Episode 92: Spring Storm Claim Playbook

Episode #97: CMS Reporting And Medicare Liens For Liability Claims

Send us Fan Mail [https://www.buzzsprout.com/1984111/fan_mail/new] A “quick” injury claim can turn into a compliance puzzle the moment Medicare or Medicaid enters the picture and if you miss it, the consequences can be expensive. We get practical about CMS, Medicare Secondary Payer rules, and what adjusters actually need to do on day one so a settlement does not blow up later. We walk through the Big Five identifiers we ask claimants for, why people understandably get suspicious, and how to explain the request without sounding like a scammer or hiding behind acronyms. Then we translate the jargon: Section 111 reporting, conditional payments, Medicare liens, Medicaid liens, and what “Responsible Reporting Entity” really means when carriers use vendors and automated reporting behind the scenes. From there, we talk settlement reality. Why you may need to wait for a conditional payment letter and a final demand, how the $750 small settlement provision fits in, and why these steps feel like a delay tactic to the average person even when you are trying to close fast. We also cover risk controls like paying first and disputing later, using hold harmless and indemnification language when attorneys push back, and protecting PII so your file stays clean. If you work property, auto, GL, workers’ comp, or liability claims, this is the kind of “unseen” process that can make or break a smooth close. Subscribe, share with an adjuster friend, and leave a review with the toughest Medicare lien question you have right now. For more insights, you might consider a career in liability adjusting or if you're searching for reliable adjusting services, visit Auten Claims Management [https://auten.claims/acm-blog/]. To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting [https://www.cmrconsulting.net/]. Promotions: * Once Upon a Claim: Explore the magical world of claims adjusting through fairy tales. Get your copy now [https://shop.ingramspark.com/b/084?QyGNpf8BnCgojjIKIpQg3CrA64GdFdxS9dYhJ1Xqyo3]. * The Art of Adjusting®: Master the art of claims adjusting with practical insights and expert advice. Purchase here [https://shop.ingramspark.com/b/084?hX7DTMY1JJB2jitQhT6BxCwMlA9NSwhSNpxXTk4JP6z].

Episode #96: The Bad Faith Warning Signs

Send us Fan Mail [https://www.buzzsprout.com/1984111/fan_mail/new] Bad faith doesn’t usually arrive as one dramatic blow-up. It shows up as a slow drip of little things: the voicemail that never gets returned, the approval that sits in someone’s queue, the vague diary note that makes sense only to the person who wrote it, and the template letter that accidentally says more than it should. We talk through the practical warning signs we see when a claim is headed toward escalation, complaint, or litigation. We dig into how understaffed claims departments force adjusters into triage, why vacation schedules and internal handoffs create gaps, and how stacked authority levels can turn a reasonable settlement into a trust-breaking delay. We also share communication habits that de-escalate fast: acknowledging frustration, picking up the phone, setting a realistic follow-up date, and explaining the “why” behind the timeline without overpromising. Then we get tactical about defendable claim handling. We explain what strong claim notes look like (so another adjuster could take over tomorrow), why “sent letter and cut check” is a dangerous level of detail, and how automation and AI can help with organizing but cannot replace human judgment or protect you from privacy risks. We close with a common landmine: form letters and 30-day status templates that include inapplicable language, creating ammunition for a bad faith narrative. Subscribe, share the show with another adjuster, and leave a review so more claims pros can find it. For more insights, you might consider a career in liability adjusting or if you're searching for reliable adjusting services, visit Auten Claims Management [https://auten.claims/acm-blog/]. To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting [https://www.cmrconsulting.net/]. Promotions: * Once Upon a Claim: Explore the magical world of claims adjusting through fairy tales. Get your copy now [https://shop.ingramspark.com/b/084?QyGNpf8BnCgojjIKIpQg3CrA64GdFdxS9dYhJ1Xqyo3]. * The Art of Adjusting®: Master the art of claims adjusting with practical insights and expert advice. Purchase here [https://shop.ingramspark.com/b/084?hX7DTMY1JJB2jitQhT6BxCwMlA9NSwhSNpxXTk4JP6z].

Episode #95: How Much Liability Are You Hosting This Weekend?

Send us Fan Mail [https://www.buzzsprout.com/1984111/fan_mail/new] Memorial Day weekend has a way of turning “just one quick favor” into a full-blown claim file. We start with a simple scenario: you borrow a friend’s car to grab ice and something goes wrong. From there, we unpack permissive use, when auto insurance follows the car versus the person, and why household access to keys can quietly expand who counts as an insured under the policy definition. Then we shift into uninsured motorist and underinsured motorist coverage, where your own carrier can end up acting like the at-fault carrier. That odd setup creates real claim-handling tension, and we talk through how adjusters can avoid treating their own insured like an opponent. We also cover the practical math of UIM limits, why state minimums can disappear fast after a serious injury, and how made whole rules and deductibles should shape subrogation expectations. Finally, we hit the holiday exposures we see every year: delivery driving side hustles that trigger business-use exclusions on personal auto policies, Airbnb and Vrbo “other insurance” conflicts, fundraiser and lemonade stand liability questions under homeowners business pursuit language, and the messy world of boats, jet skis, ATVs, and alcohol. We bring it back to adjuster fundamentals: ask precise questions, verify use and ownership, confirm motor size and policy thresholds, and document the timeline. If this helped you think differently about coverage traps, subscribe, share the show with an adjuster friend, and leave a review so more people can find it. What’s the most surprising coverage dispute you’ve seen from a holiday weekend? For more insights, you might consider a career in liability adjusting or if you're searching for reliable adjusting services, visit Auten Claims Management [https://auten.claims/acm-blog/]. To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting [https://www.cmrconsulting.net/]. Promotions: * Once Upon a Claim: Explore the magical world of claims adjusting through fairy tales. Get your copy now [https://shop.ingramspark.com/b/084?QyGNpf8BnCgojjIKIpQg3CrA64GdFdxS9dYhJ1Xqyo3]. * The Art of Adjusting®: Master the art of claims adjusting with practical insights and expert advice. Purchase here [https://shop.ingramspark.com/b/084?hX7DTMY1JJB2jitQhT6BxCwMlA9NSwhSNpxXTk4JP6z].

Episode 94: Summer Liability Basics For Adjusters

Send us Fan Mail [https://www.buzzsprout.com/1984111/fan_mail/new] A lawn mower throws a rock through a car window. A kid hops a fence to grab a baseball near a backyard pool. A trampoline turns one “fun afternoon” into a catastrophic injury demand. Summer liability claims love to masquerade as simple, and that’s exactly when adjusters get burned by policy language. We dig into the fundamentals we rely on when analyzing homeowners liability and similar third-party claims: who qualifies as an insured, what “resident relative” really means, and how a live-in partner or a college-aged child can create instant coverage issues. Then we get practical with the definitions that decide outcomes, including bodily injury vs property damage, how to think about value and diminished value, and why “occurrence” is more specific than everyday speech. From there, we follow the real workflow: read the full policy, check the edition date, find the motor vehicle exclusions, and watch for exceptions and endorsements that give coverage back under tight conditions. The backyard hazards are where it gets real. We unpack lawn mower liability and the “service the residence premises” trap, pool claims and attractive nuisance duties, wet-surface slip and falls, trampoline exclusions, and fire pits where intent vs harm can decide coverage. We also cover the money topics that can make or break a file: umbrella policy notice, keeping excess carriers in the loop, MedPay as a control tool, and how Medicare and Medicaid liens can block “quick payments” if you do not handle reporting correctly. We close with dog bite claim trends, including New York’s Flanders v Goodfellow shift and what it means for negligence arguments. Subscribe to Art of Adjusting, share this with an adjuster who handles liability, and leave a review so more claims pros can find it. What summer claim has given you the biggest coverage surprise? For more insights, you might consider a career in liability adjusting or if you're searching for reliable adjusting services, visit Auten Claims Management [https://auten.claims/acm-blog/]. To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting [https://www.cmrconsulting.net/]. Promotions: * Once Upon a Claim: Explore the magical world of claims adjusting through fairy tales. Get your copy now [https://shop.ingramspark.com/b/084?QyGNpf8BnCgojjIKIpQg3CrA64GdFdxS9dYhJ1Xqyo3]. * The Art of Adjusting®: Master the art of claims adjusting with practical insights and expert advice. Purchase here [https://shop.ingramspark.com/b/084?hX7DTMY1JJB2jitQhT6BxCwMlA9NSwhSNpxXTk4JP6z].

Episode 93: Contractor Damage, Subrogation, And Smarter Claim Handling

Send us Fan Mail [https://www.buzzsprout.com/1984111/fan_mail/new] Spring doesn’t just bring warmer weather, it brings a whole new wave of claims problems: roofers canvassing neighborhoods, frozen-pipe losses getting repaired, and construction crews breaking ground. We sit down and get specific about what adjusters and policyholders need to watch for when repairs start, because the repair work itself can create brand-new damage. When that happens, you may be looking at two separate dates of loss, a first-party property claim, and a third-party liability claim against the contractor, all at the same time. We also dig into why “just file it with the contractor” is risky advice. We talk about the duty to open and investigate a claim once the carrier has notice, how subrogation should work in the real world, and why made whole rules can change who gets paid first when limits are tight. Then we tackle valuation and communication: actual cash value vs replacement cost, why market value is not rebuild cost, and how holdback depreciation and the 180-day notice of intent can trigger avoidable disputes if we don’t explain it clearly and follow up in writing. From certificates of insurance and additional insured wording to workers’ comp verification and contractor liability exposures like New York Labor Law 240, we map out practical steps to reduce chaos during building season. If you handle property claims, liability claims, construction-related losses, or subrogation recovery, this conversation is built for you. Subscribe, share this with an adjuster friend, and leave a review so more claims pros can find it. For more insights, you might consider a career in liability adjusting or if you're searching for reliable adjusting services, visit Auten Claims Management [https://auten.claims/acm-blog/]. To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting [https://www.cmrconsulting.net/]. Promotions: * Once Upon a Claim: Explore the magical world of claims adjusting through fairy tales. Get your copy now [https://shop.ingramspark.com/b/084?QyGNpf8BnCgojjIKIpQg3CrA64GdFdxS9dYhJ1Xqyo3]. * The Art of Adjusting®: Master the art of claims adjusting with practical insights and expert advice. Purchase here [https://shop.ingramspark.com/b/084?hX7DTMY1JJB2jitQhT6BxCwMlA9NSwhSNpxXTk4JP6z].