People ask whether it is skill or luck that leads to success. The truth is that it’s a little bit of both. You have to have the skill to put yourself in a position to recognize and seize upon your opportunities. Gerrett Stier brought his podcasting gear to the 3 Kings Environmental Sumner, Washington office to discuss business with Jon Isaacson. 

Gerrett is the owner of GMS Distribution which makes power distribution tools for property restoration. His main product is a panel that allows contractors to draw additional power immediately from a dryer or range plug so that they can more equipment in the service of a water damage response. ​

Gerrett is an electrician by trade and in 2007 he started working with property restoration contractors. Because he is a service minded person, he sought to make a product for his clients that would save them money and time when sourcing the traditional spider box in situations where they needed additional power. The initial units were hand made from electrical parts.

In 2009, as the market crashed and Gerrett’s hours were cut in half, he took his product on the road and went door to door to determine if there was a broader demand for this distribution unit that he had been making for local restoration contractors. When you have a good product, a good attitude and refuse to allow tough times to take you out, you can put yourself in a position to create some luck. As Gerrett says, “Being smart enough to be lucky.” ​

As he was building GMS Distribution, he shares some really cool stories of how local vendors collaborated with Gerrett to help him get the process moving forward. Gerrett has a strong commitment to taking care of his customers and was able to attract partners who held similar values. Transitioning from a skilled professional working in a business to an entrepreneur who is building and working on your own business requires intentionality to persevere through the many obstacles.

Gerrett Stier started The GMS Podcast in late 2019 and for Episode 5 “Skill & Luck”, he and Jon discuss how GMS Distribution was formed, what 3 Kings does and what The DYOJO is about.  ​

What is The DYOJO? Gerrett asks when did Jon get started writing, speaking and coaching for property restoration professionals? Jon discusses his start in property restoration, being introduced to a mold remediation team and learning the skills of the business. He shares how he had the good fortune of learning from good mentors early on which set him up for a trajectory of career development within the industry. Jon discusses the motivation and concepts for business coaching and leadership development through The DYOJO. ​

The details will make or break a well documented loss that will enable you to get paid for your work on an insurance claim. The details of your process and the workflow consistency will make or break your ability to elevate your teams performance. When you master the most basic functions of your organization it builds momentum for tackling more complex issues within your process.

When you detect negative symptoms in your business, such as a lack of thoroughness in the project documentation from your team members in the field, it should cause you to seek the root sources. It sounds simple and yet it when these things are not practiced there are negative ripples throughout the organization. When you commit to taking calls with clarity and consistency you demonstrate to your team that you value this process and that everyone is being held to the same standard. 

You can begin to eliminate chaos in your organization and build positive momentum by intentionally developing your process. Too often teams under utilize their receptionist and allow their salespeople to get away with maneuvering around the rules. When you build clarity and consistency you establish purpose for each person in your organization. When you stand up for these principles, as change will always be tested, you prove your commitment to the cause. ​

Time is invaluable. It’s the only thing that we cannot purchase more of. In business when we are able to reduce wasted time we are able to increase our efforts in profitable endeavors. Wasted time is money bleeding out of your organization.

For those who have written estimates for an insurance claim, you know what it feels like to have your line items questioned by adjusters or your estimate picked apart by claims reviewers. Property restoration contractors often perceive the claims review process as a constant bleeding out of effort, energy and sanity.

It’s hard to produce for clients when you feel like you are always treating the wounded in your estimator bullpen.

How often have do restoration estimators say:

• “They’ve shredded my estimate!”
• “How do they expect us to make any money?”
• “I give up, there is no winning this battle with these made up rules.”
• “&#@$%”

Maybe this hasn’t happened to you but you’ve heard your peers complaining. Just wait, every estimator knows that their estimate will soon be the next victim of the insurance review gauntlet. The next time you send an estimate to a reviewer or hit upload in Xactimate, the process will run its vicious cycle with you.

For those willing to admit it, are your bruises still turning purple or are your wounds still bleeding? We all have choices to make. We can play the status quo game and complain about the system or we can work to find answers.

What would the typical response be as this scenario plays itself out?

• “Who are they to question me?”
• “They have no idea what it takes to run a business.”
• “This claims review ‘professional’ has never been to this job – they’ve probably never been to any job site ever.”
• “*&?^$”

Funny enough, this is both one of the issues as well as one of the keys to resolution as well. The person reviewing you claim has never been to this job. They typical claims reviewer works from a claims center half-way across the country. You are correct, they likely haven’t been to any job and possibly never will. It’s not their job.

This is a fact of the process and it does no good to complain about it.

Your roles should not put you at odds. One of you writes an estimate for the claim and the other reviews the estimate for the claim. Either of you may view your responsibilities to be at odds with each other but that is not inherent to the task at hand. The presiding principle should be to restore the client to pre-loss conditions and both parties should be working together to make this as expedient as possible.

The difference between what should be and what is leaves a lot of room for us to work towards a process that is clear and consistent.

As restoration professionals we can start by asking better questions.

• “What are the objections of the claims review?”
• “It appears that the claims reviewer has composed a detailed list of their reasons for the rejection of your estimate. What is the next objection?”
• “Did we utilize the correct line items?”
• “Did you call the adjuster to discuss the rejections?”

As an estimator you have the responsibility to learn how to tell the story of the loss through the estimating tool. The estimate has a language.

Whether you like it or not, for the majority of insurance claims, Xactimate has become the recognized story delivery tool. When your story does not resonate with our audience you need to learn how to communicate more clearly. In serving your client, it is necessary to use the resources in your tool bag to assist them in achieving a well executed outcome.

If your estimate is not compliant with basic carrier requirements, rejection is not the result of sadism its self-sabotage.

How do contractors gain ground in the claims review process?

• Develop your process intentionally.
• Do some research.
• Tap into your peer network.
• Communicate with the adjuster.
• Make progress in your process.

Start the process of reviewing your rejections for trends.
You can do this as a team or you can do this as an individual estimator. To assist you with collecting data we have developed a FREE PDF download -Tracking Claims Review Worksheet. Gathering this information will help you to make informed decisions about your process, adjustments for your team’s approach as well data to discuss with adjusters, claims reviewers or carriers.

​“They’ve shredded my estimate!” Exclaimed Estimator #1.
 
“Again?” Replies his peer, Fellow Estimator.
 
“It’s like they take joy in their sadistic responses.” Estimator #1 progresses from shock to anger.
 
“So brutal.” Fellow Estimator commiserates.
 
They literally took my restoration estimate and ran it through a cheese grater.” Estimator #1 continues to wallow in misery.
 
“How do they expect us to make any money?” Fellow estimator attempts to console their compatriot.
 
Fellow Estimator knows that their estimate will soon be the next victim of the insurance review gauntlet. They knows that the next time they sends an estimate to a reviewer or hit upload in Xactimate, the process will run its cycle with them.
 
Have you been in this room before?
 
If you work around insurance claims, you know this scenario is a common one in many restoration companies. Perhaps your own bruises are still turning purple and your wounds are still bleeding. We all have choices to make. We can play the status quo game and join our peers, Estimator #1 and Fellow Estimator in their glum state or we can work to find answers.

What would the typical response be as this scenario plays itself out?
 
“Who are they to question me?” Estimator #1 rises indignantly and then rattles off a hastily worded email.
 
“This claims review ‘professional’ has never been to this job – they’ve probably never been to any job site ever.” Fellow Estimator exclaims.
 
Funny enough, this is both one of the issues as well as one of the keys to resolution as well. The person reviewing Estimator #1’s estimate has never been to this job. Claims Reviewer #1 works from a claims center half-way across the country.
 
Claims Reviewer #1 likely hasn’t been to any job and possibly never will. It’s not their job. This is a fact of the process and it does no good to complain about it.
 
Their titles do not put them at odds, one writes an estimate for the claim and the other reviews the estimate for the claim. They may view their responsibility to be at odds with each other but that is not inherent to the task at hand. The presiding principle should be to restore the client to pre-loss conditions and both parties should be working together to make this as expedient as possible.
 
The difference between what should be and what is leaves a lot of room for us to work towards a process that is clear and consistent. We can start by asking better questions.
 
“What are the objections of Claims Reviewer #1?” Estimator Supervisor asks.
 
“Who invited you?” questions Fellow Estimator.
 
“My company header isn’t in the estimate,” replies Estimator #1.
 
Have you experienced this rejection note? It seems silly but it’s a requirement. Should anyone on the contractor side be upset with the claims review process if they have not updated their program to have the correct company information in their estimate headers? Who’s responsibility is it to ensure that their organization is following the basic requirements for carriers and programs? 

​“It appears that Claims Reviewer #1 composed a detailed list of their reasons for the rejection of your estimate. What is the next objection?” inquires Estimator Supervisor.
 
“My opening statement does not provide sufficient details per the carrier requirements,” Estimator #1 reads with a quizzical tone in their voice.
 
While we are laboring into the weeds a bit here we are also discussing elements of Insurance Claims 101. These are common rejection items that are easily addressed and yet continue to be hang ups for restoration companies large and small. If you read our article on the Habits of Xactimate Estimating Success, we outlined how your estimate is part of telling the story of the claim.
 
As estimators we have the responsibility to learn how to tell the story of the loss through the estimating tool that we use. The estimate has a language. Do you remember when you first sat down with Xactimate? It can seem like a foreign language. What is WTR EQD? What does HMR BARR mean? When is the right time to use PNT MSKLF?
 
Whether you like it or not, for the majority of insurance claims, Xactimate has become the recognized story delivery tool. When our story does not resonate with our audience we need to learn how to communicate more clearly. In serving our client, it is necessary to use the resources in our tool bag to assist them in achieving a well executed outcome. 
 
If your estimate is not compliant with basic carrier requirements, rejection is not the result of sadism its self-sabotage.

​“They are picking apart my line items,” Estimator #1 yells, pounding a fist against their desk.
 
“They do that to me all the time,” Fellow Estimator raises their hands in disgust.
 
“I remember when I used to be an estimator…” Estimator Supervisor starts to chime in, thinking that they are a part of the group grievance session only to be interrupted.
 
“No one cares about what you did eighty years ago!” both Estimator #1 and Fellow Estimator blurt out.
 
We are now entering much more subjective territory. There are ongoing discussions about the best ways to approach insurance claims work from various levels of the business. Resources like Restoration & Remediation Magazine do a great job of giving a voice to industry leaders and their experiences.
 
Let’s discuss a few options when faced with opposition from an insurance reviewer:

Dig our heels in. ​There are those of the mind that the carrier can never be right and the claims process is a war. If they want to question us we will know the fine print better than them and will throw it at them with everything that we have. If your organization has agreed to do program work then some of these line item concessions are part of the contractual agreement. This is why some companies have chosen to stay independent and refuse to engage in third party administrator (TPA) work. If you a person in a position of leadership you will have to decide if the potential volume is worth the tradeoff. 

Give in to expedite. Some professionals believe that a quick claim that is paid in part is better than a drawn out battle. Many of the organizations that regularly work with carriers or TPA’s exercise some level of pragmatism. As noted previously, the theory is that concessions will be made to build a relationship that will result in a volume of work that will outweigh the costs. For many of these companies this is survival mode, “We don’t know what we would do without program work so we have to do what it takes to keep the funnel open.” 

Get educated. Whether you work with a TPA or are doing direct work for carriers, after a few claims you typically get a sense for the line items that are more likely to get rejected or questioned. Know your program outlines, your carrier specifics and what sequences can be approved (or overridden) by adjuster authorization. If you have a claim that requires a unique approach you should be in contact early and regularly with the adjuster to confirm authorization for your approach to assisting their client with a positive outcome. 

​Were Keith Richards and Mick Jagger in the property restoration business prior to forming The Rolling Stones? Did they have insurance estimate reviews in mind when they penned the timeless words, “You can't get what you want. But if you try sometimes, well, you might find you get what you need.”
 
If you write a sloppy estimate and you are not learning from prior mistakes, expect to get rejected. At the same time, whenever the carrier or program initiates are rejection of an estimate this should be a time where the restorer reviews whether the objections are legitimate. This invitation to review the merit of the estimate is also a time when the estimator should review whether legitimate line items were missed in the prior submission.

“They are saying we don’t have sufficient supporting photos,” Estimator Supervisor states looking up from the computer screen.
 
“Oh, and the photos that were uploaded aren’t properly labeled or associated with the rooms in which they were taken,” continues Fellow Estimator.
 
“What?” queries Estimator #1.
 
If a photo is worth a thousand words, in the world of insurance claims those photos could be thousands of dollars. One hundred dollars (or even less) can be the tipping point between a profitable project and a net loss. A clearly written estimate that follows industry guidelines must have supporting photo documentation – we aren’t yet talking about high level Xactimate skills.
 
Estimators are story tellers. Our audience likes their stories to be full of vibrant pictures that are captioned. Often we are communicating our claim stories to persons who will not be physically present at the loss. Pictures help the claim story to come to life for them. Develop your ability to tell a story and to support your story with multiple photos that are clearly labeled to illustrate your narrative. The more detailed or unique the work you need to complete the more quantitative as well as qualitative your photographs need to be. 

If we have a losing mindset and we maintain the status quo of losing habits, we will continue to lose. Estimators have a job to do. Claims review professionals have a job to do. Organizations have a responsibility to train their people to execute with excellence when it comes to carrying out the essential functions of their roles.
 
“I don’t know what I am going to do,” Estimator #1 is on the verge of tears, “No matter how I respond they are going to tear me to pieces.”
 
“When the claims reviewer shreds your estimate, it’s time to make tacos!”
 
“Who said that?” Fellow Estimator yells into the abyss.
 
Suddenly, they can hear a familiar tune, “You can’t always get what you want…”
 
“But if you try sometimes,” Estimator #1 bobs their head.
 
“Is it lunch time?” Estimator Supervisor asks as they leave the room.
 
Unfortunately, more often than not, our responses to the estimate review process borders on burying our head in the sand or playing the victim. We throw our hands up and rail against the system. As noted above, we can choose to go to war, we can choose to give in or we can choose to get educated. Neither of these decisions guarantee success.
 
Going to war will have casualties, giving in will cost you and getting educated does not mean that everyone will admire your knowledge to the point that they will see things your way. You may feel like you have lost in the past but today is a new day, it’s time for a new approach – the “scoreboard” is blank (but the clock is ticking).

So, how do we gain ground on the claims review process? Here are some suggestions to start tracking data to inform decisions and find resolution:

• Do you review your rejections for trends? You can do this as a team or you can do this as an individual estimator. You can download the attached PDF Tracking Claims Review Worksheet (see end of article) or you can develop your own system.
• Change your mindset. Above we framed the claims review process in wins, losses and ties. With this win-loss mindset our sample restoration company was not winning. What if we change our  mindset to founded (reasonable review queries based upon the standards, practices and carrier guidelines), unfounded (contradictory to standards, practices and carrier guidelines) or in the gray area (subject to interpretation). If you download our worksheet you will notice these are the categories.
• Change your process. The status quo is to complain about the system. If you are approaching your profession with a growth mindset you will work to find solutions to your issues. Start by tracking your rejections so that you can make decisions based upon objective data rather than your collective-subjective opinions. 

You do insurance work.
 
Claims review is part of the process.
 
Our point here is not that insurance is right or that contractors are wrong, but that if we want to achieve progress in the process we have to control what we can control. Take ownership for roles and responsibilities.
 
If you are not collecting data on your rejections you should start immediately.
 
If you have data you need to use it to help educate your decisions so that you can gain ground.
 
Our conversation here is regarding mindset and process. Start gathering data so that you can make more informed decisions and work to find resolutions. Regardless of your chosen approach, develop your process intentionally.