Avoid 'claims disconnect’ with shared vision and transparency, argues MGAA panel

A shared vision and agreement on what the claims model will be, from the outset, can go a long way to preventing a ‘claims disconnect’ that could hamper the development of an MGA’s claims model.

This was the view of Kath Mainon, CEO, Claims Solutions, UK and Ireland, at the  Davies Group, as she spoke at the  MGAA Annual conference as part of a panel session titled ‘The claims conundrum - partnership or disconnect’, on June 29, 2022.

Her fellow panellists were Colin Herrington, head of claims at  Global Risk Partners (GRP), and Jeremy Trott, UK Claims director at  Ecclesiastical.

The panel discussed the disconnect between the different stakeholders in the claims supply chain.

Mainon said she spends a lot of time thinking about how to make it a partnership rather than a disconnect.

“For me, the things that would make it work well and deliver business objectives would be a shared vision, a shared view and agreement from the outset on what the claims model would be. Partnership works best when it goes beyond the provision of day to day claims services and gets into really good areas like strategic insight and good use of data.”

However, she added: “Disconnects can and do occur, so if the vision isn’t agreed at the outset there’s an obvious disconnect, but process disconnects can be unhelpful too. So we all want to deliver great, fast claims validation and acceptance and to make that work the process has got to work. So validation and referrals have got to be turned around quickly. And getting the process right and the vision right from the outset is key.”

Trott agreed with Mainon and added that transparency and understanding of what the policy wording does and doesn’t do were also key for a good claims partnership. This would help with expectations around claims being paid, or not, he said.

“One thing that hasn’t been talked about a lot today [at the conference] is the culture of all the organisations involved, whether that’s the insurer’s own claims services or an outsourced offering. It’s about understanding what is the main purpose of the MGA, what are the expectations of the customers and are they being met. And are they being met from a cultural perspective of ‘are you trying to find a way to pay this claim or are you trying to find a way of not paying this claim?”

Trott added that he knew that all insurers say they will always try to find a way to pay claims but he said: “Sometimes there are transparency and cultural angles, which will come into play and will mean partnership or disconnect whether they are aligned or not.”

GRP’s Herrington said he was the one person on the panel who sits in the middle of the chain with a partnership upwards with capacity providers and downwards with the TPA solution that his company is working with.

He said that when he joined the company five years ago there was a “total disconnect” with their TPA operation.

“We had five TPAs and most of them had been passed down to us by insurers, they weren’t of our choosing. There was a total disconnect, they were not living, as Jeremy [Trott] just alluded to, to our culture or our philosophy.”

Herrington said the firm brought about change and moved to a national provider. However, this new provider did not really improve the situation, he said.

“The provider was 200 miles from where we were based, and what we found, despite on day one having a team there of 10 experienced handlers, within six months that team became two experienced handlers and eight people with under two years [experience], because that TPA had then taken on a much larger client and they moved the resource accordingly.”

He said that as a result the firm lived through 18 months of total disconnect.

To resolve this, he said that three years ago GRP had “taken control” and hand picked its suppliers and asked a TPA to come and work onsite with the firm’s underwriting team.

“We built a much stronger relationship between claims and underwriting and it’s been a very successful journey for the last three years.”

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