Claims Conversations

CLAIMS CONVERSATIONS

Roger Howson

Claims Dispute Resolution

PSAA Newsletter Editor and Education Chair

On Thanksgiving morning my wife Barbara and I enjoyed a five mile walk in a torrential downpour. We returned home drenched from head to toe, chilled to the bone, and smiling happily because for the first time in many years we wouldn’t be capping our Thanksgiving weekend with a 26.2 mile run/walk/limp through rain, sleet, snow, and intermittent sunshine at the Seattle Marathon.

Congratulations to those of you who competed in this year’s annual test of your endurance (and sanity) at any one of the Turkey Trots, marathons, half-marathons, or Black Friday bloodbaths. Those of us conscientious objectors who stayed closer to home and watched your self-abuse on the evening news may salute you, but we definitely don’t envy you.

Speaking of questionable sanity (people question mine all the time); I’m wondering what poor liability adjuster has to handle the claims by the many Black Friday shoppers pepper sprayed by overly aggressive X-Box customers. (Why are these psycho shopper stories always about Wal-Mart; don’t any nut jobs ever shop at Nordstrom?) I find it incredible that someone is able to spray, pay, and get away without being stopped, assaulted, or caught on a smart phone or the store’s surveillance camera.

My family, friends, and acquaintances who are Black Friday veterans say I just don’t understand the whole festival-like frenzy for deep discounts while (very limited) supplies last. Yes I do. We once had a dog who acted out like these Black Friday shoppers, and the humane society made us quarantine her until the courts could decide whether or not she should be put down.

While the rest of the world revels in the holiday lights, glitter, and glitz, festive music blasting unrelentingly from speakers in every corner of every open space, and the hordes of humanity in search of the perfect gift (although REALLY scoping out the gifts they’re hoping to receive); the holidays are actually a difficult time for claims professionals.

The upbeat holiday music and merriment masks a darker anxiety that surfaces among claimants and policyholders during this time of year. They expect their claims to be paid quickly and extra generously so that they can use those proceeds to overspend on Christmas and Hanukah gifts, but they can’t get to us the claims documentation we’ve requested because they’re hopelessly overwhelmed by the demands of company parties, year-end reporting, family and neighborhood gatherings, personal entertaining expectations, gift-buying, and perpetual good cheer.

At the same time, we’re buried in claims because just like our claimants we’re also hopelessly overwhelmed by those very same demands of company parties, year-end reporting, family and neighborhood gatherings, personal entertaining expectations, gift-buying, and perpetual good cheer.

It’s hard enough keeping up with our normal work flow during the rest of the year, but from Thanksgiving through the first week in January we’re faced with holiday interruptions, deadlines that are real (fiscal year-end reporting, claims pending inventory, etc.) and artificial (settlement demands that expire just before Christmas), the corporate “use it or lose it” vacation policy, and the cumulative exhaustion from a year that has gone too long and is ending too early.

The bah humbug irony is that, regardless of the very real stress and anxiety acknowledged in the paragraphs above, every one of us looks forward to this time of year because it’s exhilarating, exuberant, and extravagant. So long as we remember to appropriately appreciate the overstimulation and high drama in the good spirit in which it is intended we’ll all be fine. Besides that, after the presents are bought, wrapped, unwrapped, rewrapped, and re-gifted and the New Year is riotously celebrated we’ll have another ten months to recover before the holiday chaos all starts up again.

Speaking of overstimulation and high drama, thank you all who attended the inaugural PSAA Holiday Celebration at Emerald Downs. And congratulations to the PSAA Holiday Committee and Board Members who really put themselves out to make sure that this year’s event would be one to remember.

Those of you who don’t remember anything from this raucous celebration might want to check Facebook, Google, Snapfish, police incident reports, and anywhere else there’s photographic evidence of your behavior that evening. Take our word for it- you had a GREAT time.

May you all enjoy your Christmas, Hanukah, Kwanzaa, and New Year celebrations, and we look forward to seeing every one of you at the next PSAA Meeting at Billy Baroo’s on Friday, January 20th at 11:30am.

Fraud Friday

Check out The Insurance Hall of Shame.

Here are a few excerpts....you won't want to miss the rest!

Burning with desire. Kenneth Allen led an arson ring that torched 50 homes and hauled in millions in bogus insurance claims, mostly in the Indianapolis and Muncie areas. Allen’s gang usually bought low-priced fixer-upper homes and loaded them with used furniture to inflate the claims.

Allen even recruited a crooked insurance adjuster to ensure the claims slid past the insurers. The scheme was so brazen that one home had no furnace oven or sink—but did have a big-screen TV, video game console and space heater all plugged suspiciously into the same outlet. Allen received four years.

Judging the judge. Elected appellate judge Michael Joyce collected $440,000 from auto insurers after lying that a 5 mph bumper bender left him in constant pain and virtually crippled.

But the Erie, Pennsylvania jurist went swimming, was an avid golfer, did in-line roller blading and went scuba diving in the Caribbean. Joyce also earned his pilot license and flew an airplane at least 50 times. And he passed the difficult pilot licensing test despite claiming he had brain damage that made it hard to think clearly. Joyce will be sentenced in 2009.

Triathlon tricks. Samuel Aaron Brabson claimed a car crash left him nearly crippled and largely confined to a wheelchair. The Richmond, Va. man made more than $1.2 million in disability claims, and even had Meals on Wheels helping him out.

But all along, Brabson competed in triathlons and took girlfriends on grueling mountain hikes. When a friend saw him in a store with no sign of disability, he told her he was Brabson’s twin. Brabson has no twin. He received one year, thanks in part to solid sleuthing by the Virginia State Police.

Fraud Friday

Fraud Friday

http://www.youtube.com/watch?v=SsGeJYMwMU8