SUBROGATION IS AN often overlooked part of claims adjusting, although it should not be because of its substantial benefits. Successful recoveries from subrogation provide insurance carriers with money they may not have anticipated; a pleasant surprise from a risk taker’s perspective.
For example, if a fifteen-year-old HVAC unit suddenly bursts into flames, the initial reaction is to assume no recovery opportunities exist. Successful subrogation stems from knowing to ask the correct follow-up questions: Is there a service or maintenance agreement on the unit? If so, when did someone last check on it?
“Those kinds of questions can change the whole scenario if the answer is yes,” Vivian Conley, subrogation claims specialist at Engle Martin Claims Administrative Service, explained. “Being able to ask that extra question makes a huge difference.”
Engle Martin Claims Administrative Service (EMCAS) is a third-party claims administrator and wholly-owned subsidiary of Engle Martin & Associates, a national independent adjusting firm. EMCAS has a dedicated subrogation unit which analyzes all claims on an individual basis to be evaluated for subrogation potential. Recovery, which can often become a secondary objective in typical claims resolutions, is given individual attention from the very beginning. By having a team dedicated to the process, the claims and subrogation investigations can occur simultaneously.
EMCAS is extremely proactive in its subrogation efforts. In addition to receiving referrals from the claims examiner or independent adjuster, new claims are reviewed for a cause of loss that may lend itself to successful recovery efforts. Claims that have a cause of loss that typically leads to a recovery, such as fire, explosion, or water damage, will automatically have a file opened for possible subrogation opportunities.
“The point is that we don’t have to wait for the field adjuster to tell us we need to open subrogation,” Conley explained. “We open it up-front, so we’re more aggressive. That does not mean, however, that other causes of loss are not identified later and then referred to the subrogation unit for recovery opportunities as well.”
Equal attention is given to claims of all sizes when it comes to subrogation efforts. According to Conley, “Pursuing subrogation and recovery only on the larger or more obvious losses inevitably leads to lost opportunities.”
Recently, the team was able to recover damages for a carrier where a commercial tenant suffered catastrophic damages as a result of a fire in the building. The fire originated two business suites away from the client’s insured and the cause of the fire was ruled undetermined. Further investigation by a structural engineer identified a building code violation: The building did not have fire walls as mandated by structural codes. Investigation revealed that the landlord had completed modifications to the building, converting it from one large space into several smaller units only about five years prior to the loss. Ultimately, the subrogation unit was able to overcome hold harmless language in the commercial lease and make a substantial recovery against the landlord for violating the building codes. In a situation such as this, a thorough subrogation investigation can lead to a positive result for the client and the insured.
EMCAS offers a variety of fee schedules, including a contingent fee agreement option. This means that clients are only charged for subrogation if the recovery is successful. In this sense, a client has nothing to lose from a subrogation investigation and no need to worry about incurring excess expense. EMCAS also offers subrogation litigation management services for more complex losses.
Additionally, the team can provide the client with subrogation loss runs and custom reports. The client receives a snapshot of what’s currently in their inventory, what has been closed and why it’s been closed. Reports can also include recovery totals, indemnity paid and forecasting on what to expect on subrogation recoveries. Based on the facts surrounding the loss, they are able to estimate what might be recovered from a loss before there has even been a settlement.
Recovery is often put on the backburner during a typical claims resolution process. With EMCAS, the subrogation opportunities begin the moment a claim is reported. By remaining proactive and creative — opening the files early, asking the right questions, and preserving evidence early on — EMCAS is able to provide their clients with subrogation recoveries that ultimately benefit the client’s bottom line and bring a higher level of service to their insureds.