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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.

To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting.

Promotions:

• Once Upon a Claim: Explore the magical world of claims adjusting through fairy tales. Get your copy now.
• The Art of Adjusting®: Master the art of claims adjusting with practical insights and expert advice. Purchase here.

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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.

To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting.

Promotions:

• Once Upon a Claim: Explore the magical world of claims adjusting through fairy tales. Get your copy now.
• The Art of Adjusting®: Master the art of claims adjusting with practical insights and expert advice. Purchase here.

Send us Fan Mail

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.

To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting.

Promotions:

• Once Upon a Claim: Explore the magical world of claims adjusting through fairy tales. Get your copy now.
• The Art of Adjusting®: Master the art of claims adjusting with practical insights and expert advice. Purchase here.