mean, it's like we uh again, we literally go back to the law. That uh it I'm not interpreting the law. That's literally the law. I mean, that's what we're supposed to be following, but that's what you would worry about, and that's what I'm saying is if you pressurize your adjuster who you give what an hour and a half of training to before throwing them into a deposition or into the court in front of a jury, then they could be saying the wrong thing and the whole kit and caboodle unravel. Whereas alleged allegedly I'm supposed to be trained for getting it.

SPEAKER_02:

And I get it, like it's very hard because adjusters are routinely exposed to things that are are 100% in the lane of the legal field.

SPEAKER_03:

Yes.

SPEAKER_02:

Um, and you may understand the law really well. And I know, like in the moments that I sat in that 30v6 rep spot and I had to be deposed as the company representative and in many bad faith, extra-contractual litigation stuff. Um I know that the attorneys that the defense counsel that I worked with always came to me and said, you all understand the coverage application to the claim circumstances much better than we do. So educate us on that and then help us to understand your reasoning as to how maybe precedent or law that in the state that you might have been handling claims, understand your reasoning. If you have if you grasp an ability to be able to explain your reasoning for your decisions, it it becomes much easier to travel in the lane that you need to travel in, right? But also know that you do get exposure to that kind of stuff, and it's okay to ask questions. And it and I will tell you, it made me a better adjuster by being that person who had to regularly be deposed, even on the files that I didn't have any direct handling on, because I could I could say, okay, yes, I understand this, I understand why the decision was made, I understand here's how the def how this decision was defended and everything. But I didn't step into the world of I know the, you know, I know the exact statute, and I can quote it chapter and verse here about, you know, what what an attorney would say about what happened here. And and that's you know, I think those are the I think those are the fine lines you gotta learn to walk.

unknown:

Yes.

SPEAKER_01:

And it's very, and it's very hard. And I love I love what you said about you, you know, the the way that we have to to word things in the fine lines. And and remember, as an adjuster, again, we keep saying this, you don't know everything, which is fine, I mean, because you're human. I don't know everything as a quote expert, end quote. And and I have even taken some court case, you know, cases where I am the expert witness, and they have hired an expert, uh construction expert or a plumbing expert or or whatever when I'm reviewing the file. And I've been asked in deposition, well, why why did you think such and such, or why did you write this in your report? And and I said I deferred to the expert. Like I deferred to the plumbing expert, I deferred to ex-expert or whatever. Of course, side note, also side story, one of the fun little things that I did get asked when I I had made some opinion about a plumbing thing, and they said, Well, are you a plumber? And I said, No. And they said, How much plumbing experience do you have? And I'm like, I uh I like did a quite a bit of plumbing, like I've replaced a toilet and I've done this and I've done that because my dad didn't want me to be, you know, uh taken advantage of by plumber. So I mean I've I've I've done a lot, but that doesn't make me a plumbing expert. I mean, that's that's the difference. So can I say this doesn't make sense? Yes, that's my common sense, you know, but I have to defer to the experts. I can say that doesn't make sense, and so did the the the plumber also said that.

SPEAKER_02:

So I think you have to what you hit on there is you had to know when you were out of your depth, right? Yeah, you don't you're not a plumbing expert, but you have some common sense knowledge of things that you've been taught, and you know when something might be out of place or something might be wrong, but you wouldn't call yourself an expert about that. And I think one of the biggest things that we could also remind people of is like experts are necessary.

SPEAKER_01:

Yes, let's talk about that. Absolutely. And again, we it's not bad, it's not expensive, and we and I know that in this hard market, everybody is wanting to save that loss adjustment expense. But let me tell you, there's two sides to that coin. There's the loss adjustment expense, and then there's the indemnity. And if you're cutting back the loss adjustment expense and overloading your adjusters, you're just making the adjusters pay or overpay on the indemnity side. And then your indemnity is going to be swinging all the way. And then you know, the board and all of them are gonna be like, oh, we need to cut indemnity, we need to start doing you know more research and all that kind of stuff. And that also leads to bad faith because then you're you spending so much time in the investigation, then you're not paying claims. So it is a it is a balancing act. It's two sides of a coin, you can't have one without the other.

SPEAKER_02:

Well, and I think I go back to what I think is like the perfect analogy because I'm a football fan. You're the quarterback, folks, right? Um, and you have a lot of different players that are out there with you on the field. All right. They are gonna have a different role throughout the process of your claim. And sometimes they they might not actually even need to be involved, you know. But knowing the moment that you need to bring them to be involved is the key skill set that you need to develop, right? And and that takes time, but that also takes you being willing to step up and say to your leader, to whoever, hey, by the way, I've got this kind of a circumstance. What recommendations do you have? I'm thinking this, but what recommendations do you have about who we might need to bring in because of these facts and circumstances in my research so far in the I love that.

SPEAKER_03:

Yeah.

SPEAKER_02:

And I always felt like if I went to my boss with a plan that said, Hey, I'm thinking this, and not just said, Hey, tell me what I have to do here. Um, they were always more willing to go, yeah, let me listen to what you have to say, let us think about how we need to case manage this and whatever we need to do from this point out. But go into them with a plan instead of I don't know what to do. Yeah, throwing your hands up. Throwing your hands up, which I get. Like if you're new, some of the time you don't know, but go to the people who might in your team who might know and get some recommendations from them. Right. And then say, here's the coverage I'm looking at. Here's what I don't understand about it, and I don't have the expertise to be able to figure that out. And with these facts that are coming in the door as we see them, and I think that some of that's muddled and gray and mucky and not really what happened, you know. Yes.

SPEAKER_01:

Recognizing that is your biggest and most powerful skill set that you can have. Absolutely. And I I do think that it it takes a special skill and and and maybe even a little humility to to say I don't know something. Uh and and one of the biggest things that I have learned is people actually respect you more if you admit that you don't know something. And and I because I would I have started saying, you know what, I don't know, but I'm going to check and I will call you back and I put it on my calendar to make sure that I call them back at a certain time. I'll call you back by 4 p.m. today or I'll call you first thing tomorrow morning. I put it on my calendar because I'm never going to remember. And that way I I don't break my promise to that person and uh and find out that that answer, even if it's calling them back and saying, hey, I I I was trying to get in touch with my supervisor and I haven't been able to let me get back in touch with you in a couple of days, uh, you know, I'll I'll let you know. Um and and knowing when to do that. It's really hard because we all want to know to know things. Um, but uh now you're an expert, and so now uh you know everything that that we know, and um we're gonna go to our spelling test or um other words. Yes, explanation. Spoliation. Uh so what anything else you wanna you wanna add you feel is important, Heather? No, I think we got a really cool episode. I do too. I think we've got an excellent episode. Now, speaking of excellent episodes, I have not confirmed yet, uh, but I'm I'm I'm I'm going to go ahead and tease it. I'm so hopefully, you know, because if I tease it, then it won't happen. But I'm gonna go ahead and tease it. I we're gonna have Paul Miller on to discuss haunted claims and insurance. If you don't follow Paul on LinkedIn, do it now. I'm gonna tell you to do it then. But he knows so much about insurance history, and his posts are terrific. Get it?

SPEAKER_02:

Get it terrifying on some words, terrific, get it?

SPEAKER_01:

And we're talking about Halloween. My favorite, favorite holiday. Mine too, because it's like you get candy, you get dressed up, you get to be with friends, you don't have to deal with family. So it's like the best. So we will see you in two weeks. Let's do it. Okay, bye.

SPEAKER_00:

Thanks for joining us on the Art of Adjusting Podcast, where we talk about life as an insurance adjuster.

SPEAKER_01:

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SPEAKER_00:

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SPEAKER_01:

In the meantime, you can contact me at theartofadjusting.com for consulting and training purposes.

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