claims panel tuesday, october 20 8:30 am -10:30 am
TRANSCRIPT
CLAIMS PANELTuesday, October 208:30 am -10:30 am
JOHN BURROWSDewitt Companies Ltd LLC
KIRRA FLOYDTotal Military Management
Claims on the Rise?
What we found:
• Percent of claims vs overall shipments has stayed consistent
• Industry standard is 20-30% of shipments with the higher counts during the peak seasons
• Claimed amounts have risen over the past 2-3 yearsWhat caused this?
• Military counseling service members to change the claimed amounts to the cost of replacement instead of their estimated cost of repair
• Driver shortages have also affected claims
• Freight shipments have twice as many claimed items and the highest average paid amount
Mold
What to look out for:
• Improper Guidance by PPSOs/QCs to “wipe down” the mold – this conceals it from the agent, or the agent assumes that professional mitigation was done when it was not
• Drivers picking up shipments where mold is visible can be prevented
• Don’t pick it up even as a “favor”, the customer will still claim
• Shipments being picked up with mold to avoid suspension
• NTS shipments with some viable mold—no opening of cartons
• Extra Pick-Ups with Mold
Billing for Accessorials
Mold guidelines
• Mold guidelines outline a process for submitting mitigation invoices when the TSP is not liable for the damage
• Most are denied
• Mitigation is covered, Replacement is not
• No common sense rule in the guidelines- even if shipment in care of TSP for 2-5 days, the accessorial invoices may still be denied if not documented as exception
• Working with the MCO and PPSO from the beginning makes a big difference
• Pre-approval needs to be submitted to the PPSO via DPS prior to submitting for billing
75 Day Notification
Be Aware of Misguidance
• Misguidance being given by the PPSOs/QCs/TMO- as long as the member files some items within 75 days they can claim any other item they find within 9 months
• This is not true• All loss and damage must be submitted in writing to the
carrier/TSP representative within 75 days of delivery
• Agencies should ensure drivers/reps know the timelines
• 75 days for notification
• 9 months to file with TSP for Full Replacement Value(FRV)
• 9 months- 2 years to file with TSP for depreciated coverage
Before Denying for Untimely?
• Decentralized claims offices sometimes get it wrong and may incorrectly advise a TSP to consider a claim timely. It is important to review these carefully, and challenge when applicable.
• DPS Claims filed on GMT time – and must be converted to determine timeliness
• When denying, the appropriate MCO should be notified in addition to the member
• Members should be directed to the MCO to determine if they qualify for an extension
75 Day Notification-Untimely
Repair Estimates
Not Conforming to Requirements
• Work with third party vendors to ensure compliance to repair estimate rules
• All repairable items should list a repair cost, even if the damage is not transit related
• Estimates can indicate that the cost is for not transit related damage
• MCOs can still pay a member for damage that the TSP is not liable for
• If TSP inspection does not include repair costs for all items the service member must pay for a second estimate out of pocket, MCO cannot pay this fee upfront for the member
New Claims Rules being Drafted
New Claims Rules for Property Damage
• Claims Liability Business Rules do not currently have a section for damage to Real Property, but services are drafting them
• TSP is ultimately responsible for property damage
• Agents responsible for damage to real property either at origin or destination should address the damage as soon as possible
• Repairs should be completed
• If agent disputes the Real Property Damage they should notify the TSP
• TSPs should review the dispute and proceed with repair or contact the appropriate MCO for further review
Loss of Value as Final Offer
You can make an offer
• BUT it cannot be marked as final in DPS unless it is for repair or replacement
• Marking an item as a final offer prevents the claimant from submitting counteroffer
• If member rebuts, TSP should negotiate on the loss of value or salvage, but should not refer the member to the MCO unless the final offer is repair or replacement
• “Horse Trading” is an acceptable means of negotiation, where member and TSP agree on a lump sum dollar amount for the overall claim
Negotiation After MCO Transfer
TSP and MCO Communication is important
• Some members transfer items to the MCO before submitting rebuttal/counteroffer with TSP
• Before completing negotiations with the member, check DPS to verify status of item
• MUST advise MCO to avoid duplication of payment
• TSP will be responsible for payment on Demand if they settle with the member after the transfer
• Member must contact help desk to have item and or claim status revised back to “demand pending” prior to making final offer/payment
Denials
What the services are seeing
• TSPs paying low dollar items and denying high dollar items for the MCOs to handle
• Inherent Vice or Defect Exclusion (section 1.3.1.2.)
• MCOs feel that TSPs are using this denial for items damaged in transit
• Recommend- have support for denial for inherent vice, from qualified repair firm or manufacturer
• 75 Day Notification overrides the presumption of correctness of inventory
-Do not deny for the sole reason that the item was not noted damaged or missing on the 1850
Signed Releases
Improper Conditions for releases, including release of Government liability
• Signed releases or verbiage on settlement checks should not be used
• TSPs cannot require claimants to sign a release of liability unless all liability is accepted
• Partial settlement release should specify that it is for the settled/agreed upon items only
• The claimant retains the right to transfer any disputed portion of the claim to the MCO for further review and consideration
Communication is Key
Explaining the Process up front is crucial
• “Peak Season” should not be an excuse for ignoring calls and emails, even if there is no new update, respond
• TSP must “review claim” in DPS
• Claim acknowledgement must be sent to the member
• Level of communication with claimant depends on the claimant themselves, as each of them have very different expectations
• MCOs advised that they are seeing delays in communication up to 2-4 weeks, unacceptable
• Do not wait until day 59 to contact member about their claim as it will cause claim to go past 60 days, and also have a negative impact on the member’s claim experience
Daniel MartinezSDDC
Military Surface Deployment& Distribution Command
DP3 UpdateInternational Association
of Movers Conference
October 2015
Claims Panel
Surface Warriors…Delivering Trust
Section Measure Definition Metric Value BVS %
A Average Days to Dispose of Claim
Days from Filing to Disposal of the Claim
Average Days 15 pts 3 %
B Late Payment Percent reporting payment not received within 30 days
% Late 15 pts 3 %
C Percentage of Over-Aged Claims
Percent of claims “Not Disposed” within 60 Days
% Over-aged 15 pts 3 %
D Success in Diverting Claims from Services
Percent of Total Claims Submitted to Military
Claims Office
% Not Diverted
15 pts 3 %
E Customer Satisfaction with TSP
Measure of “how satisfied” customers are
Average Satisfaction Score
40 pts 8 %
Total Claims Score 100 pt 20%
Claims Score Why?
GAO-03-367, BPWGs,
Feedback
Will make program rankings
more objective
Will improve claims process
for Service Members and
engaged TSPs
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Surface Warriors…Delivering Trust
Alternate Claims Score Metrics
SDDC study on Revised Claims Score metrics
Better aligned metrics with business rules
Removes member influence on TSP score
Eliminates confusion between CSS and a claims survey
Considers total number of shipments
Thoughts?
20
Surface Warriors…Delivering Trust
Claims Score Plan
Working Group to streamline metrics, placeholder SCR 7413
Objective measure
Can comprise a % of the Best Value Score
Requirement target 4th qtr FY16
Implementation TBD
Thoughts?
21
Boris PopulohSenior Vice President, Willis Relocation Risk Group
Willis Relocation Risk Group
Global Willis Group
•Third Largest Insurance Broker in World
•HQ in London and New York
•$3.75 Billion in Revenue
•17,000 Associates in 120+ Countries
•Merging with Towers Watson
•Merged // 39,000 Associates // $8.25 Billion(+) in Revenue
Willis Relocation Risk Group
•Domiciled in Washington DC/London UK
•Focus on Mobility Risk
•Arrange Coverage on approx. 30K Shipments Annually
•5% Military // 25%GSA // 70% Commercial
•Settle approx. 7,000 Claims Annually
•Focus Today on Commercial Claim
Commercial HHG Claims: Data vs. Information
First Things First:
Data is Not the Same as Information!
COMPUTERS NEED DATA HUMANS NEED INFORMATION
DATA IS A BULDING BLOCK INFORMATION GIVES CONTEXT
Us the RIGHT Data to Answer the RIGHT Question
Data Evolves / Information Changes
SNAPSHOT
a
0101010101010101
0101010101010101010101010101010101010
010101010
DATA
PROCESS
INFORMATION
a
Commercial HHG Claims: Data vs. Information
Building Block: DATA
- is the Foundation
- the First Link in a Lager Chain of Understanding
- Integrity is Key
WISOM
KNOWLEDGE
INFORMATION
DATAX
Commercial HHG Claims: Data vs. Information
HHG CLAIMS ARE:
- Inevitable- A Hassle- Result of Internal Service Failures- Someone Else’s Fault / Responsibility- Something For the Insurance Folks to Deal With- Bad Luck- Expensive (Direct or Indirect Costs)- Shippers Last Memory of The Move- Customer Service Opportunity- Learning and Improvement Experience- Risk Management Tool- Dependent on Circumstances- What You Make of Them- Response is Driven by Organizational Culture
Commercial HHG Claims: Data vs. Information
HHG CLAIMS ARE:
- Inevitable- A Hassle- Result of Internal Service Failures- Someone Else’s Fault / Responsibility- Something For the Insurance Folks to Deal With- Bad Luck- Expensive (Direct or Indirect Costs)- Shippers Last Memory of The Move- Customer Service Opportunity- Learning and Improvement Experience- Risk Management Tool- Dependent on Circumstances- What You Make of Them- Response is Driven by Organizational Culture
THIS IS OUR NEW HHGINSURANCE CLAIM
FILING PROCESS
ANY QUESTIONS?
Commercial HHG Claims: Data vs. Information
Risk Profile
Claims Data and Context
Claims Adjusting Culture
Analysis & Communicati
on
Improvement Strategy
Commercial HHG Claims: Data vs. Information
IDENTIFY YOUR INDIVIDUAL RISK PROFILE:
What Factors Impact Your Organizations Claims Risk Profile
LOSS FREQUENCY LOSS RATIO
ESTIMATED LOSS vs. TOTAL PAID
TOTAL CLAIMS PAID and RESERVED SHIPMENT VALUES ADJUSTING PRACTICES
SUBROGATION AGREEMENTS
CONVEYANCE BREAKDOWN
ORIGIN COUNTRIES/CITIES DESTINATION COUNTRIES/CITIES
DESTINATION AGENT ORIGIN AGENT
CUSTOMER MAKE UP SHIPPER EXPECTATIONS/BEHAVIOR PRE MOVE SHIPPER COUNCELING POST LOSS CLAIMANT COUNCELING
SIPMENT VALUATION METHODOLOGIES DEDUCTIBLE / RISK RETENTION LEVELS
PROGRAM COST INFLUENCERS
Commercial HHG Claims: Data vs. Information
Loss Frequency
Severity and Ratio
ConveyanceSea, Air and
Truck
Regional Route
Supply Chain
Partners OA and DA
CustomersShipment
Values
Severity of Loss
Cause of Loss
Commercial HHG Claims: Data vs. Information
CLAIMS WILL CONTINUE TO HAPPEN!
DEVELOP A PROCESS AND CULTURE TO LEARN FROM THEM
Commercial HHG Claims: Data vs. Information
- END -THANK YOU
Reference Sources:- Willis resilience Magazine // Future of Risk Analysis // April 2015 // Issue 06- Business 2 Community // What is the Difference Between Data and Information? // August 6, 2015