By: Jeff Esper | December 02, 2016

Why You Need an Independent Review at the Start
Losses that appear to be under deductible always benefit from an independent review. Deductibles for CAT losses have become more complex over the years and interdependent operations spread the impact across the organization, so it’s increasingly challenging to have confidence in the preliminary evaluation, especially when informing key stakeholders. Those who have had losses know, with hindsight, there are gaps in understanding and initial questions that are critical to the deductible evaluation. Avail yourself of a candid, independent review from the start so that whether you have a recoverable claim or not, you’ll be prepared.
  
Many policyholders engage forensic accountants when they are confident the loss exceeds the deductible, but few think to involve help when unsure. Experienced, professional help can highlight the key factors in this evaluation, and will provide a result you can rely on to make better decisions and reduce potential wasted effort.

Here are three reasons to make this step a standard risk management protocol for your company:

1. Deductibles Require Measurement

Under or over deductible is the first question once you turn your attention to the financial response. Deductible policy language has evolved over the years as insurers respond to claim nuances and program needs. The professionals at RWH Myers have assisted clients with quantifying deductibles and preparing claims throughout these changing times. We understand the languages quirks and can quickly scope out the magnitude of applicable deductibles.


2. Insurance Accounting is Unique

Loss accounting is a different discipline than financial or managerial accounting. Misunderstandings waste time and create unwanted transactional friction. Breed process efficiency with the right questions and meaningful answers from a team with experience translating managerial accounting into insurance loss accounting for policyholders.


3. Consider Motivations

Are operations overly optimistic?  Is finance overly pessimistic?  Might reporting a claim impact contingent commissions? Independent expertise will navigate through any biases to pull it all together in a way that answers the important questions based on their merits, ultimately facilitating the financial recovery process. 

No one can anticipate a loss and policyholders actively work to avoid them, but that doesn’t mean you don’t need to plan for when you have a claim. A candid, independent review will give you the confidence of an appropriate deductible threshold evaluation and segue into a smooth and fair claim process.

by William A. Warren, CPA, CGMA

By: Jeff Esper | September 07, 2016

Once disaster strikes, the first priorities are always safety and preservation of property, but there are priorities to consider ahead of a loss to avoid unexpected surprises. Disaster mitigation and restoration is a critical service after property damage, and how you manage it may impact the outcome of your claim. Though there are many capable firms that specialize in property damage clean-up and restoration, there are some that will make mistakes and others may even take advantage of the situation. When it comes to recovering the cost of mitigation and restoration services for an insurance claim, any mishaps can create big problems that may leave you stuck with the bill. 


Here are some techniques to prevent potential problems before they arise:

  1. Vet your emergency response team prior to loss - Preparation is the key in any endeavor but with property damage claims, you cannot be too prepared. Recovery service providers should be identified and interviewed. Make sure the company you choose will be able to handle your potential issues. Involve your insurer during vetting. There are “approved” vendors that insurance companies recommend; however, just because they are “approved” does not mean there will not problems. Notify the insurance company of who you plan to use as well. 
  2. Clarify and document scope of work - Be clear on scope of work with the recovery firm and make the adjuster part of that conversation. Often, emergency response does not follow the normal protocols of a typical project. There likely won’t be time for detailed estimates, so try to get the adjuster to approve work in real-time to avoid second guessing. 
  3. Take a hands-on approach - Your property may still be underwater, but once access is granted, you must be hands-on. No one should have access to your facility without the presence of a company representative. Assign a property supervisor to the affected site to keep track of who is there and what they are doing. It’s your property and your responsibility. The bigger the loss, the more people coming in and going out, so it is vital to have a company representative onsite to observe and answer questions.
  4. Audit contractor charges before approving - The first weeks after a loss is chaotic. It’s important for policyholders to put controls in place to monitor activity and to verify work has been completed to specifications and according to the terms of the agreement. Reimbursable insurance expenses should be separated and audited prior to payment for proper detail and accuracy. This needs to be done efficiently in real-time. If you don’t have the resources, this step can be completed by your claim preparation accountants i.e. forensic accountants. Having forensic accountants on your team, along with your technical experts, can process this information in the context of insurance recovery. Don’t assume your forensic accountants will automatically audit invoices. Identifying errors or worse, fraud, is critical to avoid delays in payment or project completion. If you hire RWH Myers, we will discuss the proper protocol and work with you to establish the internal controls to intercept errors. 

  1. Address issues immediately - When the first invoice arrives, insurance companies may act surprised and even deny coverage, especially if the steps above have not been followed. Make sure to get the parties together to discuss the issues. Don’t procrastinate and don’t assume. It is important to be proactive with any potential discrepancies. The policyholder is responsible if there are unresolved differences. If the adjuster disagrees with the work performed and the invoices are paid, it may be difficult to recover everything your expenses. 

The immediate aftermath of a disaster is stressful and hectic. Preparation and communication can help you weather the storm and minimize unwanted surprises when you’re looking for claim payment. Having an experienced and independent forensic accounting team will reduce the stress, the workload and reimbursement issues. Per the tagline for one of the largest restoration firms, in the end you want it to be “Like it never even happened.”

Category: Insights 

Tags: Claims, Property Damage 

By: Jeff Esper | June 28, 2016

I am not sure why policy language has to be so confusing. Truly there are some complicated risks that insurance covers, but even the simple ones seem to be made complicated by the language used. A good example of this is extra expense. The words themselves seem pretty self explanatory; a policyholder spends extra money due to an occurrence and submits the expenses as part of the claim. Though it sounds straight forward, within a property claim these expenses require different types of measurement, documentation and coverage. To ensure you are buying the right coverage for your risks, it’s important to understand the details and the differences.

Per the International Risk Management Institute (IRMI), extra expenses are defined as: 

…additional costs in excess of normal operating expenses that an organization incurs to continue operations while its property is being repaired or replaced after having been damaged by a covered cause of loss. Extra expense coverage can be purchased in addition to or instead of business income coverage, depending on the needs of the organization.” 

This is true, however there is another kind of “extra expense” that is included as part of your business income - this is commonly known as “expense to reduce loss.” These expenses meet the definition of extra expense, however, they are incurred to reduce the duration or magnitude of the business income loss.

Consider this scenario. A manufacturer is shut down because of a covered cause of loss. Despite damaged machinery, they manage to resume operations in the facility by performing work manually with more than normal labor. The extra labor costs enables the insured to maintain some production that reduces lost sales. Is this a business income loss, extra expense loss or both? 

In this case, extra expense coverage in excess of the business income would not be necessary since the extra expenses reduced the business income loss. Any sales that were lost could still be recovered as well. If only extra expense coverage was purchased, the manufacturer could recover the extra expenses but not any lost sales.

The distinction between “extra expense” and “expense to reduce loss” is important when you are placing coverage. Quantification and documentation of extra expense exposures depends on the types of expenses and the scenarios envisioned. If the only extra expenses that are foreseen would be to reduce a greater business income loss, then it might not be necessary to purchase the additional coverage. If business income is not at risk or can be avoided entirely with extra expenses, extra expense coverage may be the way to go.  

Another category of coverage that gets confused with extra expense is expediting expense. Per the International Risk Management Institute (IRMI) expediting expenses are defined as: 

…expenses of temporary repairs and costs incurred to speed up the permanent repair or replacement of covered property or equipment.

The need for expediting expense coverage came from a time when boiler and machinery coverage applied to specific objects written on separate policies. Modern all risk policies will include expediting expense as a part of expense to reduce loss or extra expense coverage.

Again it is important to understand how you might incur these loss related expenses when placing coverage. To the extent that you can save the insurance company money by expediting, you are less likely to meet resistance. If you will need to expedite repairs for other reasons, regardless of cost or time savings, you may need to get coverage that provides full reimbursement.

Understanding the different types of expense coverage and how they apply to your business risks is critical when buying insurance. You don’t want to find out how your coverage works during a claim or realize that you’ve been paying for coverage you don’t need. Think through your potential scenarios, consult your broker and a forensic accountant to explore what coverages and limits are best for your risks. Then, share your conclusions with your underwriter to make sure everyone is speaking the same language.

By Christopher B. Hess, CPA, CFE

 

By: Christopher Hess | June 01, 2016

Remember the classic 80’s film “War Games” where the computer system named War Operation Plan Response, or WOPR for short, asks Mathew Broderick in that See ’n Say computer voice “Shall we play a game?” The movie was a tense thriller that was topical for my Cold War childhood but pointed out, among others things, that all games are not fun. Insurance claims should not be a game, where one side is playing games as a tactic to delay or reduce claim payment. It’s much like a battle in a war, in which one side is lured into an ambush. Unfortunately,  I see this all to often when preparing property and business interruption claims for my clients. 


The reason it is so frustrating is that my client is usually struggling to recover from a major loss to it’s business, affecting them financially and emotionally. They have done their best to protect from such an occurrence via loss control, insurance procurement and a proper claim filing. So when they document their losses and present their claim under the terms of their insurance contract, they should not have to battle bullying, stall tactics and misguided theories. 


As an example, I had a chemical company as a client whose business was heavily dependent on the supply of raw materials from specific international locations. The exclusive relationships with these international suppliers and their governments took decades to forge and represented a distinct competitive advantage. Their business was cyclical and during a low point, their manufacturing plant was devastated by a hurricane. If they were not able to get back up and running quickly, the long term contracts with their suppliers would be cancelled undoing years of supply chain efforts.  


The CEO had a legal background and recognized the real possibility that his company would not recover from this loss if the insurance they bought could not reimburse in a timely manner. He knew he was facing the possibility of laying off over 1,000 employees as well as losing long term supplier relationships.  


The insurer’s tactic was to overwhelm the client with requests for information while demanding time and attention to explain the operational complexities. While scrambling to answer the flurry of questions, my client had to accommodate a large group of insurance investigators at their chemical plant that was still underwater. Contractually, the insurance company has the right to gather information they need; however, there is a tact and decency that should be observed. The insurers strategy was to leverage the policyholder's crisis situation to establish reasons not to pay the claim based on misguided theories about their business. Because of the chaos, when the insurance consultants arrived on site to survey the damage, the client was not prepared. They did not have a proper escort for the insurer consultants to review the damaged facility. As a result, information was gathered from which they made critical assumptions about the damaged equipment that formed the basis for their theory on the valuation of replacement equipment and lost production.  


The client was not informed about these conclusions until some months later when the report was presented. They were ambushed and put on the defense, backtracking trying to disprove the incorrect information. All the while, claim payment is withheld until the issues are resolved. 


This tactic is common in claim war games. While the insurance team may just be doing their job as instructed, a company’s existence is at risk. Adjusters are often cavalier about this process and will hide behind their “duty” or policy wording, while in reality they are just playing games with the money owed to the policyholder. 


Despite the games, I am happy to report that through a lot of hard work and foresight, we were able to overcome these obstacles and secure advanced payments to stabilize the client’s operations, maintain supplier relations and create an equitable settlement. The CEO and other executives were relieved and appreciative of the results we achieved considering the situation we were facing. 


So how did we do it?  


It takes an effective strategy and careful execution to be successful and here’s the approach that we know works best: 


  1. Take Control - You do not want to put off the insurance company too long, but it is okay to let them know you are going to control when they get access and who they can interview. More claims are derailed in the first week by uncontrolled access and miscommunication. 
  2. Agreements in Real Time - one of my favorite risk managers relates this mantra during claims, “we make decisions in real-time.” What he means by this is that when confronted with a decision - say rebuild or replacement of equipment - you use all the information you have at that time to make the decision. As long as the adjuster is aware of the decision and your reasoning, they should not second guess what you have done down the road once more information is known. For example, immediately after a loss you think you need two cranes onsite to move equipment and debris. After the fact, you realize you could've got by with just one. You made a decision in real-time that was based on what you knew at the time and should not be penalized based on your initial estimation. If the adjuster doesn’t object at the time of the decision, they have no grounds to object after the fact. 
  3. Clarify Requests - the insurance company is going to ask for information - a lot of information. In general, these requests are broad in scope and may even be used to fish for something that can be used against the claim. Don’t let this happen. Ask that requests be specific - if they are not specific, send the request back. Ideally, claims are presented with supporting documentation and that should be the focus of requests. I am often used to filter this information down to what is really necessary to provide - which should be specific to what is being claimed. Extraneous information can create confusion and lead to more requests. Your loss accountant, if experienced, will be helpful with interpreting these requests and focusing on what is relevant to the claim. 
  4. Recruit Experts  - Adjusters and their team work on claims every day. It’s their full-time job. For you, it is an infrequent part of your job. If you want a smoother process and positive outcome, you need experts working on your behalf. In addition to your internal team, your brokers claim experts, as well as independent forensic accountants, engineers and outside counsel are critically important. Ensure that those on your team are working on your behalf and match-up well against the insurance company representatives. In my claim example, we were not engaged from the onset, so it is vital to have your independent team vetted and agreements in place ahead of a loss. Remember, like this example, many claims are hindered by mistakes made in the initial weeks post loss. Immediately after a loss is no time for shopping. 
  5. Don’t play games - In other words, focus on the claim, not the games. Prepare an accurate claim from your perspective, be upfront with relevant information and be reasonable in final negotiations. As stated before, games have no place in claims. Just because insurers may play games to offset your recovery, doesn’t mean you need to do the same. You are much better off being prepared, being professional and being confidently in control of the process. 


If you follow this advice, you will stand a much better chance succeeding with claim recovery. Just like WOPR realized in the movie, with claim war games there are no winners.  Avoid this ambush by being prepared and informed.



Published 6-8-16: InsuranceThoughtLeadership.com

Category: Insights 

Tags: Claims 

By: Christopher Hess | January 23, 2016

More often than not, a large property and business interruption insurance claim turns into an “us vs. them” scenario, creating a rough process for all involved. Not unlike a football game, someone is trying to win - at any cost. As a forensic accountant for over twenty years, specializing in quantifying business interruption losses and documenting property claims for policyholders, I’ve seen the good, the bad and the ugly. The problem is that the process is designed to focus on disagreements. 


We’ve heard the concerns from our clients and the insurers, and we can understand both perspectives. Policyholders accuse the adjuster of being  unreasonable - trying to stick it to them at every turn. Insurers accuse policyholders of trying to take advantage of the claim in an attempt to get more than they deserve. The battles can become very heated, even on a personal level. Once during a claim meeting on a large loss, the discussion between the parties intensified until an executive, from the insured, ordered the adjustment team to “get out of my building!” 


Disagreement in the course of a property insurance claim is an anticipated part of the process, but there are ways to keep it civilized and productive. It is possible to come to a fair representation of the loss without all the aggravation. The fix is really quite simple but will require the insured and insurer to take responsibility for their contribution to both the problem and the solution.



Here are some ways insurers can improve the claim process: 


Take time to understand the insured’s business 

Too often the adjuster wants to appear to know it all. It is better to listen first and try to understand the insured's position. Understanding your customer is common business sense. 


Adjusters should have superlative people skills

A big part of an adjuster’s role is to coordinate with experts needed for the situation. These are management and organizational skills. In other words, the adjuster does not need to know all the technical aspects of every loss and would be better served knowing more about how to manage people and deal with customers. Whether it’s from retiring baby boomers or cost cutting, there is a lack of well trained and experienced adjusters. 


Give the adjuster more control 

Even the best adjusters are impaired by the current claim process. Adjusters seem to have limited authority to make decisions. Policyholders find it pointless to explain their issues in great detail, when the real decision maker is somewhere in the background. When pressed to make a decision, they just throw their hands up. It’s difficult to make any progress, when the adjuster has to get every little decision approved by their superiors. To the insured, it just seems like it’s a delay tactic to put off payment, and only adds to feeding mistrust.



Here are some ways policyholders can improve the claims process: 


Give the process a chance 

While there are many times you will experience some of the problems mentioned above, the process can work with the right people involved. Communicate with the adjuster and their team. Be responsive to all requests that are reasonable and appropriate. If otherwise, ask for clarification and then address your concerns right away. 


Maintain good relations with realistic expectations

Set realistic expectations for what you want, like advance payments and resolution of differences. Though insurers are not obligated to finance a rebuild project, they should be willing to advance money to stay ahead of the cash expenditure. By maintaining good relations with the adjuster, they’ll be more open to working with you rather than against you. 


The best defense is a good offense 

Be prepared and organized on your end so that you can require the same of the insurance company. You cannot withhold information until the last minute and then demand resolution and payment. The faster you answer questions and requests, the faster they can review them. Often times it takes them longer to review the support you provide because they review the information in a vacuum. Don’t assume they understand what to ask for or what has been presented. Promote frequent meetings and discussion to make sure misunderstandings are not made part of their reports to underwriters - once it is on the record, it is harder to change. 


Escalate when needed

If issues start to arise that cannot be resolved, rather than letting it fester, escalate it to the markets involved. It is no different than speaking to a manager at a restaurant. It’s better to deal with decision makers when action is needed. This should only be used as a last resort to avoid litigation.


The insurance claim process has it's flaws. I don’t think it’s intentional, but rather a result of how it has evolved. The best approach to improving the process is by recognizing the challenges with an “us vs. them” mentality and finding a way to work cooperatively through the claim. Both sides need to help to fix it, so that more claims get resolved as they should.



Published 2-1-16: InsuranceThoughtLeadership.com

Category: Insights 

Tags: Claims 

By: Jeff Esper | October 26, 2015

Policyholders insure against business risks to protect their financial integrity. When these risks become a reality, claim recovery is the return on investment. 

Unfortunately, it’s not quite that easy. Claim recovery is a process that requires expertise to secure a fair settlement. As you know, your carrier has experts assigned to adjust and audit your claim, so, in turn, you should have experts to help you quantify your losses and prepare a well-documented claim. But expertise is not enough. If you want the best chance to be made whole, independence definitely matters.

Many companies promote themselves as focused on client needs, but, in claim preparation, it has to be more than a slogan. When it comes to preparing claims, true independence isn’t as common as you might think.

Is your loss accountant independent?

The most common "claim preparers" are forensic accountants. Let’s take a look at where they exist in the insurance industry:
  • Insurance company forensic accountants
  • Insurance broker forensic accountants
  • Consulting firms with forensic accounting service offering
  • Accounting firms with forensic accounting service offering
  • Independent loss accounting firms

It should go without saying that the firms that are hired by the insurance companies cannot provide independent and unbiased service to policyholders, but many still do rely on the insurers’ accountants to measure their losses. If asked, the insurers’ accountants would likely recommend the insured retain an independent firm to assist them, yet there are those who don’t know and don’t ask. For the policyholders in this category, I hope you see the light after reading this article.

Broker-owned accounting firms have their own set of potential conflicts, starting with the strategic relationship they have with insurance companies. As a former broker, I can tell you these relationships are sacred. The carrier’s profitability is directly related to claims paid, and the carrier will reward brokers for profitable accounts with a bonus commission, aka contingent commissions. If you are on a fixed-fee arrangement, it does not mean there’s no contingent commission in play. Your broker wants to serve your needs and will work hard for you, but, when you have a loss, the broker has a conflict of interest.

It’s also important to remember that your claim can last longer than your broker agreement. It’s hard enough to end a relationship with your broker, but if the broker is preparing an outstanding claim it will prolong your dealings with the broker. If you change carriers and your broker at the same time, the situation can be harder to resolve. If you are using your broker for claim preparation, consider an independent option that only serves one master, you.

The large accounting firms with consulting practices will scale back their consulting activities when faced with financial debacles that cause regulators to scrutinize their independence. The inherent conflict of an auditing firm preparing a claim for a client should be obvious. The audit firm will have a direct impact on creating an asset or revenue stream, which the firm would then audit as part of the financial results. Those two activities need to remain separate to maintain independence.Also consider what it means if your claim preparation firm is also the auditor for your insurer. 

As you can see, there are potential conflicts on both sides. Why not avoid potential conflicts and work with an independent specialist?

Hiring consulting firms presents similar conflicts to consider. Is it a provider of another service to your company? Does it also serve your carrier in some capacity? Making this determination can be time-consuming, and conflicts can be easily missed. Any firm you consider should be clear about possible conflicts, but it’s your recovery at stake, so it’s best to do the proper vetting.

In the insurance industry, it’s the policyholders’ right and obligation to value their own losses for submission to their insurer. Your insurer may be more than willing to help, but is that’s what is best for your business? Claim recovery is the reason policyholders invest in insurance, so be sure to hire a firm that knows how to prepare a claim and is working on your behalf. 

Loss accounting is a specialized craft that comes as a result of experience and expertise with insurance claims. Seeking an independent, third-party valuation of your losses is not only smart business but may be a fiduciary responsibility, especially with a large property and business interruption claim.




Category: Insights 

Tags: Claims 

By: Jeff Esper | September 30, 2015

When I started as director of marketing at RWH Myers, I asked a lot of questions of the partners. With the firm specializing in loss accounting, I wanted to understand the most important attributes in a successful claim. What I learned seemed too obvious at first, but I soon discovered why each component was essential.


The five keys to successful claims are not rooted in complex business interruption equations or piles of documentation. They are critical fundamentals. Fundamentals in any endeavor are easily missed and hard to execute without practice. But if you master the fundamentals, you’ll be on your way to a positive outcome. Get them wrong, and you’ll struggle to recover what you deserve. When millions of dollars are on the line, risk management cannot afford to come up short on recovery. Our firm exists to help policyholders in their attempt to be made whole after a loss, so we thought it would be valuable to share what we found to be most important.


Here are the five keys to successful claims:


  1. Define the Claim’s Priorities

When you have a loss, it is important for everyone to understand what is important to the organization at that time. Is it the recovery amount? Is it the speed of settlement? Is it a smooth process? Is it cash flow? Is it resource relief? It may be all of these and more. Risk managers should discuss the priorities with executives and other key personnel to ensure all considerations are accounted for. When cash flow is critical, the claim preparation strategy should incorporate interim claim filings. If the primary need is to get the loss off the books before financial reporting, the strategy may focus on speed of settlement. Knowing the priorities of the organization will enable a claim strategy that can meet those needs. As the old saying goes, “If you don’t know where you are going, any road will take you there.” With a property and business interruption claim, everyone involved needs to know where to go.


  1. Have the Right Team in Place

If you’ve been through a significant property claim, you know that your insurer(s) will have a team of experts whose job it is to adjust and audit your claim filings. Their goal is not to pay out the claim amount. It is to minimize the exposure to the underwriter to preserve profitability. Insurance companies are for-profit enterprises, and they take their profits seriously. Knowing what their priorities are should reinforce the need to have a skilled team representing you. You will undoubtedly need to involve internal personnel to assist you, but know that they do not have the experience to match the insurers team’s acumen. It is in your best interest to assemble your own team of experts ahead of a loss. Savvy policyholders may specify certain adjusters to be written into the policy in an effort to minimize potential claim issues. No matter what, you should avoid relying on the insurer’s forensic accountants’ calculations as the measure of your losses. An independent loss accounting firm can not only provide you with an accurate loss valuation but will be instrumental in guiding the claim to meet your goals.


Experience matters greatly, and you will need it to ensure success. Professional fees coverage is available for this service. It is there to pay for the experts you’ll need. Take advantage of it. Having your team in place in advance will make a big difference.


  1. Develop a Claim Strategy

The claim process involves many activities that could be daunting and burdensome to everyone in your organization, but the demand to achieve your priorities is relentless. It is critical to develop an effective strategy to get the best results from your claim. Engaging experts can help develop your strategy as they will know the obstacles you will face and can plan for them. The strategy should incorporate your priorities and the steps to achieve them. It should involve analyzing possible adjustments and ways to overcome them. To keep the claim moving, create a timetable that maps each milestone. It should include request for information (RFI) responses and feedback, interim claim filings and audit results, periodic meetings and requested settlement date. Don’t rely on hope or faith that your carrier will do the right thing. The carrier will do what’s right for it, not for you. Engage your experts immediately after a loss so that they can be involved in the design and execution of your strategy from the onset. If you are looking to recover millions of dollars, you better have a solid plan to do so.


  1. Give the Claim Appropriate Attention

At the beginning, claims get a lot of attention, but, as time passes, other items will distract from your claim. Managing an insurance claim is not a normal part of the job for anyone involved unless that is their job. For the insurer’s team, managing the claim is their job. It’s what they do everyday. If you engage a loss accounting firm that specializes in preparing claims for policyholders, the firm will help to ensure your claim gets the appropriate attention. Not only will the firm keep your attention on the claim, but the firm will hold the insurer’s team accountable to the timetable. Claims take time. You must be patient, but persistent. You can ill afford to lose attention. Don’t let your claim get lost amid all your other duties.


  1. Prepare a Logical Claim

When I worked for one of the largest brokers in the world, I often wondered what exactly our claims group did to help clients with claims. I was surprised to learn that the onus was on the client to actually put the claim together — all the financials, the calculations, all the invoices, the claim report, everything. This documentation is the basis of the claim. It’s what’s reviewed, audited and adjusted. As the broker, I thought our claims group did it. I came to realize it’s not our responsibility, nor should it be. After all, we’re the broker, not the policyholder. For the clients that used a loss accounting firm, the claims went much more smoothly and were resolved faster. I didn’t understand why until I joined RWH Myers. Putting the claim together is only half the battle. There is a technique to it that makes the difference from start to finish. As the claim progresses, there are always gray areas. Sure, you’ll recover some of your claim regardless of your approach, but that gray area may represent 20% or more of your losses. If recovery is important, that 20% matters greatly.


When claiming time element as business interruption, you are claiming earnings that you would have earned had the loss not occurred. There is an art to the model used to calculate these losses and a science to showcasing the logic behind it. A simple, logical and easy-to-understand claim will meet less resistance and recover more than a complicated, confusing and overbearing claim. Unfortunately, there isn’t a cookie cutter formula. You can’t just teach it. Experience is the only way to ensure this “key” will lead to a successful claim.


The bottom line is that claims have lives of their own. There are two opposing sides with opposing agendas. Claims ultimately come down to a negotiation. The amount remaining at the negotiation table tells the tale of how well the claim was prepared, including all the fundamentals — the priorities, the teams, the strategy, the attention and the claim report. It all matters to recovering your losses efficiently and effectively.



Category: Insights 

Tags: Claims 

By: Jeff Esper | August 25, 2015

New information is slowly filtering out of China about the Tianjin explosion and many companies are trying to figure out how their operations and business income will be affected. As the proverbial dust is settling, the one certainty is that a critical cog in the international supply chain wheel has been crippled and will not likely be fully functional for some time. The insurance implications are expected to be substantial according to Reuters analyst Arian van Veen, “It is still very early to determine the level of insured losses, but the event is likely to be large with initial insured loss estimates of $1-$1.5 billion and a large number of insurance companies affected,"

If you expect to have a loss stemming from Tianjin, here are some tips that may be helpful:

Policy Communication

Communicate with your claims team, from brokers to forensic accountants, so they are ready to respond.  They also may have some information you do not have as they likely are speaking with many other companies in the area.  Review your policy for coverage availability and/or limitations.  What are the details of your CBI coverage, ingress/egress, civil authority?  Discuss potential claim strategies and prepare internally for documenting your claim.  

Internal Communication
Now is the time to communicate and gather information as best you can.  Your internal groups, from supply chain to finance, need to know you are a resource for them, but you need to stay in the loop with regular updates on what effects the company is feeling.  The more information you can gather right now, the better positioned you will be when discussing with your carriers how your policy applies to the loss.  

Adjuster Communication
You are likely in contact with the local adjuster regarding the possibility of a claim. Let them know that you are on top of things and that you’ll keep them informed. If information is requested be sure to maintain control of the information that is shared.

Category: News 

Tags: Claims 

By: Christopher Hess | July 15, 2015

The world is getting smaller. Companies of every size do business around the globe. This poses business interruption risks both direct and indirectly. Recent examples include the devastating flooding in Thailand and the Tohuku earthquake and subsequent tsunami in Japan. Property claims can be hard enough when they are at home; adding distance and language differences can make things more time-consuming and add expense to resolving a claim. There is good news, though: International claims are not that different than any other claim. 


For example, in 2013, when Ingersoll Rand suffered an $11 million-plus flood loss at a manufacturing plant in Shanghai, we calculated the property damage and business interruption loss amounts, prepared the claim and worked with the loss adjustor and the insurance company’s forensic accounting team. We effected a settlement within three months of the end of the loss. 


Experience is the key. 


The Language 

The insurance world speaks English. The first question we are asked about preparing international claims is whether we have someone who speaks the local language. While this might have some benefit, it is far more important that someone understand the process and the numbers. On the rare occasion where a translator is necessary, that is all that is needed: a translator. It is not necessary to have a claims practitioner who is fluent. You are much better off with practitioners who know what they are doing on a property claim. 


The Location  
The time and cost to fly consultants around the world is a real concern. Often, policyholders will be inclined to hire less experienced professionals because of their proximity to the loss. This is a mistake. For the most part, information can be transferred electronically and explained over the phone. For companies based in the U.S. with operations abroad, all information necessary to prepare a claim can be transferred through headquarters. 


There are certain elements of a property claim where on-site assistance is needed (physical inventories, building or equipment inspections, etc.) This type of specific technical assistance can be coordinated with the insurance company and local resources. As with accounting information, the results of these physical inspections can be documented and sent back home. There is usually no need to send someone from here to there. 


As real examples, we have prepared and settled dozens of claims around the world without setting foot on the loss site. This is accomplished by sharing information electronically and communicating by phone, web meeting, web sharing portal, etc. The alternative of using local, less experienced professionals would undoubtedly add confusion to the process. Experience is the most important requirement in preparing any property claim. Don’t get the wrong impression – we have traveled all over the world for our clients when asked. Sometimes, the parties involved require the travel, or the loss simply demands it. However, this type of travel is less frequent now. If required, travel should be scheduled to maximize productivity to reduce the amount of travel needed. Again, experience and expertise allow this to be accomplished most efficiently. 


The Local Policy  
Local policies that cover losses abroad may have some differences from the global policy. If these differences affect recovery, in general the master policy can be invoked to make up any differences. You will want to prepare the claim according to the local policy, but be aware of differences. Your broker should be able to help sort out any differences and the reasons for those differences.

 

The interpretation of the local policies by local adjusters can create confusion. Just be aware that the intent of the local policies should fit in with your global program – to indemnify for the loss. 


Summary  
Losses happen all over the world. Just because you are in New York and the loss is in Paris, France, does not mean you should treat it any differently than if it were in Paris, Texas. Language and location are not a barrier in this day and age. If you compromise expertise for proximity to the loss location, in the end it will cost you more. Look for a team that has had success managing international claims throughout the process, leading to results for clients.


Published 7-9-15: InsuranceThoughtLeadership.com

Category: Insights 

Tags: Claims 

By: Jeff Esper | July 06, 2015

The 4th of July has come and gone, but we should not forget the reason we celebrate this holiday- Independence. The freedom and liberty we enjoy in our lives started with the need for independence. It is also a critical part of business, law, medicine, accounting and insurance.

In the insurance industry, policyholder’s insure against business risks in order to protect their financial integrity. When these risks become a reality, claim recovery is the return on investment. Unfortunately, it’s not quite that easy. Claim recovery is a process that requires expertise to secure a fair settlement. As you know, your carrier has experts assigned to adjust and audit your claim, so in turn, you should have experts to help you quantify your losses and prepare a well-documented claim. But expertise is not enough. If you want the best chance to be made whole, independence matters.

As service providers to insurance policyholders for several decades, the partners of RWH Myers have remained the independent specialists, free of conflicts of interest, and devoted to policyholders. This means that your interests, needs and objectives are all that matters. Many companies promote themselves as focused on client needs, but in claim preparation, it’s more than a slogan. It’s a matter of ethics and a code of conduct.

“According to AICPA Practice Aid 08-1, Independence and Integrity and Objectivity in Performing Forensic and Valuation Services, before accepting a forensic accounting engagement, one should carefully evaluate their relationships, if any, with all parties to the action to identify potential actual and perceived conflicts of interest. These parties include named and potential adverse parties, and counsel for the parties on the opposing side.” Richard Fletcher, Accountingtoday.com

In the claim preparation business, true independence isn’t as common as you might think. So why does independence matter so much in claim preparation? Independent loss accounting is the only way to preserve “client interests,” professional integrity, and freedom from conflicts. The partners of RWH Myers understand the code, but to us, it’s really a matter of principle. How can you put your clients interests first if you have other interests and influences? The only way is to remain independent.

Is your loss accountant independent? The most common claim preparers are forensic accountants. Let’s take a look at where they exist in the insurance industry:

    •   Insurance company forensic accountants
    •   Insurance Broker forensic accountants
    •   Consulting firms with forensic accounting service offering
    •   Accounting firms with forensic accounting service offering
    •   Independent loss accounting firms

It should go without saying that the firms hired by insurance companies cannot provide independent and unbiased service to policyholders, but many still do rely on the insurers accountants to measure their losses.  If asked, the insurers accountants would likely recommend the insured retain an independent firm to assist them, yet there are those who don’t know and don’t ask. For the policyholders in this category, hopefully, you see the light after reading this article.

Broker owned accounting firms have their own set of potential conflicts starting with the strategic relationship they have with insurance companies.  As a former broker, I can tell you these relationships are sacred and, for the most part, one cannot exist without the other. The carrier’s profitability is directly related to claims paid and they will reward their brokers for profitable accounts with a bonus commission, aka contingent commissions. If you are on a fixed fee arrangement, it does not mean there’s no contingent commission in play. Your broker wants to serve your needs and will work hard for you, but when you have a loss, they have a conflict of interest. It’s also important to remember, your claim can last longer than your broker agreement. It’s hard enough to end a relationship with your broker, but if they’re preparing an outstanding claim, it will prolong your dealings with them. If you change carriers and your broker at the same time, it can make it harder to resolve. If you are using your broker for claim preparation, consider an independent option that only serves one master, you.

The large accounting firms with consulting practices will scale back their consulting activities when faced with financial debacles that cause regulators to scrutinize their independence.  The inherent conflict of an auditing firm preparing a claim for a client should be obvious.  The audit firm will have a direct impact on creating an asset and/or revenue stream, which they would then audit the financial results.  Those two activities need to remain separate to maintain independence. Also consider what it means if your claim preparation firm is also the auditor for your insurer. As you can see there are potential conflicts on both sides. Why not avoid potential conflicts and work with an independent specialist?

Hiring consulting firms present similar conflicts to consider. Are they a provider of another service to your company? Do they also serve your carrier in some capacity?  Making this determination can be time consuming and conflicts can be easily missed. Any firm you consider should be clear about possible conflicts, but it’s your recovery at stake so it’s best to do the proper vetting.

In the insurance industry, it’s the policyholders right and obligation to value their own losses for submission to their insurer. Your insurer will be happy to help you measure your loss, but is that what is best for your company? Recovering your losses is the reason policyholders invest in insurance, so be sure to hire a firm that knows how to prepare a claim and is working on your behalf. Loss accounting is a specialized craft that comes as a result of experience and expertise with insurance claims. Seeking an independent, third party, valuation of your losses is not only smart business but may be a fiduciary responsibility, especially with a large property and business interruption claim.

RWH Myers stands by our declaration of independence and we’re proud to support your interests and your success. It’s clear, Independence matters to us. If you like the idea of conflict free claim preparation, then Independence matters to you too.

Category: Insights 

Tags: Claims 

By: Jeff Esper | June 04, 2015

This article might seem out of place coming from a policyholder advocate who is often at odds with property adjusters. However, I feel for them. Their job is not easy and is further complicated by the system that has evolved.

Having prepared property claims for more than 20 years, I have seen the process change into what it is today — and the change is not favorable to the policyholder. Historically, the adjuster was the point person for the insured to interact with. The adjuster was given authority to make judgments as to coverage and measurement of property and business interruption claims, often relying heavily on their expert accountants and engineers to form their opinions.

Today, the adjuster is still the point person, but there is a group in the shadows that makes most of the decisions. Much of the authority has been taken away from adjusters, oftentimes putting them in the middle between the ultimate decision makers and the insured. This leads to confusion, delay and frustration by all parties involved. I liken it to the “Telephone Game” — where you get a group together in a circle and whisper something to the person next to you; by the time the message makes it around the circle, whatever you said has been distorted into something completely different. Just like the game, the insurance process suffers from a communication breakdown that confuses issues and delays resolution.

Some would say this evolved out of necessity for the insurance companies. They do need to be on alert for fraud, so close management of the process by those paying the bills is reasonable. However, the point of assigning an adjuster is to avoid micromanaging the process and to delegate some of that authority. Additionally, the adjusters are the closest to the loss and need to be able to make decisions on ambiguous issues. Having them go back to their superiors to clear every agreement defeats the purpose of having an experienced adjuster.

There are better ways to prepare for the challenge of claims than pointing fingers:
1. Adjuster Selection – the policyholder may be able to specify certain adjusters and even have them written into the policy. Even though they are subject to the same system, experienced adjusters are more likely to have clout with the insurance company. This may allow them to have more freedom than those adjusters who are less experienced. Additionally, the adjuster will appreciate being a part of your program and will be less likely to create problems.
2. Leverage Underwriters – the insurance business has two sides: sales and claims. These sides do not necessarily communicate. Often, the policyholder can feel that one thing was sold and another is being adjusted. Make sure that the claims side knows that you are willing to involve the sales side if differences arise. While this is not something you want to do on every claim, it can be an effective way to correct the claim adjustment team on issues you feel strongly about.

3. Policy Acumen – Do not assume the adjuster knows how your policy should respond better than you do. Involve your broker and coverage counsel when facing interpretation issues. Often, we see an adjuster make claims of fact about adjustment methods that conflict with our experience with previous claims.

4. Claim Stance – It is the duty of the policyholder to prepare the claim. Prepare your claim as you see it and be prepared to defend it. Do not leave it up to the adjuster and his team to tell you the number. Understand the areas of your claim that might be subject to debate and prepare your best arguments. Recognize the strengths and weaknesses of your claim and anticipate adjustment attempts.

5. Empathize – It is common to think that the adjuster is out to get you and just wants to minimize your claim. Though it does happen, for the most part, the adjuster is just doing her job. If there are unreasonable positions coming from the adjuster, she is likely just the messenger. Working with the adjuster instead of against her, showing empathy, may just get her to empathize with you and your position. Help her help you!
Like with anything, preparation is the key to success. Add a dose of a positive attitude, and you might even enjoy the process. It’s a better approach than the blame game. When you are faced with an insurance claim, having the right perspective, a little understanding and being prepared will make a huge difference. Incorporating these steps will improve your claim outcomes and will help make the most out of any claim situation.


Category: Insights 

Tags: Claims 

By: Christopher Hess | March 09, 2015

How to Recover from Winter Losses

Ten things you should do immediately after a loss

As far as winters go, this one has been a doozy in the Northeast. Record setting snowfall coupled with record low temperatures means roof collapses, frozen pipes and sprinkler leakage. If you are one of the unlucky businesses affected by this winter, this list is for you. 


Here are ten things you must do after disaster strikes:


  1. Safety first - make sure all employees are accounted for and safe.
  2. Secure the location - temporary fencing and security may be required to make sure the site is secure. You will want to preserve the damage for inspection by the insurance adjuster and other interested parties. Do your best to salvage and preserve undamaged property.
  3. Report the loss - call your broker or insurance agent to report what has happened. Do not speculate on damages at this point but act fast to get in line - adjusters will be busy. Alert third party vendors that you may need their help with recovery, including forensic accountants, forensic engineers and attorneys. 
  4. Secure temporary facilities - try to get up and running in temporary space as soon as possible.
  5. Assign internal responsibilities - you will need point people for information gathering and communications. If you have a risk manager, much of the coordination will be through them related to insurance, but operations and management will have to be involved as well.
  6. Locate/acquire "as was" estimates of damaged property - the "as was" estimate will likely become the baseline for your property claim, regardless of what you actually do to repair or replace property.
  7. Prepare estimates of property and business interruption losses - even early in the process, it is important to develop the best estimates you can so that the insurance company can set reserves.
  8. Meet with management - it is important to set reasonable expectations for recovery. Do not overstate how much might be recoverable.
  9. Meet with adjustment team - the initial meeting should cover procedural and communication protocols as well as contact information. If estimates are available for reserves, those should be shared.
  10. Finalize and execute reconstruction plans - decisions to re-build, not re-build or build differently can take time. Do your best to finalize these plans in a reasonable amount of time.

RWH Myers is a forensic accounting firm dedicated to assisting policyholders through all stages of the insurance process. We assist in calculating loss amounts and presentations to insurance company representatives on your behalf, with the goal of settling your claim for what it's worth as quickly as possible.  If you would like a personal consultation about winter losses or anything related to property damage claims, please do not hesitate to contact any of our offices.  We take great pride in our services and enjoy helping when we can.

Category: Insights 

Tags: Claims 

By: Christopher Hess | November 19, 2014

Property insurance claims require significant time, effort and attention from risk management, finance and operations personnel. From the moment the loss is reported, insurers will have what seems like endless requests for information, and they’ll scrutinize every figure presented. Then the insured has to put the claim together and present it to the property insurers. The amount of activity is often more than the policyholder anticipates. Insurers understand the burden this places on the policyholder, and it is the reason most insurers offer professional fees coverage. This minor endorsement can be a major difference maker both in effort and outcome.

Here’s an example of professional fees wording from a recent policy referring to the coverage for actual costs incurred by the insured: “reasonable fees payable to the insured’s: accountants, architects, auditors, engineers and other professionals; for producing and certifying any particulars or details contained in the insured’s books or documents, or such other proofs, information or evidence required by the company resulting from insured loss payable.” 

As you can see, the wording is intended to cover the additional costs associated with the claim. Here’s what’s generally not covered: 

1) “attorneys, public adjusters and loss appraisers, including any of their subsidiary, related or associated entities either partially or wholly owned by them or retained by them for the purpose of assisting them, 

2) “loss consultants who provide consultation on coverage or negotiate claims.” 

The specific wording of the endorsement will vary and should be carefully reviewed before engaging outside claim services. Some wording is broad and will cover most consultants. Other wording is more restrictive and eliminates certain classes of consultants. To determine what’s best for your business, consider the available service providers and evaluate who would best represent your interests. 

Often, policyholders don’t fully understand the nature of this coverage. Some don’t know of it. Some are unaware if they have it. Others may not know if or when to involve a specialist in their claim. 

Don’t confuse the purpose of this coverage with the “free” help that the insurance adjusters offers. The adjuster’s job is to confirm coverage and audit the claim. It is the responsibility of the insured to measure, document and present the claim. If the adjuster’s consultants offer to help measure the loss and put the claim together, it would be like having the IRS prepare your taxes. As a courtesy, you should notify the adjuster that you plan to use a claim preparation firm and disclose billing rates and proposals, but the decision is yours to hire, and if the work matches the coverage the insurance company is required to pay for it within reason. The consultant is engaged by the insured, and invoices are reimbursed by the insurance company as part of the claim. 

So who is the best choice to help you prepare your claim? Forensic accountants are the most common and appropriate service provider for claim preparation. Forensic accountants can help with: 

1. the tedious and burdensome tasks associated with the claims process 

2. expertise on the adjustment process 

3. efficient interface with policyholder data gathering resources 

4. maximizing recovery and expediting claim resolution 

5. making the formal claim presentation 

While the policyholder still needs to produce information, the claim preparers will efficiently package the information in the form of claim presentations. Some brokers have a claim preparation unit, but there could be a conflict of interest there, as well. The broker is an intermediary between the insured and the insurer. It is difficult to walk that line and truly be supportive of the insured. Most brokers accept contingent commissions based on the profitability of an engagement during the policy year, and the client executives have incentives to use their own services. While not a clear conflict, it certainly has potential to influence the position of the insured. 

The good news is there are firms that won’t come with baggage — i.e., conflicts of interest. The best solution is a third party, independent firm that has ample experience and can represent your interests with a specialized skill set. Remember, the firm must be skilled in the complexities of property damage and business interruption claims. 

It is critical to have your claim preparation team vetted ahead of a loss. Finding time to interview forensic accountants and review proposals after a loss can waste precious time and derail a claim before it even gets going. 

“Do your due diligence and find the best fit for your organization by arranging introductions to your finance/accounting leadership. It is worth the effort when you find the right partner,” says John Lafferty, manager, risk and insurance management, at Air Products & Chemicals.” 

If you have property exposure, it’s wise to have your forensic accountants in place and to have the coverage for their services. Risk managers should include professional fees coverage in their discussions with underwriters. With most carriers, it should not materially affect your premium — if at all. As the market continues to soften, many policyholders are enjoying rate reductions with improved terms, so this is the perfect market climate to explore professional fees coverage if you don’t have it. If you do have coverage, look for increased limits. A good benchmark for limits would be to 1% to 2% of your probable maximum loss. This should easily cover the costs for claim preparation from a reputable firm. 

If you apply this information and incorporate these recommendations, the next time you have a property loss with business interruption the process will be smoother and results will impress you and your executives. So find your team and get that coverage. You’ll be prepared to recover whatever loss comes your way.


Published 11-19-14: InsuranceThoughtLeadership.com

Category: Insights 

Tags: Claims 

By: Christopher Hess | October 01, 2014

No one wants to deal with a property claim. Unfortunately, claims do happen, and that is why you buy insurance. There are right ways and wrong ways to manage a claim — here are three common mistakes and how to avoid making them:

Too many cooks...

Too Many Cooks...
One of the first things you should do after a loss is assign a point person to handle communication and dissemination of information to the insurance company. Oftentimes, this role defaults to the risk manager, but she is not always the best choice. Obviously, the risk manager needs to be part of the team, but you need someone who can dedicate a substantial amount of time to the claim. This ensures consistent communication and avoids the insurance team’s relying on information that has not been vetted.


Not controlling the schedule...

Not Controlling the schedule... 
As with most projects, planning and execution are necessary for a successful outcome. It is critical in the claims process to assign responsibility to the team members at the policy holder and require that they provide information in a timely manner. This compels the insurance company to provide feedback in a similar fashion. A timeline should be established early on, and the parties should be held to it. For example, claims will be submitted by the fifth day of the month; feedback will be provided by the 15th day of the month; and payment will be received by the end of the month. Scheduling like this can improve cash flow and ensure progress on the claim. Get the parties to commit to this early! 

Unreasonable expectations...

Unreasonable expectations...
It’s true that the insurance company is not likely to accept your entire claim, but building up your claim to unrealistic expectations is not the answer. By claiming a “pie-in-the-sky” number, you can hurt your credibility and dramatically slow down or prevent a reasonable settlement. The better approach is to present a reasonable claim that is fully documented. This prepares you to counter the insurance company’s rebuttal with confidence. It’s reasonable to be aggressive, and, by all means, do not lower you claim in anticipation of pushback from the insurer. Just do not build up the claim to unrealistic totals with the plan to fall back to a lower position — this gives all the credibility to the insurance company.

Category: Insights 

Tags: Claims