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Claims busters: Plymouth Rock's mobile claims adjusters mix technology with a personal touch to keep costs down while making customers happy. (Property/Casualty: Claims).

It's a Thursday morning and Joe Deboisbriand is about to head for work from his home in Salisbury, Mass. But before he hits the road as a field adjuster for Plymouth Rock Assurance Corp., he pulls up a chair at the roll-top desk in his living room and switches on his laptop computer. The screen lights up; he quickly connects to the Boston-based company's Web site and enters its claims handling system. He scrolls down the list of the day's assignments for his territory, which covers nearly all of Boston's North Shore from Newbury to Lynn.

This day, his assignments will take him to Lynn, Salem and Danvers. He will meet face to face with one disgruntled policyholder, talk to two others angling for a fatter claims check and confer with a body-shop owner on the status of another client's car repairs. He also is down for handling a door-to-door claim, a company service that delivers the damaged car to the body shop, provides an optional rental car, pays the bill and returns the repaired car to the customer faster. By day's end, Deboisbriand will have inspected all manner of damage, ranging from what he dismisses as "two dings" in the door of a worn Ford pickup to a wrecked suspension system in a new Chevy Cavalier.

While 99% of the claims he looks at are straightforward accidents, he remains alert to any policyholder story that doesn't add up.

Once Deboisbriand has printed out his schedule on the laser printer next to his desk, he plots his route based on the availability of the vehicles he must inspect. In one case, he recognizes the policyholder as a repeat claimant. Still in the claims handling system, he goes to the form screen, types in the claim number and accesses that claim form. He notes the type of damage and whether or not there is a lien holder on the vehicle who will have to be notified in the event of any insurance payment. He also sees that the collision deduction has been waived, indicating that liability has fallen on someone else. He prints a hard copy of the form, then returns to the screen and prints the claim to a spool file so that he can download it into his computer, a process he will follow for all of the claims he will investigate this day.

"When I started this job, the computer was totally new to me," says Deboisbriand, the former manager of an auto-repair and body shop. "But now, I wouldn't go backwards at all."

On the Road

After he signs out of the home office's Web site, disconnects the laptop and puts it into his briefcase, Deboisbriand heads out his front door to the white Chevy Astro van parked in his driveway. This is no ordinary van. In the front and on the sides, it bears the logo "Crashbusters," the name that Plymouth Rock coined in 1990 when it launched what it says was the industry s first complete "come-to-you" auto claim service. The company purchased the van stripped--except for the front seats--then had an outside contractor do the rest. The result is a modern office on wheels, featuring a spacious desktop with computer connections, laser printer, fax machine and phone. A battery of filing cabinets above and below the desk holds Deboisbriand's records going back 18 months or more. A calendar, phone extensions for other company adjusters and an array of family photos hang on the bulletin board to the side.

"This is so efficient," he says of his mobile work space. "I've seen other companies' adjusters bunched up in the front seats of their cars, hunched over laptops. They get the information, but when they go back to the office and find out they still have a question, they have to call the policyholder back. This way, I can do everything at once."

The claims that Deboisbriand and his 12 fellow field adjusters check each day have come into Plymouth Rock's toll-free, 24-hour service line from agents who, before the advent of all this technology, had to fax them to headquarters. For each claim, an in-house adjuster compiles a report that lists coverage and policy information, descriptions of the vehicle's condition and how the customer can be contacted. Compiling the information this way eliminates the need to make follow-up calls that slow down the claims process, the company said.

Insurers in the highly regulated Massachusetts auto insurance market can differentiate themselves only through service. Deboisbriand says his bosses believe that their representatives "have to go one step beyond customer service, providing something that no one else does." That was the motivation for creating the Crash-busters program, he adds. Plymouth Rock Cos. is the ninth-largest writer for all private-passenger auto insurers in overall direct premiums written in Massachusetts in 2001, with 3.97% of market share, according to A.M. Best State/Line reports.

While the van idles, Deboisbriand slides into the swivel chair at the mobile desk, switches on all the machines and reconnects the laptop. He opens up all the programs he will need during the day and lets them run. One is Mitchell's e-Claims Manager, which identifies the vehicles in his territory that still need inspections and those that require supplements, or follow-up work. These follow-ups can mean visiting a body shop where a mechanic has discovered yet more damage than first thought. Each claim has a folder that he can access by typing in the vehicle identification number.

Deboisbriand, a senior claims adjuster who has worked in the field for nine years, has a mail carrier's knowledge of the streets in each of his towns. But sometimes even he is stumped, and this morning he has to pull out his Streetfinder's map book to identify the nearest crossroads for the first address. That done, he moves to the driver's seat and sets off, swinging onto nearby Route 1, then taking Interstate 95 South for 30 miles to Lynn. On the way, he starts sipping the Dunkin' Donuts coffee that he'll nurse through the day and notes how the northern Massachusetts countryside is still marked by mounds of snow.

First Customer

In Lynn, a town that looks like it deserves better days, Deboisbriand approaches the first address--a small apartment complex in a blue-collar neighborhood. "I'm looking for a white pickup truck," he says as he swings onto a major thoroughfare. "There it is!" He pulls the Crash-busters van over to the curb, right behind the truck. Deboisbriand calls the client from his cell phone to say that he has arrived and will be up to see him in 10 minutes with an estimate. He also reminds the customer that he has a $500 deductible.

Then, Deboisbriand grabs his digital camera and strolls over to the truck. He sees two recent dents in the passenger side door below the handle. "These are not big at all," he says, adding that he would guess a repair cost of about $300. In his examination of possible prior damage to the truck, Deboisbriand spots quite a few scrapes, including a large one over the right rear wheel near the bumper. Once he checks the vehicle identification number and license plates to verify that this is indeed the truck in question, he snaps a series of photos. When he returns to the van, he calls in-house adjuster Emily Hatfield to ask for a more detailed accident description and she tells him that the driver's passenger door flung open and the door hit a parked car.

"Now I have a better idea of what happened," Deboisbriand says. For the policyholder, he assembles a packet that includes information on the claims process, the names of every registered body shop in the area and adjuster Hatfield's phone number. He next turns to his laptop, takes the digital photos from the flashcard and attaches them to the claims folder. He deletes the photos from the flashcard so the camera will be ready to use as soon as he reaches the next stop. Using Mitchell-Ultra.Mate 4 software, he receives an estimate of $356--below the $500 deductible. "I wasn't too far off," he says with some satisfaction. He fills in the blanks in the folder by reporting that the claim resulted from a collision, the deductible applied and the estimate was made at the insured's home address. Then he types in his own remarks: "No check issued. Damage was not insured."

He prints a copy of the estimate for the policyholder, closes the folder on his computer and hits send. It travels to a secure section of the Web site. "Emily will be able to look at this within the hour," he says.

Deboisbriand knows this policyholder won't be happy. "The first thing he asked me was, 'You going to give me a check?'" Still, the adjuster heads up to the man's second-floor apartment, hands him the information packet and relays his findings. The customer voices some complaints--he insists that the entire outer panel of the door be replaced, a much more expensive repair--but Deboisbriand remains polite yet firm. He hands him a copy of the estimate and leaves. Back in the van, he shakes his head. "One more minute up there and I would have been drunk," he says. The man he just dealt with at 10:30 in the morning reeked of alcohol. "That's the first time that's happened to me," Deboisbriand says.


Things will get back to normal at his next stop, also in Lynn but about a mile away. This is the repeat claimant he recognized earlier. The policyholders run a convenience store and park their car there, where it frequently gets hit. The 1999 Toyota Camry in question is now parked at an apartment building across the street from the convenience store. After Deboisbriand arrives and telephones the owners from his van, a woman comes outside to point out the damage to the front and rear bumpers. This time, they were stopped at a light and someone rear-ended them, pushing their car into the car in front.

After she returns inside, Deboisbriand examines the Toyota and takes digital photos. The rear shows an indentation where the license plate once was, and the front cover also shows some damage. But then the adjuster spots a dent above the front right bumper that, he recognizes, resulted from a different collision.

"This is prior damage that we paid for and that they didn't get fixed," he says. "In this case today, the liability is on the other carrier, but still, if we paid for something already..." He suspects that the previous claim was filed within the past year. Back in the van, he calls the home office adjuster in charge of this file. "I'm wondering if I paid for damage covered the last time," Deboisbriand says. She checks the records and photos from the previous claim and reports that it was settled not one, but two years earlier.

He goes through the same procedures on his computer that he followed at the first stop, then pauses to study the pictures on his screen. He now can see that the owners have touched up a few scrapes that Plymouth Rock had paid for earlier. He decides that the company will pay for replacement of the front bumper with an after-market part, and cover the repair of the rear bumper. Under Massachusetts law, insurers can specify the use of after-market, or generic, parts as long as they don't compromise safety.

The software arrives at an estimate of $591.01. Deboisbriand commits the estimate to the folder and the information is transferred to check-writing software. The printer, stocked with check paper and equipped with specially inked microfonts, issues the check on the spot.

Although the couple is pleased, the husband still presses for coverage of the right rear damage that Deboisbriand disallowed. "I don't think that happened this time," he tells them genfly. 'Are you sure you don't remember this happening before?" The wife concedes that the adjuster is right, but the husband insists that the damage is new. "Now it's between the two of them," Deboisbriand says, climbing back into the van.

Acting Like Columbo

In many cases, he notes, people falsely report their cars were hit while parked. "But if the car was parked, how can the damage be in circular motions?" he asks. Whatever the nature of the damage, if he suspects they're lying, he says he tries to take on the "old Columbo routine," a reference to the rumpled but savvy TV detective who played dumb to solve his homicide cases. "When I say to them, 'So you're telling me the car came down the bill, struck a mailbox and then hit the curb,' people will look at me like I have two heads," Deboisbriand says. "But eventually, they usually admit that really wasn't how it happened."

The next car he must see in nearby Salem, however, has definitely had too close an encounter with a concrete island. This is an electric-blue, 2003 Chevy Cavalier IS Sport that is parked behind Hillcrest Body Shop. From the claims report, Deboisbriand already knows that the car's suspension is damaged and it cannot be driven. So he has decided to ask the body shop to start repair work with a front-end alignment. "That'll tell them what's off," he says.

This time, he not only takes photos of the mangled right front wheel and the pleated front bumper, but also gets down on the ground to look under the bumper to see if he can spot any undercarriage damage. From his van, he calls the in-house adjuster and learns that the Chevy's driver, while trying to avoid another car, hit a curb and rolled over a traffic island, and the car came to rest on another island. Deboisbriand checks the vehicle identification number and notes the mileage at only 760. "This poor guy," the adjuster says.

He guesses the estimate will be between $2,500 and $3,000. The software can't supply him with a grand total for such a late model car, so Deboisbriand has to break it down to the components. He lists replacement of the front bumper parts, fender, suspension parts, wheel and rocker molding, and the computer returns with the figure $2,725.57. He adds on $100 to reimburse the customer for the towing fee, then subtracts the $500 deductible. The policyholder will soon receive a check for $2,325.57.

Over a quick, late lunch, Deboisbriand admits that new adjusters, especially, face challenges in dealing with body-shop owners on their routes. It helps, he adds, to have the kind of car-repair background that he does.

"The garage guys do test you," Deboisbriand says. "The majority are straightforward, honest people, but they want to make a buck, and they want to make the customers happy. They're going to try to get as much as they can from

Deboisbriand's territory includes towns with plenty of high-end vehicles such as Volvos, BMWs and Saabs. His average appraisal is $2,400 a claim and, in 2002, he wrote about $500,000 in checks. Still, he knows he has to be accountable. "I don't want to give away the farm," he says.

His last stop is in Danvers where a silver 2001 Mustang convertible sits in a homeowner's driveway. Deboisbriand recalls that he has paid a visit here sometime before and paid a claim. He calls the owner's cell phone number, and she tells him to look for the damage on the section of the car that she has wiped clean. He notes a scratched left bumper and a dent on the left side of the bumper panels. "Her deduction was waived, meaning somebody probably hit her in a parking lot," he says. "It's the inside adjusters who make the liability decisions. Lots of times my report can tell them who the liability goes to."

After taking the customary photos, he makes sure to check the vehicle identification number. "Sometimes people have two of the same model cars--I once wrote the wrong car," Deboisbriand explains. He looks for other damage, but doesn't find any. With her folder complete and the information relayed to the company's Web site, the adjuster prints a check for $491 to pay for repairs. He slips the check into an envelope with the claims and repair shop information, then pushes the envelope through the woman's locked mailbox as she had requested. "I know she'll get this fixed," he says.

It's now late afternoon and Deboisbriand is wrapping up a shorter than usual workday. Normally, he handles six to seven claims a day, but this Thursday he has tackled only four. Two other assignments, including the door-to-door claim, had to be pushed back because of body-shop schedules. The lighter workload means a heavier one the following day. Once he's back home, he will move the laptop from the van to his living room desk, check his e-mails and review his next assignments. But he already knows he will be tackling nine claims that Friday, including three supplements or follow-ups.

One of the new claims ahead involves a 2002 Mercedes C430 that was stolen and recovered with a report of salt water flooding. "They probably found it in a marsh somewhere," Deboisbriand says. From experience, he knows how salt water can corrode a car's electrical and computer systems, and these problems may not surface for weeks or months. "I already know what I'll be writing on this one--total loss," he says.

The circumstances of the claim, plus the fact that the policyholder has only a $300 deductible, arouse his suspicions. A number of questions come to his mind: Did the owner damage the car, then try to cover it up? Were the keys found in the car, indicating it may not have been stolen? Was there a point of entry showing a break-in and did the thieves defeat the steering column?

This claim could well be the result of simple theft, but Deboisbriand has to be extra vigilant. "Some people think it's all right to get rid of a car through the insurance company," he says. A key reason for his caution is the knowledge that Plymouth Rock, like other insurers, will pay actual cash value for a car deemed a total loss. And in this case, he adds, the check would be $49,000.

RELATED ARTICLE: Adjusting Claims Adjusting

With claims severity skyrocketing, Marshall & Swift/Boeckh is focused on analyzing the way claims adjusters work. Building claims costs have been increasing as much as 9% a year, said Jonathan Kost, MS/B's claims director. In contrast, construction costs have been rising only 3% annually.

"Our initiative is to make sure we can figure out what's driving that cost and find out if it is appropriate," Kost said. "That is what all of our systems are geared toward."

MS/B, New Berlin, Wis., provides building cost data, estimating technology and analytical services for the property/casualty industry. The company's tools for contents estimating and structural estimating for partial loss claims were built with huge data collection capabilities that allow an insurer to learn where specific training for its adjusters might be warranted. MS/B's analytical services point companies to the key cost drivers of their claims business and help companies implement changes based on industry best practices.

"In the world of paper files and paper pushing, it was very difficult for a company to be able to analyze what its field force was doing," Kost said. "The only way was through field audits, ride-alongs or examining a specific file. But it's very difficult that way to figure out whether or not there are patterns or trends in the adjuster's behavior or in the behavior of contractors."

Over the past four years, however, administrative tools have become more prevalent in claims adjusting, he said. These are built to track what's happening with cycle times--how long it's taken to close claims--the contacts with the insured and the estimates. "You can pull up the adjuster's estimate while he is working on the file," Kost said. "That's fairly new, considering that the file used to reside with the adjuster out in the field, so there was no visibility to what was going on other than a diary that was resubmitted back to the home office."

This new type of technology allows home office, management, examiners and supervisors to see what's happening with the file anytime during the claims process, Kost said.

For adjusters, productivity is enhanced because many of these technologies can be hooked into the legacy system or the main policy system at the carrier's location, he said. As a result, all of the information about a loss is automatically replicated on the forms within the estimating software, meaning far less time is spent typing repetitive information with fewer errors and problems surfacing in the data entry.

To improve accuracy, tools are being built with profiles and audit checks that remind adjusters when they've made a mistake. "It performs a lot of the calculations for them" Kost said. "It'll remind them if they've added items in the room several times or potentially performed some overlap."

New emerging technologies also add a scripting layer to the estimating technology that's valuable for inexperienced desk adjusters, Kost said. As they talk with insureds on the phone, adjusters are taken through sets of questions that drill down to what the right replacement and right calculation should be. For example, a homeowner's report of glass breakage needs to show if the breakage occurred on the outside or inside of the structure, a circumstance that makes for a different clean up. An indoor breakage could mean that glass landed on a carpeted area, in which case the carpeting might have to be torn out and replaced.

Starting with DOS estimating systems, this software has been available since the early 1990s, and the first Windows tools came along in 1996, Kost said. Still, only 65% of property/casualty companies have actually automated their claims adjustment. The rest are not fully automated or are still doing estimates on paper, Kost said.

Tom Kirkpatrick, president of A.S.A.P Adjustment Co., Westfield, Mass., not only is in the majority when it comes to automation, but his 10-member adjusting firm seems cutting edge.

For starters, A.S.A.P. uses Integriclaim, one of the MS/B estimating systems. The independent firm's work is 80% homeowners and 20% commercial. It serves 25 major insurers in an area covering most of Massachusetts, Connecticut, parts of Rhode Island and southern Vermont.

His company is on a full application service provider platform called Coin Central, which allows adjusters to connect to the system anywhere they have Internet access, Kirkpatrick said. Most do more than 50% of their work outside the office.

They are equipped with laptops and digital cameras. They also carry digital voice recorders to take reports or statements if need be, and these voice files can then be e-mailed to the insurers. These adjusters are participating in a pilot program in wireless Internet connections which allows them to connect to the Internet anywhere at fairly high speeds, Kirkpatrick said.

On the road, most of his company's adjusters rely on GPS, the global positioning system, to reach an insured's home. They enter the policyholder's address into the system, which uses satellites to pinpoint the exact location on the ground. Adjusters receive a map to follow on a liquid crystal display as well as verbal commands to guide them to the insured's front door.

"When the adjusters go to the insured's home, they utilize the MS/B estimating program to take the pictures, put the pictures into their report, do the estimate and show the insured the estimate on the site," Kirkpatrick said. If the insured agrees with the amounts, as is often the case, the automated systems in the software will help complete the report, connect to the Internet, send the file in to the carrier and request payment-all of which can be done at the insured's kitchen table, he said.

Only a few years ago, adjusters would go to an insured's home, take measurements and snap photographs. Then the photos would have to be processed. At some point, the adjuster would try to come up with an estimate. If the insured agreed with the figure, the adjuster would have to create a report, staple the photographs to a sheet of paper, write an explanation next to it of what those photos represented and send the paper report to the insurance company, all of which would take a considerable amount of time.

The new technology not only allows more claims to be processed; it also improves the quality of those claims, Kirkpatrick said. The company now sends out products with a computer-generated diagram of the building and its roof, and a photo showing the exterior.

"The insurance company can see the building that it is insuring, the dimensions and size, and what it would cost to rebuild it if it burned to the ground, so they know if the people are protecting themselves in the best and wisest fashion," Kirkpatrick said. "They're receiving various analyses from the information that simply couldn't be generated before. It's just a completely different world."

The equipment keeps improving, he noted. His company plans to purchase a Tablet PC which will allow adjusters to speed up the estimating process. They will have only to touch the screen with a stylus to file information as they walk through a home.

Instead of using a tape measure, he and co-workers use laser measuring devices that, when placed against a wall, read out dimensions quickly and accurately, Kirkpatrick said. Also, his adjusters have moisture meters that detect hidden moisture in wall cavities. "It prevents the possibility of a situation arising two or three years later when someone may say it wasn't handled properly and it wasn't properly assessed by the individual on site' Kirkpatrick said. "This way, it's based on science, not speculation."

Talent, Technology Produce Good Claims Results

At Liberty Mutual Group, the leading workers' compensation insurer in the nation, driving losses down through good claims management is vital to the insurer and its customers, said Mark Sidney, senior vice president and general claims manager, in the insurer's National Market operation, which provides commercial insurance products to large companies.

"We're trying to get the best outcomes for our customers while making sure that the injured workers get the best medical care and return to work as quickly as possible," he said.

A key factor is quality of staff, more critical in the claims organization than ever before, Sidney said. "The job is not getting any easier. It's getting more complicated, especially now with prices rising," he said. "Customers are looking for more value, quality services, since they're paying more for the product."

In recent years, Liberty Mutual has pursued a talent-management strategy that starts with a recruiting program on selected college campuses. The company looks for candidates who could be groomed to become case managers--its term for claims adjusters. "We have minimum grade-point requirements that we use to screen people, and we go out and basically try to find the best and brightest and bring them into the organization," Sidney said.

He thinks this approach--hiring the inexperienced at entry level in claims departments and offering them training--is unusual. "There's a fair proportion of the industry that just goes out and takes other people's talent when they need somebody," Sidney said. "But we have an entry-level strategy of wanting to train people our own way, and having them grow and progress with us."

Technology comes into play in the training in a Web-based tool called ECFR, which stands for electronic closed file review. This includes a library of practice files specifically crafted to raise common claims issues. As part of the company's development process, ECFR gives new or medium-range claims adjusters several files to review, then has them fill out a detailed questionnaire online. The questionnaire asks them to evaluate each claim that they have reviewed and how well it was handled. Then ECFR, based on their answers, produces a score according to a particular claim-handling process-investigation, evaluation, negotiation and disability management. "We use that as a way of developing mentoring and training programs that target specific areas where they need help," Sidney said.

The customized software program, introduced about 2 1/2 years ago, will soon serve a dual purpose. The company will begin using it to test proficiency in moving employees to other levels within the organization.

For each of its clients in the National Market, Liberty Mutual creates an Internet portal offering access to a range of proprietary risk management tools and data, including an Internet claims reporting tool that speeds the reporting process. The customer accesses its portal, then types in information to send the insurer an electronic first report of injury for workers' comp.

The report goes through Liberty Mutual's intake center electronically and, based on rules in the insurer's system, is transferred automatically to the appropriate branch office for handling the claim. Once there, an electronic triage tool predicts how simple or complex the claim will be and how much it will cost the insurer. "After it goes through that tool, which has a predictive model in it, the system will direct the claim to the appropriate resource level to handle that level of complexity," Sidney said. The claim is then directed electronically to a case manager who sees it show up in his or her inbox as a new report. The entire process, from first reporting of the claim to assignment of a case manager, can take as little as 60 to 90 minutes, Sidney said.

Speed at the outset of the claims process is critical in generating the best outcomes, he added. "Prompt reporting of an assignment allows us to do early intervention on the claim, making sure the claimant is getting the right medical treatment, and allows us to do our initial investigation to make sure that it's a compensable claim," Sidney said.

Only five years ago, insurers had call-center technology, but nobody was reporting workers' comp claims over the Internet, he noted. Even earlier, first reports of injuries had to be typed and mailed to carriers, a three- to four-day process. "That is just not acceptable in today's environment," Sidney said.

Every claim now includes an online action plan, within which the claims handler sets goals and lists activities that need to be done.

"All of that feeds into our automated case-management organizational tool and diary system, so you can schedule activities for yourself in the future and they pop up in your inbox on the day they are scheduled," Sidney said.

Liberty uses some outside vendors but mainly relies on its own field investigators and nurses. All the referrals made to a field investigator, a nurse or the central recovery units that do subrogation and second-injury fund are done electronically within the system. "Outside resources who do work on that file for the claims adjuster are also posting all of their results in the same operating system," Sidney said. "Basically, everybody sees everybody else's work electronically, and it speeds the process of getting those other people involved in the claim, then getting all of the information together in one place so the claims adjuster can act like a quarterback, looking at all the information and making decisions about what to do."

The insurer has yet another tool, a Web application called I-Case Manager, that allows a claims adjuster to ask questions of one of the four medical directors on Liberty Mutual's staff. With I-Case Manager, claims handlers can type Out a question about a claim they may be struggling with, a diagnosis they don't understand or some medical treatment that might be new. Usually, within 24 hours, they will receive an electronic response from one of the doctors.
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Comment:Claims busters: Plymouth Rock's mobile claims adjusters mix technology with a personal touch to keep costs down while making customers happy. (Property/Casualty: Claims).
Author:Bowers, Barbara
Publication:Best's Review
Geographic Code:1USA
Date:May 1, 2003
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