Tag Archives: insurance adjuster

A Word With Shefi: Ashili at Smart Drivinc

This is part of a series of interviews by Shefi Ben Hutta with insurance practitioners who bring an interesting perspective to their work and to the industry as a whole. Here, she speaks with Shashaanka Ashili, founder of Smart Drivinc.

To see more of the “A Word With Shefi” series, visit her thought leader profile. To subscribe to her free newsletter, Insurance Entertainment, click here.

Describe Smart Drivinc in 50 words or less:

We are focused on developing crash-prevention technologies in affordable ways. Our solution for distracted driving is affordable, configurable, tamper-resistant and backed by intelligent evolutionary algorithms.

How did the idea develop?

In 2014, my wife’s car was rear-ended by a distracted driver. A non-fatal, four-car pileup resulted in a total loss of the car. Finding another car, with infants in the family, was a painful process. The unfortunate part is that the accident could have been prevented, had the driver been a bit more careful. That is the focus of Smart Drivinc – crash prevention.

What’s in a name?

Our solution is supported by smart technologies that make driving safer…hence Smart Drivinc.

Describe your typical client:

Our B2B clients are companies with employees on the road: sales workers, insurance adjusters, etc., for whom we reduce risk by preventing accidents. Our B2C clients are parents of novice drivers, for whom we provide peace of mind.

What does competition look like?

The space is crowded with all kinds of solutions, however, we are the only company that solved this problem in an affordable fashion and created a win-win ecosystem for end users and insurance carriers.

What’s on your to-do list?

The top of my to-do list includes forming collaborations with insurance companies. Our solution not only reduces accidents but also brings new customers to the table.

What are you most excited about with respect to Smart Drivinc?

At the end of the day, what matters and excites us most is providing peace of mind to parents and making our roads safer.

Why are you part of the Global Insurance Accelerator?

GIA occupies a niche, a space that has not been visible before. Combining insurance and technology in the Heartland is a brilliant strategy. For the past three weeks, we’ve met with the best in the industry and were offered unconditional support for our venture. I learned a lot from each individual meeting. GIA has created a mentor pool that is like a library where you can find answers to everything. The best part is they’re one call or one email away from us.

One takeaway:

Make no assumptions, stop “talking” and start “asking.”

Who else has been supportive of your cause?

CEO of MinMor Industries, Joe Morris, is one of our strong supporters. Thank you, Joe!

Biggest challenge:

By profession, I am a bio-optical systems guy, no relation to the insurance or the transportation industries. Developing contacts and traversing these sectors was my biggest challenge. Being selected to GIA solved this problem for us.

Where do you see Smart Drivinc in five years?

Our motto is “Crash Prevention,” and we have several products lined up to address this, with the goal of launching a product once a year. For instance, we are developing a suite of products to personalize one’s interaction with his/her car, starting with the actual purchase of the car, down to maintenance, insurance and even the sale of the car.

Best life lesson:

Believe in yourself; you will have some discouraging encounters.

get along

Why Can’t We All Get Along?

More often than not, a large property and business interruption insurance claim turns into an “us vs. them” scenario, creating a rough process for all involved. Not unlike a football game, someone is always trying to win and is willing to do so at any cost. As a forensic accountant for more than 20 years specializing in quantifying business interruption losses and documenting property claims for policyholders, I’ve seen the good, the bad and the ugly. The problem is that the process is designed to focus on disagreements.

We’ve heard the concerns from our clients and the insurers, and we can understand both perspectives. Policyholders accuse the adjuster of being unreasonable, trying to stick it to the policyholder at every turn. Insurers accuse policyholders of trying to take advantage of the claim in an attempt to get more than they deserve. The battles can become very heated, even on a personal level. Once, during a claim meeting on a large loss, the discussion between the parties intensified until an executive from the insured side of the disagreement ordered the adjustment team to “get out of my building!”

Disagreement in the course of a property insurance claim is an anticipated part of the process, but there are ways to keep it civilized and productive. It is possible to come to a fair representation of the loss without all the aggravation. The fix is really quite simple, but it will require the insured and insurer to take responsibility for their contribution to both the problem and the solution.

Here are some ways insurers can improve the claim process:

Take time to understand the insured’s business 

Too often the adjuster wants to appear to know it all. It is better to listen first and try to understand the insured’s position. Understanding your customer is common business sense.

Adjusters should have superlative people skills

A big part of an adjuster’s role is to coordinate with experts needed for a given situation. These are management and organizational skills. In other words, the adjuster does not need to know all the technical aspects of every loss and would be better served knowing more about how to manage people and deal with customers. Whether it’s from retiring baby boomers or cost cutting, there is a lack of well-trained and experienced adjusters.

Give the adjuster more control 

Even the best adjusters are impaired by the current claim process; Adjusters seem to have limited authority to make decisions. Policyholders find it pointless to explain their issues in great detail when the real decision maker is somewhere in the background. When pressed to make a decision, policyholders just throw their hands up. It’s difficult to make any progress when the adjuster has to get every little decision approved by superiors. To the insured, it just seems like a delay tactic to put off payment and only adds to feeding mistrust.

Here are some ways policyholders can improve the claims process:

Give the process a chance 

While there are many times you will experience some of the problems mentioned above, the process can work with the right people involved. Communicate with the adjuster and his or her team. Be responsive to all requests that are reasonable and appropriate and ask for clarification and address your concerns right away.

Maintain good relations with realistic expectations

Set realistic expectations for what you want, such as advance payments and resolution of differences. Though insurers are not obligated to finance a rebuild project, they should be willing to advance money to stay ahead of the cash expenditure. By maintaining good relations with the adjuster, insurers will be more open to working with – rather than against  you.

The best defense is a good offense 

On your end, be prepared and organized so you can require the same of the insurance company. You cannot withhold information until the last minute and then demand resolution and payment. The faster you answer questions and requests, the faster the insurance company can review them. Often times, it takes them longer to review the support you provide because they review the information in a vacuum. Don’t assume they understand what to ask for or what has been presented. Promote frequent meetings and discussion to make sure misunderstandings are not made part of their reports to underwriters. Once it is on the record, it is harder to change.

Escalate when needed

If issues start to arise that cannot be resolved, rather than letting it fester, escalate it to the markets involved. It is no different than speaking to a manager at a restaurant. It’s better to deal with decision-makers when action is needed. However, this should only be used as a last resort to avoid litigation.

The insurance claim process has its flaws. I don’t think it’s intentional but rather a result of how it has evolved. The best approach to improving the process is by recognizing the challenges with an “us vs. them” mentality and finding a way to work cooperatively through the claim. Both sides need to help to fix it so that more claims get resolved as they should.

Cars That Self-Assess Accidents

“Star Trek” fans love to point out that, over the last five decades, many of the show’s futuristic technologies have gone from science fiction to fact. Mobile communicators (cell phones), non-invasive surgery (focused ultrasound surgery), food replicators (3D printers) and phasers (now being tested by the U.S. military) are but a few examples.

But in its own way, a show in the 1980s was just as prescient: “Knight Rider”– a show about the exploits of Michael Knight (David Hasselhoff) and his car KITT, a talking, thinking and feeling car is nearly spot on.

In the show, this highly autonomous vehicle could map locations, conduct video calls and talk much like Apple’s Siri system. In reality that’s headed our way, automobiles that feel and virtually think will be made possible by technologies that include augmented reality, microscopic sensors and mini-microprocessors. These technologies will enable vehicles to perform a variety of tasks now done by humans – from assessing the damage caused by accidents and ordering replacement parts to booking rental cars and assessing liability.

Tomorrow’s vehicles will, in part, assume the roles of insurance adjusters, collision-repair technicians and drivers. And “tomorrow” may not be too far off.

“Smart Skin”

Already, engineers at the British defense, security and aerospace company BAE are developing a “smart skin” – a thin surface that could be embedded with thousands of micro-sensors (aka “motes”). The company says that when this layer is applied to an aircraft, it will gain the ability to sense wind speed, temperature, physical strain and movement with a high degree of accuracy.

According to several articles, the micro-sensors could be as small as dust particles and could be sprayed on the surface of the aircraft (and on a car or truck). The motes would have their own power source and, when paired with the right software, communicate in much the same way that human skin communicates with the brain.

Once sensory and virtual-reality technologies have evolved to the point where our vehicles can genuinely “feel” and evaluate changes to themselves and their environment, the main thing needed to complete this automotive Internet of  Things will be data – lots of real-time data that is freely exchanged between car owners, insurance companies, auto repair shops and auto manufacturers. Achieving a consensus among consumers and corporations about when, what and how much data should be exchanged may be a sticking point, but, once that agreement is reached, it will be just a matter of time before self-diagnosing cars start hitting the roads.

The Car of Tomorrow

Imagine a future in which your car is covered with an intelligent “skin” that monitors every component and function – from the engine to the exterior sheet metal.

Now imagine the moment your car gets into an accident. The car will instantly calculate how much damage has been done, where it was done and what needs to be repaired or replaced. This information will be quickly ascertained and collected by the vehicle’s computer. From there, it will be transmitted to the cloud, where it can be downloaded by a repair facility or insurance company. By viewing a three-dimensional virtual-reality image of the automobile, the repair technician and insurance adjuster could literally “see” – and almost feel and touch – the damage.

Imagine a time when all that damage is self-assessed by the vehicle. It diagnoses itself, feeds the information into estimating software and tells the collision-repair shop what needs to be done. The vehicle also determines how long repairs should take and even orders parts by automatically sourcing suppliers. All this ensures that your vehicle is fixed ASAP. In addition, your hyper-smart car can order a rental, so you’ll have alternative transportation while the claim is being processed.

All the information regarding your accident – the speed at which you were traveling, location, direction of travel, etc. – will be instantly transmitted to your insurer, enabling the adjuster to make more educated decisions. Think of all that information being fed to a predictive, cognitive claims system that can make intelligent recommendations, helping consumers receive the best possible outcome on every claim.

This is the future – an era when data, sensor and cognitive computing technology are meshed to create a seamless auto claims process that speeds repairs, handles claims more efficiently and provides an amazing customer experience.

How to Avoid Work Comp ‘Fact-cidents’

Every workers’ compensation claim is not preventable, when you consider that some are deliberate. With due respect to the art and science of safety, preventing real physical accidents and repetitive traumas is essential. However, we also need to be mindful of and prepared for the non-accident accident. Let us refer to these situations as “fact-cidents” because their construct relies on the ability of a claimant to tell a credible story void of facts.

First of all, let’s establish fact-cident detection as an employer’s responsibility. An adjuster with the best list of “red flags” cannot match the gut instinct of an astute employer who knows an employee’s history and extraneous issues and has opportunity to look that employee in the eye. An unwitnessed fall out of a chair or a bump against a restroom-stall door, or a “giving out” of the knee when turning with a parts tray in hand can be very valid claims… until they are not, mainly because the employer knows something deeper about the employee’s motivation.

The employer must share concerns with the adjuster within the early hours or days of a claim to support heightened focus. Most fact-cidents cannot simply be denied. Very quick work is required. The good news is that fact-cident defense is time-consuming but not complicated. It simply involves obtaining multiple verifications of the story. Just like the old saying, “there is no such thing as the perfect crime,” there is also no such thing as the perfect false claim. Enough prodding will diminish credibility and isolate the fact-cident for the house of cards that it is.

Quick Tip: Ask, Ask Again and Ask Some More

An injured worker should be required to reiterate his story four to six times within the first 48 hours. Here is an optimal sequence:

– Report to supervisor, who writes down claimant’s account

– Call in to triage line, where a nurse interviews and records claimant’s detailed account

– Workers’ comp lead (WC or risk manager, HR, benefits, company nurse, etc.) requires discussion and writes down another reiteration of the incident

– Treating doctor requires a detailed reiteration of the incident as part of history

– Adjuster takes recorded statement of the claimant’s account

– Adjuster and employer-leaders separately circle back to claimant after doctor visit to get claimant’s version of the doctor’s assessment

With these multiple stories and queries, the true detective work begins in comparing and sharing claimant versions. Fact-cident claimants notoriously will assume what certain parties want to hear and adjust stories accordingly. They also may enhance their story gradually with each reiteration. After medical visits, they often alter what actually happened or was said by the doctor. Sadly enough, many seem to think they can play all sides to the middle with no cross-checking among the crowd. Don’t let that happen!

The investigative test relies on comparing all versions and then, as might be indicated, sharing with other parties. For example, if the initial supervisor and HR manager reports mention non-falling incident with ankle pain but the version to the doctor claims a fall to the floor adding hip, back and elbow pain, you have an immediate piece of evidence validating suspicions. You can confidently invest and engage denial, defense, independent medical exam (IME), surveillance, field nurse, et. al.

Inconsistencies can also be presented to the doctor for review and revision or re-exam to correct any false reliance on claimant’s story. If possible, with cooperative providers, the early internal reports can be shared with treating doctor in real time so she can diligently test the employee’s credibility against other statements.

An even more powerful reason to collect and solidify various versions is to avoid future attorney representation and fact-cident influencing. Worst-case scenario with lack of early employee statements is that an attorney gets to coach the employee into a tighter self-serving story later on.

When you suspect an accident is actually a fact-cident, don’t accept any aspect at face value. Put in the time to either confidently validate and pay the claim or justify heavy investments in defense.

As a bonus, from the big-picture perspective, this type of consistent diligence establishes a general no-nonsense workplace attitude and culture when it comes to workers compensation.

The Fallacy About International Claims

The world is getting smaller. Companies of every size do business around the globe. This poses business interruption risks both direct and indirectly. Recent examples include the devastating flooding in Thailand and the Tohuku earthquake and subsequent tsunami in Japan. Property claims can be hard enough when they are at home; adding distance and language differences can make things more time-consuming and add expense to resolving a claim. There is good news, though: International claims are not that different than any other claim.

For example, in 2013, when Ingersoll Rand suffered an $11 million-plus flood loss at a manufacturing plant in Shanghai, we calculated the property damage and business interruption loss amounts, prepared the claim and worked with the loss adjustor and the insurance company’s forensic accounting team. We effected a settlement within three months of the end of the loss.

Experience is the key.

The Language

The insurance world speaks English. The first question we are asked about preparing international claims is whether we have someone who speaks the local language. While this might have some benefit, it is far more important that someone understand the process and the numbers. On the rare occasion where a translator is necessary, that is all that is needed: a translator. It is not necessary to have a claims practitioner who is fluent. You are much better off with practitioners who know what they are doing on a property claim.

The Location

The time and cost to fly consultants around the world is a real concern. Often, policyholders will be inclined to hire less experienced professionals because of their proximity to the loss. This is a mistake. For the most part, information can be transferred electronically and explained over the phone. For companies based in the U.S. with operations abroad, all information necessary to prepare a claim can be transferred through headquarters.

There are certain elements of a property claim where on-site assistance is needed (physical inventories, building or equipment inspections, etc.) This type of specific technical assistance can be coordinated with the insurance company and local resources. As with accounting information, the results of these physical inspections can be documented and sent back home. There is usually no need to send someone from here to there.

As real examples, we have prepared and settled dozens of claims around the world without setting foot on the loss site. This is accomplished by sharing information electronically and communicating by phone, web meeting, web sharing portal, etc. The alternative of using local, less experienced professionals would undoubtedly add confusion to the process. Experience is the most important requirement in preparing any property claim.

Don’t get the wrong impression – we have traveled all over the world for our clients when asked. Sometimes, the parties involved require the travel, or the loss simply demands it. However, this type of travel is less frequent now. If required, travel should be scheduled to maximize productivity to reduce the amount of travel needed. Again, experience and expertise allow this to be accomplished most efficiently.

The Local Policy

Local policies that cover losses abroad may have some differences from the global policy. If these differences affect recovery, in general the master policy can be invoked to make up any differences. You will want to prepare the claim according to the local policy, but be aware of differences. Your broker should be able to help sort out any differences and the reasons for those differences.

The interpretation of the local policies by local adjusters can create confusion. Just be aware that the intent of the local policies should fit in with your global program – to indemnify for the loss.

Summary

Losses happen all over the world. Just because you are in New York and the loss is in Paris, France, does not mean you should treat it any differently than if it were in Paris, Texas. Language and location are not a barrier in this day and age. If you compromise expertise for proximity to the loss location, in the end it will cost you more. Look for a team that has had success managing international claims throughout the process, leading to results for clients.