|Lisa Moore, Once Not Allowed To Have Pockets In Her Pants, Is Now A Veteran Owner Of A California Workers' Compensation Claims TPA|
By Lonce LaMon - January 18, 2012
Lisa Moore is a veteran workers’ compensation claims handling specialist who today owns Accelerated Claims Services, a third-party-administrator for workers’ compensation claims, and Sundance Copy Services, Inc., a legal process server company, in Santa Ana, California.
Lisa has been in business since 1997 and her TPA handles workers’ compensation claims only in the state of California. She loves being a boutique firm and puts it like this, “I don’t want to be the biggest, but I would like to be the best. And our clients would all attest to that. One of my clients I have had since 1997.”
Lisa spoke to adjustercom by phone last week and agreed to share her knowledge along with some of the highlights in the history of her career.
Lonce LaMon: How do you handle claims and give excellent service? What is your style?
I don't want to be the biggest, but I would like to be the best.
Lisa Moore: We have constant communication with our insureds, the managers, risk managers, everyone. It’s just a lot of constant communication. So that they are always updated. Some insurance companies, TPAs, will only give clients quarterly claims reviews. They put restrictions on updates and contacts. And we’re here to work for the clients. Whatever they need is what they get.
Lonce LaMon: So, if they call and want to know something any day…
Lisa Moore: Some of them call every single day. And we talk to them with a smile every single day.
Lonce LaMon: Okay.
Lisa Moore, left, and Linda Palmer, right, supported the Benefit "Taco Tuesday For A Cause" sponsored by SLT Law to help troubled youths in March of 2011.
Lisa Moore: We return all phone calls within 24 hours. But most of them are same day. But our clients are our most important asset. So there’s a lot of communication with them. Most people start off in a contract getting quarterly claims reviews. And that’s a maximum. But it can be less. We have one client that we have so much communication with that we haven’t done a formal claims review in three years. Because they don’t need a formal claims review. They are constantly kept abreast of what is going on in their claims.
Lonce LaMon: So, they just tell you, “We don’t need it. We’re fine.”
Lisa Moore: Yes. That’s how close our clients are. We kind of feel like we’re one of their employees. We represent them. And we are always looking out for their best interest.
Lonce LaMon: So, with each client you are able to give something pretty customized?
Lisa Moore: Yes. Every client is customized. And there are certain things the adjusters are required to do as far as communication. You are supposed to look at a file once a month to insure that the reserves are adequate. So, let’s say that I get notice that Tom Smith is going to have back surgery. So, that’s my notice and now I know that I’ve got to increase those reserves for the surgery. Or if he gets an attorney, we know that the reserves need to increase. As you obtain information, you are required by law to increase the reserves. But what my adjusters do is they also look at the files once a month and decrease the reserves if it’s called for on the file. And a lot of companies don’t do that. They leave the reserves as they are until the case closes. Reserves are a huge issue to every single employer out there.
Lonce LaMon: Why are they such a huge issue?
Reserves are a huge issue to every single employer out there.
Lisa Moore: Because that’s what they set their premium or their bond on. If you are self-insured, you pay your bond 125% of whatever your reserves are. So, reserves are critical.
Lonce LaMon: Okay.
Lisa Moore: And that ties up their money and they can’t grow their business in other ways because that money is tied up. And they’re stuck with that for a year. So, we not only adjust reserves up but we also adjust them down.
Lonce LaMon: You said that in various places often claims adjusters will adjust them up but not down.
Lisa Moore: Yes.
Lonce LaMon: And that’s universally acknowledged.
Lisa Moore: Yes. All the audit arena puts a lot of pressure that your reserves have to be adequate. But they don’t always decrease them when you obtain new information, and you realize that that money is not needed up there. So that’s why brokers hire claims consultants, and that’s why people do quarterly reviews, to try and get the reserves reduced as well as make sure they’re adequate for the life of the file.
If the adjuster's doing a good job they are on top of the file. Just because you're auditing something doesn't mean you find negative.
Lisa also does consulting work for risk managers and brokers who represent employers and insurance company insureds. They hire her to evaluate the way the claims are being handled.
Lisa Moore: If the adjuster’s doing a good job they are on top of the file. Just because you are auditing something doesn’t mean you always find negative. I am doing consulting work for brokers and employers trying to reduce their costs. By reducing costs that means that their files are being handled efficiently and their reserves are set adequately.
Lisa Moore started in workers’ compensation claims back in 1983 in Indiana working for GAB aka General Adjustment Bureau. She started as a trainee and then applied for a transfer to California after she visited a friend in California and fell in love with the state. She made it to the GAB Downey, California office by December of 1984. Within a few months she was also handling Longshore and Harborworkers claims.
Lisa with her husband Jim Ghahremani in late 2010. They were on their way to the American Music Awards.
Lisa also worked as a waitress at night for many years. In Indiana, she had waitressed at Victoria Station. So when she moved to California, she worked at Victoria Station in Torrance.
Lisa Moore: Do you remember the trains? The little train cars? They had one at Universal where you would take the train up. And they also had one in Torrance. So, when GAB transferred me, Victoria Station transferred me. So, I worked both jobs. I did that for quite some time.
I didn't see a lot of potential for a blonde female to get promoted at that company. At the time, we weren't even allowed to wear pants that had pockets.
Lisa left GAB in September of 1985. She got an opportunity to work for Tokio Marine Management in Los Angeles. She oversaw the claims for California, Hawaii, and Longshore. She found it to be a most excellent company to work for.
Lisa Moore: But I didn’t see a lot of potential for a blonde female to get promoted at that company. At the time, we weren’t even allowed to wear pants that had pockets.
Just before she got to Tokio Marine, females were not allowed to wear pants at all.
Lisa Moore: But now we could wear pants but they could not have pockets. That was a huge deal. So, I didn’t see the opportunity.
All the upper management at Tokio Marine were men. There was a Japanese counterpart for every American. But it was a very organized company and Lisa loved working there.
Lisa Moore: It was a company that gave you what you needed to get your job done. But there was no growth potential for me personally.
So, Lisa went to AIG in Los Angeles in May of 1986. She started as a senior claims examiner, was promoted to supervisor in May of 1987, and then was promoted to assistant claims manager in April of 1989.
Lisa at Trader Vic's in the Downtown LA Live center near Staples Center in 2010.
She got promoted to claims manager in 1990 when the current claims manager resigned. But then that claims manager rescinded her resignation. Lisa was told she was not going to be the claims manager after all because the resigning manager had a change of mind and decided to stay.
Lisa Moore: I was kind of embarrassed. I was kind of dumbfounded. “Here you’ve told me I’m going to be the manager and now I’m not going to be because she’s decided to stay?” So, they let me keep the salary and I was assistant manager. But they took me on an audit in Hawaii.
In Hawaii there was a really nice AIG office which was workers’ comp and liability. By a twist of fate the Hawaii claims manager resigned shortly after Lisa went there. So, she was offered the position and jumped at the opportunity.
She got a large cost of living increase and a company car. She had about 26 employees. She loved the job and enjoyed her time in Hawaii immensely. However, in 1990 and 1991 the California laws changed. That was a big time for legislative changes.
Lisa and husband Jim dressed up as Dog the Bounty Hunter and his wife Beth on Halloween 2011!
Lisa Moore: I thought, gosh; I was kind of nervous. What’s going to happen if I ever decide to go back? So, then they (AIG) decided to close the Los Angeles office and move it to Costa Mesa, because they felt they would have a better pool of people to draw from.
So, Lisa was brought back to California to open up the Costa Mesa office and be the claims manager there. It turned out to be a huge undertaking. What was at first anticipated as a small office for her at two units, or ten to twelve people, eventually as a result of new decisions turned into Lisa having to hire over fifty people.
Lisa Moore: I believe at one time I had over 72 employees.
So, Lisa was the AIG Costa Mesa claims manager from October of 1990 to August of 1992. Then, in 1992 she went to Acordia Benefits Services, a company that handled group
medical benefits. Someone had approached her with an opportunity to help Acordia start their third-party-administration company. So, she did it.
I was kind of embarrassed... kind of dumbfounded. "Here you've told me I'm going to be the manager and now I'm not going to be because she's decided to stay?"
Then in 1995 she became part-owner of an investigations firm. She got her PI license. Then after a year or so, one of her former Acordia claims administration clients told her they were unhappy since she left Acordia with the way their claims were being handled. So, Lisa thought it over and decided she could start her own TPA.
With her partner, she became 51% owner of Accelerated. In the year 2000, she and her partner parted ways. She kept the TPA; he kept the investigations company.
Lonce LaMon: What do you think of the TPA business?
Lisa Moore: It’s a hard market right now. With all of the consolidations, the big TPAs are just getting bigger and bigger. And it’s hard to compete with that because of price.
Lonce LaMon: How do you feel about that?
Lisa Moore: When they get that big, they just aren’t able to have the control and provide the service that the clients want. So, it’s cyclatory. A lot of these TPAs started out small and they either went out of business or they got swallowed up by these big companies.
California is very paper intensive, which means we have to fill out so many forms, send so many letters...
Lonce LaMon: Right.
Lisa Moore: So, it’s cyclatory. But we’ve been able to stay in business 15 years. And our clients are very happy. We provide an excellent service. But it’s hard. It’s hard to attract new clients.
Lonce LaMon: So, you sell yourself on service. That’s your big deal.
Lisa Moore: Yes.
Lonce LaMon: Does anyone want to buy you? Do you ever get approached?
Lisa Moore: All the time. I get offers a lot. But it’s not anything that I’ve even entertained so far. That’s my livelihood. What am I going to do? I’m not ready to retire, so it’s not really a money issue. It’s being able to work and have control as opposed to reporting to a big corporate company that makes all the rules and decisions.
Lonce LaMon: So you like your independence.
Lisa at Taco Tuesday For A Cause in March 2011 with Allen Kennedy, Claims Supervisor, of her TPA Accelerated Claims Services.
Lisa Moore: Back in the day, when I worked for an insurance carrier, someone on the East Coast was making all the decisions for the entire country not knowing how paper intensive California is. California is very paper intensive, which means we have to fill out so many forms, send so many letters, and someone on the East Coast doesn’t have all those same requirements and is making the rules for the whole country. We were allowed to voice our opinions but were never allowed to deviate from their rules because they were the corporate rules.
Here in my office if we have a plan that we put together and it doesn’t work, it’s just me. Now we all talk and we all say, “Let’s change it. The client wants something sooner, later, whatever, and people can change it without going through that whole corporate thing.”
Lonce LaMon: So, you can work faster and more efficiently. There’s a longer response time in a larger organization.
Lisa Moore: Yes.
Lonce LaMon: So there’s a tremendous benefit to a boutique California TPA and you have the clients who want that.
Lisa Moore: Yes.
Lonce LaMon: So, how do you find new clients? After you got your first client in 1997, how did you get your second one, third one?
Lisa Moore: It’s all been through personal referrals. It’s been through friends that are brokers or business acquaintances. It’s basically people that know me. I don’t have a marketing staff. It’s me.