control over claims decisions
Property Casualty


Rod Miner
Rod Miner
Vice President of Commercial Claims, Property Casualty

Control. It’s more than a Janet Jackson song from the 1980s. Control is what most clients want when it comes to their property casualty claims experience, specifically third-party claims. Control over what is reported. Control over who is contacted. Control over what is reserved. And, control over what is paid.

The reality is the insurance adjuster, or more so, the carrier or third-party administrator (TPA), has that ultimate control.

However, there are steps you can take or put into place to provide you more control with your carrier or TPA and their decisions.

  • Increase your risk appetite — In guaranteed cost programs, while any claim payments can impact future premiums, the actual money being spent is the carrier’s. With the use of higher deductibles or self-insured retentions, that layer of money is yours. Good claim organizations and professionals will often say, “Resolve claims as if it were your own money.” There is an even stronger argument for this when it is, literally, your money. While still the carrier’s or TPA’s ultimate decision, your involvement and input should have more impact.
  • Partner with a third-party administrator — In most cases when you partner with a carrier for coverage, their claim services are included. Some carriers are better than others. Carriers’ claim departments spend the money, but it’s not where they make their money. We will often see clients choose which carriers they partner with solely based upon price, regardless of claims performance and service. On the other hand, TPAs earn and lose business directly related to their claim service and outcomes. To do so, they understand they must provide a strong product — one which works closely with their clients. Like carriers, some are better than others and TPAs ultimately make coverage and settlement decisions. But, it behooves them to communicate and listen to their clients.
  • Establish teamwork and communication — Don’t give up hope if you don’t currently have either of the two above in place. We’ve established that you’ll never be able to truly have free reign on all claim decisions. What you need to have is the opportunity to be part of the decision-making process. A good adjuster will want you to be part of that process. Tools, such as new carrier claims installation meetings where contacts and expectations are established, can serve as a way to ensure this happens. Periodic claim reviews are another tool to use. Not only does this provide a format to dig deep into individual claims, but it’s also a great opportunity to review the entire process, including communication expectations. Especially with the possibility of adjusters or your own contacts changing over time, establishing special claim handling instructions with your carrier or TPA can help memorialize expectations surrounding claim handling and resolution.

I feel when most clients say they want control of their claims, what they really mean is they want more involvement in the decision process of claim outcomes — more sense of control over their destiny. Holmes Murphy can help you achieve this level of control. Just talk with us!

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