1. The Three Ps of Effective
Claims Management -
PLANS, PROTOCOLS, &
PARTNERSHIPS
Gary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLA
Principal, Strategic Claims Direction LLC
Gary.Jennings@StrategicClaimsDirection.com
www.StrategicClaimsDirection.com
678.520.3739

2. When should you consider
these issues?
When you are setting up a new program or
adding lines of insurance.
When you need to evaluate your current
program to achieve the best results you
can.

3. Section 1 - PLANS
“If you don’t know where you’re going, any
road will get you there.”
- Lewis Carroll
“If you don’t know where you are going, you
will wind up somewhere else.”
- Yogi Berra

4. PLANS
What do you and your members expect out
of the pool?
Cost-effective coverage
Professional claims management that
controls claims costs and expenses
Additional services – e.g., loss control,
training
Others?

5. PLANS
Develop plans based on
Expectations
Program administration requirements
Execution needed to reach the desired
level of quality, professionalism, and cost
controls

6. PLANS
FOCUS ON CLAIMS ADMINSTRATION
Who
 will manage the claims?
Self-administration?
Third Party Administration?
will you hire (responsibilities, functions,
expertise, experience) as claims
managers and for ancillary services?

7. PLANS
What
 growth plans do you have?
type of claims will you manage (now and
in the future)?
claims system will you use?
guidance and training will you give to
claims staff and to the members?

8. PLANS
When
will you be “up and running”
will you add personnel?
will you feel comfortable to grow the
program and/or offer additional lines?

9. PLANS
Where will you locate the claims personnel?
All at one site?
Field based?
Combination?

10. PLANS
How
will you measure results?
will you deliver training to the members?
will you provide regular updates/progress
reports to the members?
can you be sure your program attains
leading industry practices?

11. PLANS
Develop a Business Plan
Answer the WHO, WHAT, WHEN,
WHERE, and HOW questions and
address other issues that arise
Review periodically (e.g., semi-annually)
Clearly define roles and responsibilities

12. Section 2 - PROTOCOLS
“When you come to a fork in the road, take
it!” -Yogi Berra
“Let‘s get this straight. The police don’t
cause disorder. The police are here to
preserve disorder.”
-Mayor Richard Daley

13. PROTOCOLS
For purposes of this discussion, protocols
are also known as
Procedures
Processes

14. PROTOCOLS
Address
controls and authority levels/needs
guidelines necessary to achieve leading
industry practices
metrics needed to measure your
program’s success

15. PROTOCOLS
Should you document your protocols fully?
Yes – to improve adherence to standards
and required practices and to improve and
maintain consistency.
No – I have a concern about
“discoverability” of the procedures that
might work against us.

16. PROTOCOLS
These should include:
“TO DOs“
“TO DON’Ts”

17. PROTOCOLS
What should they include?
High level plans, philosophies, goals
Program characteristics
Organizational Structure
 Staffing and pending workloads –
supervisors/managers and adjusters
 Supervisory span of control
 Field personnel or use of independent adjusters
and other partners

18. PROTOCOLS
Program characteristics (continued)
Claims system and documentation
 Hardcopy files?
 Paperless processing?
 A combination?
How much should I document the individual
claim files?

19. PROTOCOLS
Program characteristics (continued)
Communications with claims staff and
members
 Training
 “Roundtables”
 Frequency and type of reports to claims staff and
members
 Dealing with non-compliant members

20. PROTOCOLS
Program characteristics (continued)
Procedural documentation
 Claims procedures manuals with DATED updates
when needed
 Coordinating internal procedures with system
steps and fields
 Documentation for partners

21. PROTOCOLS
Claims Management
 File documentation
 Claim intake, set-up,
and assignment
 Coverage analysis
 Contact (initial and
ongoing)
 Investigation and
Inspection
 Liability assessment
 Damage appraisals
 Damages
documentation
 Fraud Investigation
 Payments and
supporting
documentation

22. PROTOCOLS
Claims Management (continued)
 Reserving
 Settlement valuations
and negotiations
 Litigation / hearing
management
 Potential recoveries
 Potential recoveries
(subrogation, salvage,
risk transfer, excess
insurance reporting)
 Manager/supervisor
control / involvement
 File closure

23. PROTOCOLS
Metrics
“If you don’t know where you’re going, you
can’t tell when you’ve arrived.”
-Anonymous

24. METRICS
Know when you arrive
Develop specific protocols
Create fields to capture the needed
information to measure compliance
Perform regular and objective measurements
Communicate results objectively and promptly
Develop corrective action plans when needed
Follow up

25. Section 3 - PARTNERSHIPS
“A Good Ball Club” – on what it takes to
make a good manager
-Yogi Berra

26. PARTNERSHIPS
Internal
Members
Safety / Loss Control
Risk Management
Road Department
Maintenance
Sheriff / Police
Others

27. PARTNERSHIPS
External – COMPETITION IS HEALTHY
Independent adjusters
Appraisers (auto and property)
 Buildings
 Standard vehicles
 Heavy equipment / unusual vehicles
Mitigation specialists
Surveillance specialists
Defense counsel

28. PARTNERSHIPS
Clarify roles and responsibilities
“TO DOs”
 Specifically inform them the services they are to
provide, including time requirements, reports,
forms to use, etc.
“TO DON’Ts”
 We will not pay for services you perform that
exceed our instructions
 We will remove you from our panel if you do not
meet our standards

29. PARTNERSHIPS
Clarify your expectations in writing and tell
them how they will be measured
Ask them to provide accomplishment reports
Provide regular reports to them based on the
pool’s measurements
Review contract and service requirements at
least annually
Remove non-compliant vendors promptly and
transfer to compliant vendors

30. CONCLUSION
“It ain’t over ‘til it’s over.”
-Yogi Berra
DISCUSSION / QUESTIONS
Gary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLA
Principal, Strategic Claims Direction LLC
Gary.Jennings@StrategicClaimsDirection.com
www.StrategicClaimsDirection.com
678.520.3739