The Information Experts

If you think of industries that readily adapt to technological change, the property and casualty industry doesn’t quickly come to mind. The industry’s cautious approach makes sense, however, if you consider the fact that they are in the business of evaluating and managing risk. Still, in today’s world of claims processing, the need to work as efficiently as possible while at the same time providing the customer with the highest level of service are two critical success factors that set a company apart from the competition.

At first glance, it seems strange the property and casualty claims industry is filled with people who go home and use leading-edge technology in their everyday lives outside the office. They use online banking systems, online stock-trading sites and online auctions. They download and burn music and movies. They use advanced, often complex software to edit and create home videos.

Yet very seldom do they have the opportunity to put this technological know-how to use at the office. Insurers, often with good reason, sometimes do not use – and in certain situations don’t even allow – online tools and technology that might generate increased efficiency and create clarity in claim investigations. Although these tools are available, opening the door and allowing each and every claims adjuster uncontrolled access to these resources can create significant problems for insurers.

How does a large claims organization train its staff to use these tools? How can management be sure the information is being obtained from legitimate sources? What are the costs associated with the loss of production time while adjusters attempt to master the intricacies of unknown Web sites or software packages? The risks and costs associated with getting new tools and technology into the claims-handling process are much greater than they would appear at first glance. It is simply not easy to do.

EVOLUTION OF TECH

Unfortunately, this dilemma creates a disadvantage for claims professionals who conduct investigations into individuals or groups who seek to take advantage of the property and casualty claims industry. The bad guys have evolved. They have used the advanced tools and technology available to them; developed more complex and sophisticated methods to create identities; copied or created supporting documents; and, in some cases, they have accessed information that is ultimately used to make their claims appear legitimate. Those who would exploit the system for their own gain continue to stay one step ahead: they have no constraints on the use of technology, and no costs about which to be concerned – only “profit.”

It’s not that the claims industry hasn’t adapted. After all, many technologies that were once exclusive to law enforcement – such as statement analysis, accident reconstruction, polygraph examinations and kinesic interviewing techniques – are tools now routinely used in many claim investigations. But a simple review of readily available technologies underscores the implementation and training complexity for insurers who wish to equip their staff to compete with the fraudsters.

A few years ago, it would have been totally unreasonable to consider the use of DNA analysis in the investigation of a property and casualty claim. The cost would have amounted to thousands of dollars and the expertise was so limited then that the results would have taken months to come back from the lab. In today’s world, for a few hundred dollars, private DNA labs can take only days to process a strand of hair found on an airbag or embedded in a windshield. A DNA analysis can be used to determine whether a driver was male or female: the test result may confirm or create a discrepancy in a statement taken from a female policyholder who stated, for example, that she was the driver of the insured vehicle when it went into the ditch, not her unlicensed male passenger. DNA tests can also determine whether or not the blood left on a ledge by an individual who is alleged to have entered the home through a broken window actually belongs to the homeowner. This can be a very useful tool in a case were there is some question about the legitimacy of a break-and-enter. Customized Internet search engines can be used to scour the Internet for specific items; they can monitor the Web for a certain period of time, check online classified ads, and alert claims investigators to items previously paid for in a claim settlement.

Investigative analysis software can pull together names, addresses and phone numbers from many documents and sources of information, mapping out a schematic diagram of complicated schemes involving large organized groups.

Voice stress analysis software, presently in use in some call centers in Europe and the U.K., can pinpoint unusual levels of stress in the voice of an individual reporting a claim. This indicator can lead to the claim being assigned to a field investigator for a detailed review.

HIGH-TECH IMAGES

Photographic tools and technology can be of great assistance in the investigation and substantiation of the facts of a claim. Satellite images, once available only to a few select government agencies, are now quickly and easily obtained. They can provide the adjuster with a bird’s eye view of an intersection in an auto loss or the characteristics of a residence property in a fire claim. Aerial photography can be a key element in providing a complete perspective of a large commercial loss or in presenting the details of a complicated section of roadway. Databases of intersection photos are also available, giving the claims profession the ability to instantly view the scene of the accident as if they were behind the wheel of the vehicle.

High-tech tools like Strikefax and Striknet objectively verify lightning strikes through the U.S. and Canadian National Lightning Detection Network. Within minutes, adjusters can verify whether lightning caused losses or surges in power, damaged property, or started wild land or building fires. Such technology, which can record lightning strikes 24/7, can assist the claims professional in answering the question: ‘Was the loss really caused by lightning?’

The technology is complex, but attainable. How can a property and casualty claims organization take advantage of these legitimate and valuable tools and resources, without incurring significant internal efficiency and training costs, while reducing the risk of using “bad” information in a claim investigation?

The answer may very well be for claims professionals to partner and work closely with third-party experts – firms that specialize in the use of the latest information tools and seasoned claims professionals who can rapidly adapt new technologies to access instantly and legitimately obtained documents and information for use in an investigation. These experts have created successful businesses evaluating new information and technology as it applies to the claim industry, separating useless or questionable tools and bringing the valuable and legitimate tools to insurers and adjusters through one controlled access point.

By using third party information specialists, an adjuster will have access to all the latest information tools and technology. Adjusters will be able to access valid information quickly and easily, gaining the knowledge they need to help in the resolution of a claim.

Accurate information, obtained in a timely fashion through the use of today’s information tools and technology, empowers the adjuster with knowledge that will not only help them keep pace with today’s sophisticated fraudsters, but also help them to resolve the legitimate claim as quickly as possible.