How can safelite or any other TPA negotiate pricing during the 3way call with the shop and the insured when their not licensed adjusters.
I would think that they and their phone staff each would have to be licensed
in every state in order to legally talk pricing during the call to set up the claim.
Can anyone help me with this, it has been something we would like to address
on a national level.
Also I feel there are several other things the TPA industry does that I feel
needs to be looked at and examined.
We are new to glass business and see a lot of problems in dealing with the TPA,s especially the ones that are also your direct competitor.
A family member is a well known business Atty here in Houston,
that is looking at this whole business model of the TPA to see what can be done to make dome serious changes in the industry to help the Independents.
He see,s issues like unfair trade practices, possible fraud, price fixing ect.
Let us no on the forum other things you find that could bring about legal
action to help with litigation if we pursue a anti trust case
or any other type of legal remedy to stop this corrupt TPA industry.

Well...welcome to the club. There is millions of shop owners just like you wondering and asking the same question. I am also a new shop been in the business for years, But just recently went on my own. There is a way to bill the amount you want and not accept TPA prices i have done that since day one. And so far have got great results. Just bill what you think is right. Make sure you have a good Assignment of benefits on your work orders and in some cases take before and after pics.

It would seem that in many definitions of "adjuster" or "insurance adjuster" or "claims adjuster", that said adjuster may "negotiate a settlement".

In that the amount of loss has not yet been determined, some would define the effort to determine that amount to be consistent with the "adjuster" asking "will you accept the job for the following pricing?".

I would initially find that to be partially acceptable if I was unknowing of the proceedings taking place, except when noting that the insured is usually NOT in that part of the call, but is on HOLD on the "back line" of the TPA.

If the answer to the "will you accept the job at the following pricing?" question posed to the repairer is "NO", then the TPA CSR states clearly that they are noting in the file that "you are rejecting THE JOB", when in fact, the repairer has rejected the PRICING that was "offered".

Two key points here. First, no NEGOTIATION has taken place. A "take it or leave it" scenario has been placed in front of shop, with the consumer requesting that shop "on hold on the back line" unbeknownst of what is occouring.

Second, there was no "REJECTION" of the job by the repairer, only the "PRICING" that the TPA has "offered".

The "adjuster" has now changed from "adjusting" or "negotiating a settlement" to BROKERING JOBS. An "adjuster" may "negotiate a settlement" but once "acceptance of the job at the following pricing" occours, we have crossed a line and burned the "adjuster" bridge, and become an "auto glass job broker".

We have established a dark market for glass claims, for glass jobs, to be brokered. This is not adjusting, nor the job of an adjuster.

Further, absent of a final repair bill, no "settlement" can be final, especially if the final repair bill, which is the proof of the insured's loss, is higher than the "adjuster's" amount, which proves his "settlement" or "offer" asking "to accept the job at the following pricing" was insufficient.

Again, absent of charges of fraud against a shop over its invoice, the invoice must be within a range of fair and reasonable, legally speaking.

I also see many state laws that seem to require the "adjuster" to notify the insured whom he is working for, and whose interests he holds primary. The adjuster may hold the insurer's interest primary, while stating to the insured that "this is all the insurer is willing to pay, if that shop charges more, you may be responsible for any difference". The insured had no idea that he is speaking to someone that does not have his interests in mind, primarily or possibly at all.

I suppose that old saying holds true: "Never take advice from someone that owes you money."

JMHNLO

Who really thinks the magic "licensed adjuster" hat will return profitability to the industry?

Your question mirrors your name. We are and have always been profitable because we refuse to let anyone dictate our price. That still doesn't make it ok for insurance companies or their tpa goons to lie to my customers, or steal jobs. This will help level the playing field. I say help, not fix. Unfortunately there are shops willing to self-implode by doing poor quality work at an unprofitable price point because they're afraid someone else will get the job. But hey, if my life is a little easier because TPAs can't operate all willy nilly I'm all for it.

For starters I'm betting when they send joe a dispatch saying 50% off that same job going to slave would have been 0% off. I'm tired or I would try harder to make my point.

They already have negotiated their GAI. They use their competitors that accept the insurance company's offer to help them stay at or below the GAI. They already have thousands of shops that have signed on the dotted line and endorsed the "Safelite" brand and indicated that they are willing to take less in order not to be stigmatized as "non-preferred".

Is SGC adjusting claims?