A Tale of Two Restaurants

“It was the best of times, it was the worst of times.”

If you’re not familiar with the Charles Dickens novel, A Tale of Two Cities, you might not have recognized its opening line. But whether you’ve read the novel or not, there must have been times in your life, perhaps your working life, in which you’ve felt the seemingly contradictory truth in that line.

We were reminded of that contradiction in a conversation we had with a risk manager for a restaurant chain. To protect his identity, we’ve identified him as RM (risk manager) in the transcript that follows. We’ve identified ourselves (modestly, of course) as CE (claims expert).

Here’s the transcript:

CE: Hi. Thank you for looking at our website and contacting us. Please let us know how we can be of service to you.

RM: Thank you for taking the time for this call. The truth is I reached out because I thought Cloud Claims looked interesting.

CE: That’s a great place to start. Do you have a claims system at present?

RM: I do.

CE: Do you mind if we ask what system you’re using?

RM: Not at all. It’s called Claims Bomb.

CE: Okay … well … how do you like it?

RM: I love it. It’s automated so many of the process I was doing manually.

CE: Excellent. Can you tell us what kind of reports it gives you.

RM: What kind of who?

CE: Maybe that’s not the best place to start. Does Claims Bomb let you tie individual claims to the incidents that precipitated them?

RM: No. But it does number all my claims. So, all I have to do is go back to figure out what caused them in the first place.

CE: Is that a distraction?

RM: It depends on what else I have to do.

CE: Right. Of course. And does Claims Bomb let you attach files in various digital formats?

RM: Isn’t that why God invented paper?

CE: Are you experiencing any backlog in the claims you have to manage?

RM: Yes. But the only people who complain are the ones whose claims aren’t being paid.

CE: Alright, then. Just one more question: Overall, how do you feel about Claims Bomb?

RM: I hate it.

CE: But you said earlier you love it.

RM: Yeah. But that was before I realized all the stuff it doesn’t do.

CE: We’re here to help when you’re ready.

RM: Are you busy right now?

Chapter Two

The moral of the story is this: There are good reasons to have a headache. Claims management isn’t one of them.

Please let us know how we can help you feel better.

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International Pi Day

In case you’re not aware, today is International Pi (π) Day, March 14 or 3.14.

The day is named in honor of Arnaldo Pi, the inventor of mathematics, who realized if he calculated the ratio of the circumference of a circle to its diameter, he’d come up with 3.14. He also realized its decimal representation never ends and never settles into a permanently repeating pattern. And he was astute enough to realize, therefore, that he could never sell pi as an end-to-end solution because it didn’t exactly have an end.

What Arnaldo did not realize, however, is that his formula for calculating the area of a circle — πr2 — would land him in hot water with the WAG (World’s Authoritarian Grammarians). According to the WAG, the formula, πr2, is grammatically incorrect. Rather, the WAG insisted, the formula should be πis2 because π is singular.

Arnaldo’s Defense

As a means of justifying his formula, Arnaldo wrote the following letter to the WAG in hopes that they might leave him and his formula alone or at least cut him some slack:

Esteemed Members of the WAG,

I appeal to you for some latitude in rendering my formula for calculating the area of a circle on the following grounds:

First, I’m the inventor of mathematics, for cryin’ out loud. Nobody ever did this before. Since I’m making it up as I go along, how can you say I’m wrong?

Second, what about Toys ‘R’ Us? You let a retail chain that sells junk to impressionable kids get away with that — and you want to bust my chops?! I have to say it feels like I’m being singled out unfairly.

Finally, I think you have to decide whether you’ll err on the side of mathematical accuracy or grammatical accuracy. After all, you can’t have your pi and eat it, too.

Yours sincerely in numbers,

Arnaldo Pi

The Verdict

Arnaldo, as we now know, prevailed. That’s why all of us are now able to calculate the areas of circles with mathematical precision, albeit with grammatical incorrectness. But who cares? Arnaldo’s victory gives us all the more reason to celebrate International Pi Day, regardless of whether we prefer apple, peach, blueberry, strawberry, rhubarb, chocolate, custard, banana cream, lemon meringue, key lime, or mince.

Eat responsibly.

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Who Knew: Part Two

In an earlier post, we wrote about the ways in which companies go about reporting the incidents that spawn claims. And we recounted a conversation we’d had with a prospect on the subject of that reporting.

We recalled that post and that conversation in a more recent exchanges with another prospect. That made us think about what kind of risk-management reporting some companies might be getting. More important, it made us think about the extent to which many companies settle for what they’re getting.

Here’s a transcript of the exchange:

Us: What kind of risk-management reports do you get from your TPA or from your claims system?

Them: You mean loss runs or summaries?

Us: No. Risk-management reports. You know, the kinds of reports that would let you identify loss trends and such.

Them: Oh, you mean like reports of accidents, injuries, and stuff like that?

Us: Uh … not exactly. We were thinking more along the lines of reports that break down losses by type, by individual, by activity, by geography, and a number of other factors that could help you mitigate your risks and costs.

Them: Gotcha. You’re talking about the kinds of report that would help us improve safety, reduce the probability of accidents, and minimize our exposures.

Us: Exactly!

Them: Whew. Now we’re on the same page.

Us: Precisely. So, now that we understand our terms, what kind of risk-management reports do you get from your TPA or from you claims system?

Them: We don’t get anything like that.

It Doesn’t Have to Be That Hard

If you find yourself in a situation in which you’re not getting the risk reports you need to manage your risks adequately, you can do one of three things:

  1. Ask your TPA for them.
  2. Ask your risk manager for them.
  3. Get a system that will generate them for you on demand.

We know what we’d do. But we’re biased because we know how easy it is to get the reports you need.

If you’re ready to find out just how easy, we’d love to talk with you.

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It’s 2022. Do You Know Where Your Claims Managers Are?

A popular introduction to local news used to ask, “It’s 10 o’clock. Do you know where your children are?” Along the same lines, many companies in industries as diverse as insurance, transportation, construction, local governments, TPAs, self-insured groups, and restaurants are wondering where their claims managers and risk managers are. They might be in the office. They might be working from home. They might be on the road. It doesn’t matter. Wherever they are, they need access to information. And they need to be able to find the information they need as efficiently as possible.

If that was true to some extent before the coronavirus pandemic, it’s a way of life now. Some folks call it digital transformation. Some folks call it the new normal. We call it evolution and common sense. Paper’s been been on the decline in working environments for more than 20 years because digital technology has been on the rise for that same period of time. And there’s no going back.

Digging Digital

Much of the digital progress has been made in claims management and risk management. Digitization facilitates automation. Automation facilitates workflows. Workflows facilitate efficiency and productivity. Efficiency and productivity improve loss mitigation, customer service, and profitability. Digitization also facilitates better data. Better data facilitates analytics and reporting. Analytics and reporting improve decision-making. It’s a pretty straight line. And there’s more.

As data analytics and decision-making improves, so does claim prevention. By identifying trends, incident types, claims frequency, times of occurrence, affected activities, accident-prone individuals, and more, claims managers and risk managers can work with their customers and their employees to reduce the likelihood of risk.

We’d never say COVID-19 was a good thing. But it did bring about — or at least accelerate — some very good things. Because it created the need for enhanced digitalization, it created the opportunity for claims management and risk management to advance rapidly. If we can keep the momentum going, the future will be bright, indeed.

It’s 2022. You don’t need to know where your claims managers are.

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Who Knew?

We had a conversation the other day that made us think about the ways in which companies — even or maybe especially companies that use TPAs — go about reporting the incidents that spawn claims. We were talking with a prospect, and the conversation went something like this:

Us: What does your reporting process look like?

Them: Everything goes directly to our TPA.

Us: Every incident, every claim, or both?

Them: What’s the difference?

Us: Well, if one accident spawns a physical injury claim and a property damage claim, how do you report them?

Them: We’d report the accident.

Us: How?

Them: We could use a form or a phone number.

Us: Do the forms ever get lost?

Them: Sometimes.

Us: If you use the phone number, do you document the accident?

Them: I guess we’re not sure.

Us: Would the TPA receive or track every claim stemming from that accident?

Them: I guess we’re not sure.

Us: Are there any incidents or accidents that don’t go to the TPA?

Them: I guess we’re not sure.

Us: Since you’re not sure about what gets reported to the TPA and how it gets reported, how do you manage your reporting to ensure the right people know about accidents, to maintain control of your data, to manage your costs, and things like that?

Them: We were afraid you were going to ask us that.

They’re Not Alone

You might be surprised to know the number of companies that take it on faith that everything goes directly to their TPAs. We used to be surprised. But we’re not anymore. But it’s not a difficult problem to fix. And believe it or not, the remedy starts with the definitions of everything and directly:

Everything goes to a TPA only if you systematize the tracking of every incident, systematize the tracking of every claim to every incident, and verify every incident is going to the TPA. Everything goes directly to the TPA only if you submit everything completely and electronically. Paper forms have a way of getting lost. Phone calls have a way of getting forgotten. And here’s the bonus: Everything you track and submit directly to the TPA can be reported quickly and efficiently.

We grant you we’re biased. But tracking and reporting your claims — and managing everything in one system — feels like sound business practice to us.

Can we help you track and report your claims?

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Juggling Municipal Risks

We don’t envy municipal risk managers. Having to contend with claims for property damage, workers compensation, and other liabilities; accidents on school yards and sports fields; resident complaints; and more other things than most of us can imagine must leave most risk managers wishing they were jugglers … or octopuses (octopi, if you prefer the Latin derivative).

But while we don’t envy them, we definitely support them.

Don’t Agonize — Organize

When you’re being bombarded with claims, public safety issues, and the other aspects of managing risk, the last thing you can afford is disorganization. That’s why Cloud Claims is incident-based, tracking each claim related to each specific incident. Consider this, however far-fetched it might be: A Department of Public works employee is out plowing snow one night. He has the driver’s side window of his truck rolled down. A neighborhood kid throws a snowball that hits the employee in the head, causes a laceration, and knocks the employee unconscious. Out cold, the employee, with his foot still on the accelerator of his truck, crosses a yard and crashes into a house.

The employee’s medical claim, his workers comp claim, and the resident’s property-damage claim would track to the same incident, including every attendant document, image, or any other related file. In addition, Cloud Claims allows you to track lost time — and to visualize risk trends, incidents vs. claims, and your areas of greatest exposure to liability.

Don’t Complicate — Automate

Even a small town can generate hundreds, if not thousands, of claims in a year. You don’t want to contend with this equation:

[the number of claims, x the documents and files associated with each claims x the time required to manage each one = weeks or months of work]

In contrast, Cloud Claims lets you contend with this equation:

[the number of claims x entry of details x electronic upload x automated workflow = weeks or months of work saved]

Add dashboards that enable you to get the reports needed, when they’re needed, and municipal risk managers reduce their own risk — of stress, of burnout, of overwork, of overtime, and of sweating the small stuff (but their juggling skills might suffer as a result of all that organization and efficiency).

As an added benefit, happier municipal risk managers may very likely result in better service and happier municipalities.

As Robin Williams would have said, “What a concept.”

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Santa’s Workers Comp Claim

Santa Claus Contends with Workers Compensation Claim

Elf claims physical injury and mental stress due to heavy workload.

North Pole — (December 20, 2021) — Saint Nicholas, sometimes known as Kris Kringle but most popularly known as Santa Claus, has had a workers compensation claim filed by one of his elves. It appears the elf suffered from Pre-Holiday Burnout (PHB), caused by the effort required to make gifts for everyone in the world. He also suffered a broken toe when he dropped a toy anvil on his foot. Mr. Claus consented to sit for an interview with a reporter from WILBUR (World Insurance-Leading Business Underwriting Report). The elf, identified only as Ernie, declined to be interviewed. What follows is a transcript of the interview with Mr. Claus, edited for brevity and clarity.

WILBUR: How are you feeling about Ernie’s claim, Mr. Claus?

Santa: Look. I know this is supposed to be the season of giving. But all this claim is giving me is grief and agita.

WILBUR: You have the proper insurance coverage, don’t you?

Santa: Well, yeah. But managing two different claims is a nightmare.

WILBUR: What do you mean?

Santa: Ernie filed one claim for physical injury for the broken toe. That caused him to file another claim for the PHB. Now I have to manage both of them.

WILBUR: What if your claims system tracked claims by incident, recording every claim resulting from that one incident?

Santa: Right. And what if reindeer could fly?

WILBUR: Uh … they can.

Santa: Okay. I forgot. But where do I find an incident-based claims system?

WILBUR: In the cloud.

Santa: You mean with the reindeer?

WILBUR: Not exactly. It’s called Cloud Claims. I’ll get you the information.

Santa: Thank you. But I have to get back to work now. I’m short one elf. Ho, Ho, Ho!

About WILBUR

WILBUR is the world’s foremost insurance authority. If it’s insurance, it’s WILBUR. For more information, please visit www.wilburinsurance.com, email info@wilburinsurance.com, or call 1-800-WILBUR1.

About Santa Claus

Santa Claus is a fat guy in a red suit who flies around the world in a red sleigh on Christmas Eve and brings everybody everything they want. For more information, please write a letter to the North Pole.

Media Contact:
JoAnna Bennett
203-341-2360
joanna@obriencg.com

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The PAID Act Deadline is Here

Last June, we published a post called, Clean Up Your PAID Act. It laid out the reasons that entities required to comply with the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of the Centers for Medicare and Medicaid Services (CMS) and its Section 111 reporting requirements would soon be facing new mandates. Those mandates would be coming under the new compliance guidelines of the Provide Accurate Information Directly (PAID) Act. The PAID act was signed into law on December 11, 2020. As promised by CMS, the new law goes into effect on December 11, 2021. That’s Saturday of this week.

The PAID Act enable insurers to better identify claimants’ Medicare plans and to avoid unnecessary litigation. And it prevents the lawsuits that were being filed by Medicare Advantage Plans against insurers for double recovery and for failure to provide primary payment or reimbursement for qualifying charges. But it will require all responsible reporting entities (RREs) to manage additional data from CMS — data they they weren’t required to manage before the PAID Act. More specifically, the PAID Act requires CMS to deliver Medicare Part C (Medicare Advantage Plans) & Part D information to help RREs resolve liens with Medicare. That, however, requires significant changes to Section 111 reporting systems.

That means, beyond your present system’s inability to access the new fields, without changes, many systems won’t be able to process the new CMS query responses at all. That may render your current Section 111 reporting process obsolete. And it will put your CMS compliance at very real risk.

Depending on when your CMS reports are due, you don’t have much time. But with MIR Express™, we do. MIR Express is our secure system for managing your Non-Group Health Plan (NGHP) Medicare reporting. It’ll ensure you’re ready to handle CMS’s changes and to access all the valuable new information you’ll be getting from CMS right away. And we’ll make the transition painless.

If you’re already using MIR Express, you don’t have anything to worry about. And if you’re not already using MIR Express, you still don’t have anything to worry about because you can get it and be using it before your actual reporting deadlines.

We’re ready right now. Please let us know when you are.

December 11 is five days away.

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Property Management Claims … and a Moose

We were flipping through an older issue of Insurance Journal the other day and came across an article with this headline: “The Complicated Risk Exposures of Property Managers and Investors”. We were okay at first, especially when we read this:

Property managers and real estate investors face bedbug exposures, mold behind the dishwasher, tenant and vendor service issues, tenants without insurance, vetting contractors, insurance claims, property inspections, tax authorities, tenant harassment and discrimination claims, and more.

That’s nothing but true, fair, and accurate. But this part freaked us out a little bit:

In most cases, the property manager is responsible for tenant screening and placement of the tenant in the investor’s property, which leads to another potential financial exposure for the property manager … Medical payments, property damage to others, additional living expenses, and contents coverage are not required or reviewed.

The fact that property managers may not be aware of the extent of their exposures is bad enough. But what really freaked us out was the reality that all those claims — whether the property manager saw them coming notwithstanding — will have to be managed.

If you were using Excel, you could record an incident. Then, if you were able to tell what claims resulted from that specific incident, you could put links to those claims in other spreadsheets or documents. That feels like a dicey proposition because it feels like a pretty big if.

When we got to this part of the article, we completely flipped:

Property management firms often assume that by having their investor add the property management firm as an additional insured on the investor’s personal homeowners or commercial multi-family policy they can mitigate all their liability exposures related to the servicing of the individual property … [but] they may be facing uninsured losses due to vacancy clauses, intentional acts or damage by the tenant, and “service animals” that could take down a moose.

The potential liability inherent in vacancy clauses and intentional acts or damage is scary enough. But the idea of heading out to a property inspection and having to face off with a service animal that could take down a moose, is terrifying — especially if the resulting claims have to do with a leg in the service animal’s choppers.

You could trust all that to Excel. Or you could use Cloud Claims. Cloud Claims won’t protect you from a service animal that could take down a moose. And it won’t read your policies for you. But since it connects incidents to claims — and claims to policies — it will protect you from disorganization and inefficiency. And it’ll help you identify patterns, assess risks more effectively, and mitigate them accordingly.

Note to Self: Give service animals a much wider berth.

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Connecting the Dots in Restaurant Claims

Have you ever played Connect the Dots? At first it might seem like a bunch of dots and numbers. But as the dots begin to connect, the image magically appears. Restaurant claims are similar. At first it might seem like a bunch of events and numbers. But eventually general liability, personal injury, liquor liability, product liability (food poisoning, allergic reactions, hepatitis), and fire can all come together and magically reveal the whole picture.

It’s obvious enough that insurers have an obligation to fulfill the promises they make to protect against losses when they sell policies. But who protects your risk managers? How can they ensure they’re properly identifying all of the risks they’re paid to mitigate? How can they do so efficiently and coherently? And how can they connect the dots between claims to identify patterns, to improve their risk selections, and to maximize guest satisfaction?

The Whole Picture

They can start by tracking incidents, rather than claims. Here’s a scenario: One evening, Gladys, a waitress at Ernie’s Chop Joint, trips on her way across the dining room and drops a tray containing a carafe full of water and eight water glasses. The glasses shatter. As the carafe rolls across the floor, water runs into some electric sockets in the floor, causing a fire. (Claim #1, property damage.)

On its way to the floor, the carafe full of water, ricochets off the right foot of Herb, a gentleman having dinner with his wife, fracturing three metatarsals. (Claim #2, bodily injury). Herb’s wife, Grenadine, believing Gladys dumped the tray on purpose, convinces Herb to sue Ernie’s. (Claim #3, general liability.)

The risk manager now has three claims to contend with, all stemming from Gladys’s stumble, but that may be unrelated in terms of coverage. For that matter, it’s possible for the claims to be managed by different people who may have no way and no reason to connect the dots. If, on the other hand, the claims had been tracked by incident (poor Gladys), then all the dots would have been connected.

If the claims system the risk manager used tracked incidents — used tag-based organization for documents to eliminate network folders and files; attached image files, videos, PDFs, and other documentation to each incident and anchored every claim to an incident — dots would connect themselves. As a result, claims would be managed more efficiently, patterns would be more readily identified, risks would be assessed more effectively, and conditions and circumstances could be adjusted to mitigate those risks.

We can’t promise to protect Gladys. But we can definitely help the risk manager who’s trying to.

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