The premise of this study is that 15% of claims are closed with a missed subrogation opportunity. We set out to try and identify the drivers of this industry challenge and to provide some meaningful solutions.
Going back to my days of running a claims Quality Assurance team for a Top 10 insurer, missed subrogation has consistently ranked among the industry’s biggest challenges. In our case we identified solutions by first admitting that we had a problem. Money was being left on the table. Our adjuster assessment of comparative negligence was abysmal. Our metrics were focused in such a way that subrogation was not deemed a priority.
To understand what our opportunity as a major insurer looked like we partnered with SecondLook. As an industry leader in the subrogation space, they helped us to not only to understand what we were missing, but why we were missing it. Since joining the SecondLook team, I have had the benefit of seeing firsthand how an impartial partner can help so many carriers to improve their subrogation processes and results, giving them a significant competitive advantage.
It has now been over ten years since my first article The Subrogation Cash Cow was published, which outlined many of the challenges faced in the industry, yet many of those same challenges persist today. So why does the challenge of missed subrogation persist? In this article we will break it out into areas of productivity, training, hiring and quality assurance. But first, lets see what the study tells us.
Over the past week, we have been reviewing files internally as well as polling our LinkedIn community. With nearly 2,500 engagements with our post, we received some very valuable insight. First and foremost, there is a consensus that subrogation frequently gets overlooked. The question we posed was why?
According to the industry professionals which included many claims adjusters, managers, executives and attorneys, the biggest reason was lack of a timely investigation.
In second place was missed third party liability, followed by missing evidence.
In the “other” category the comments generally focused on adjusters simply missing the opportunity altogether.
Based upon our internal reviews, the poll findings are very much in line. At SecondLook, we are routinely brought into insurers, self-insureds and TPA’s to find missed subrogation with our no cost closed file audits. Having seen claims practices in a variety of organizations we are in a unique position to share processes that seem to work well, and not so well.
Let’s begin with why subrogation is missed. The reasons are often not mutually exclusive. Identification of subrogation can be super easy; or it can be extremely difficult. There are many basic situations where subrogation is not considered, such as an intersection or parking lot accident in a pure comparative jurisdiction. In more complex bailment, risk transfer, cargo and contractor situations, the investigations can take an inordinate amount of time. Whether simple or complex, liability often gets overlooked, with duties owed and breached not being thoroughly examined and spelled out in the adjuster notes.
Consider the number of files you have reviewed over the years where the liability decision was either 0% or 100%. In many carriers the percentage of claims where there is a comparative liability assessment in the file can be in the low single digits. Now consider that juries apportion liability in more than half of all cases adjudicated. This is a delta with a tremendous amount of opportunity to yield substantial subrogation dollars.
During my years in claims we faced this frequently, and ultimately implemented a tool to assist adjusters in identifying comparative situations. In some locations this worked well, in others adjusters found workarounds to “game” the system. The reality is that the best tool to assess liability remains a highly trained adjusting staff and an impartial business partner to serve as a second set of eyes.
Lack of a timely investigation was cited as the most common reason for missed subrogation giving credence to the adage that time is money. There is a quantifiable correlation between the time of subrogation ID and the recovery of dollars with a steep decline the longer a claim sits.
This becomes a challenge when adjusters are asked to do more with less, while being measured on claims disposition. When pushing claims quickly to closure becomes the main focus missed subrogation often becomes an unintended consequence.
For many of us who began our careers years ago, adjusting was a skill that was honed over time. Those adjusters who had an insatiable curiosity to get to the right outcome were the most successful. Subrogation ID was part of what we did, on every single claim. Timely investigations were critical to the ID process given the direct correlation between time compression and recovery dollars.
In the years since there have been a lot of changes in the industry, in particular specialization and consolidation into large service centers. While this structure can create economies of scale and provide certain advantages, other aspects of the claim’s process can suffer.
In my own experience of moving from generalist to specialist I had many situations arise where a front-line liability adjuster was paying 100% on claimants who clearly had some liability, making the resolution of injury claims significantly more challenging, often resulting in litigation that could have been avoided had the proper decision been made up front.
5 Key Steps To Improve Subrogation ID
- Getting the right person in the right position. Not everyone is cut out to be an adjuster. Beginning with the hiring process, identify those people who have an insatiable curiosity. Some of my best adjusters had no experience in adjusting whatsoever. It is easy to teach good claims habits, it is hard to break bad ones. Focus on hiring the right people every time.
- Show me the money! It is often there, sometimes in very strange places. Finding 80% of subrogation is not overly difficult. But what about the other 20%, which is often a disproportionately higher dollar amount. Successful subrogation adjusters have an insatiable curiosity and will leave no stone unturned. Giving them the tools and the time necessary to dig deeper on claims is critical to both quality and outcomes.
- Early identification of subrogation should be paramount to internal processes. Many carriers are leveraging analytics to assist in this process, which can be beneficial but should not be the only solution. Analytics are outstanding at identification of simplistic scenarios, but as those scenarios become more complex they simply can’t keep up. In our own experience at SecondLook we recognize the limitations of analytics and created Chameleon, a solution that embraces analytics, AI and Machine Learning but adds to it the benefit of over 600 years of collective claims experience to improve subrogation identification.
- Create partnerships to help with the process. Let’s face it, the pandemic has turned a lot of claims organizations upside down, and many carriers are seeing substantial turnover. Some are re-allocating resources. Properly staffing for claims in normal times is tough enough, but with the challenges of today, it has become as difficult as I have seen in my thirty years in the business. Having a trusted business partner that can not only help to ID missed subrogation but provide desk level support for overflow, outsourcing, applicant/response arbitrations, and general overall training and consulting can be extremely beneficial.
- Measure for success. By moving from disposition to quality focused metrics can have a profound impact on results. Focus on creating total file quality scores, including components for proper liability assessment, timely investigation, and recovery recognition. During my QA days we moved from disposition to a quality focused process and saw improvements in indemnity results, timely and accurate disposition of claims, subrogation recognition and referral and recovery dollars.
Missed subrogation is a challenge, but one that can be overcome with the right people, processes, and technology. I have seen tremendous improvements in a number of situations where carriers have made subrogation a key priority from the top on down. In the world of claims, subrogation provides a meaningful way to bring money back into claims organizations, while getting deductibles back to customers, driving up retention and customer satisfaction results.
Chris Tidball is an Executive Claims Consultant with SecondLook, a national leader in subrogation solutions. He has held adjusting, management and executive positions with multiple Top 10 insurers. He is the author of several books including Re-Adjusted: 20 Rules To Take Your Claims Organization From Ordinary To Extraordinary! and the fictional thriller Deep State: A Jake McFarland Thriller which is being adapted into a television series called The Adjuster. You can reach Chris at firstname.lastname@example.org