So how does this lesson translate to our claims organizations? Again, it comes back to the execution of fundamentals. As Vince Lombardi said, “The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather a lack of will.”

As I review claim files and dissect claims processes and procedures in various organizations, these words ring very true. Looking about the industry, we see many companies who fundamentally execute on the basics, while others struggle. It's not only in claims, but in any industry.

New England Patriots' Julian Edelman is upended by Atlanta Falcons' Philip Wheeler, bottom, during the first half of the NFL Super Bowl 51 football game Sunday, Feb. 5, 2017, in Houston. (AP Photo/Jae C. Hong)

The will to win

New England had the will to win. They knew that they were struggling at half-time. It was time for adjustments to be made. Atlanta, led by league MVP Matt Ryan, seemed to be firing on all cylinders. Then came the implosion, unlike anything ever seen in Super Bowl history.

Related: 7 steps to paying the right amount for bodily injury claims

Now let's translate the performance of these two teams into a claims scenario. An adjuster receives a demand from an attorney for $50,000 for a fairly routine soft tissue injury. Following the New England example, the attorney has the upper hand early in the negotiations. However, at some point during the negotiations, the adjuster gets his hands on a set of tools to help him more accurately price the medical specials, improve the company's liability position, and effectively negotiate a fair outcome.

Atlanta, on the other hand, has the upper hand against the attorney and is working without the aforementioned set of tools. They have the edge in negotiations until the attorney provides documentation to support additional medical treatment and even higher bills. Without the tools to win, the adjuster ends up paying significantly more on the claim than had he followed the path of the first adjuster.

We see this time and again in our industry as severities across many lines continue to rise. Arguably, bodily injury (BI) severities are leading the pack. Medical inflation is outpacing the national consumer price index. Cost shifting is resulting in more expensive, and often unnecessary procedures. The art of claims adjusting has shifted to more of a claims processing role. At the end of the day, companies are being asked to do more with less. It's almost a self-fulfilling prophecy.

A host of tools are available to help claims professionals maximize all resources. (Photo: iStock)

Tools for success

As I discuss in “Re-Adjusted: 20 Essential Rules to Take Your Claims Organization from Ordinary to Extraordinary,” success is derived from three fundamental concepts: people, processes and technology.

As a claims consultant, I find it fascinating to learn how these concepts are utilized in a multitude of claims organizations. While no two organizations are the same, there is one overarching theme to those that routinely get results and outperform the industry – they understand the value of leveraging technology.

Related: 12 keys to rein in bodily injury severities

There is a method to the madness of the highly successful. By leveraging available technology, insurers have the ability to automate large portions of the BI process, such as medical bill review. As we often see in BI demands, there is a propensity for upcoding, unbundling, modifier abuse and other deceptive billing practices that often can slip past a claims professional who is not using tools to identify adjustment opportunities.

In my own organizations we found processes that were rife with opportunities that could often be resolved by leveraging tools. We utilized a combination of DecisionPoint for medical bill review and ClaimIQ as a liability and decision support tool. Not only did efficiencies improve, but so did accuracy.

At the end of the day, BI severities declined despite a rise across the industry. This process also opened up new avenues of monetary improvement, such as identifying previously overlooked subrogation opportunities and an increase in arbitration response victories.

Our approach was much like that of New England. We weren't perfect. We had portions of games that could have been played better, but at the end of the day we leveraged our people, process improvement and technological enhancements to consistently win.

As for the game last night, it might have been the biggest comeback in Super Bowl history, but it was not entirely unexpected. Winning becomes a way of life because it is institutionalized in organizations, be it football or any other industry.

To again cite Vince Lombardi, arguably one of the few coaches in history greater than Bill Belichick, “Winning is not a sometime thing; it's an all-time thing. You don't win once in a while, you don't do things right once in a while, you do them right all the time. Winning is habit. Unfortunately, so is losing.”

What we should always strive for is to be that winning organization that defines not only themselves, but their entire industry.

Christopher Tidball is a casualty claims consultant, industry veteran and author of multiple books, including ”Re-Adjusted: 20 Essential Rules to Take Your Claims Organization from Ordinary to Extraordinary.”