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Calls into DealersEdge have sent a clear message - Ford has been busy with claim adjustments and denials. If you have a good understanding of Ford's claim payment system and the warranty policies that guide them, you will have a better than average chance of getting a reversal.
Ford's warranty department takes a two percent sampling of claims to review for accuracy. While there seems to be little rhyme or reason to the review process, Ford does tell us that high-dollar claims with excessive actual time and/or parts are the leading characteristics that will lead to the selection of a single claim.
When an assessor gets a claim, they look to see if it adheres to warranty policies. They look to see if the claim is accurate in that all the calculations add up. And they look to see if the repair is logical. The assessors are technically trained to be able to examine the repair procedures and judge the appropriateness of the time and parts being requested. They will judge, sometimes on very limited information, if the technician followed a logical approach to the diagnosis and repair. That means that they check to see if the repair follows published repair procedures and that the supporting information and technician comments support the repair as claimed.
Therein lies part of the problem. Being technically trained, (sometimes they are master technicians), does not mean they can diagnose and repair a vehicle on paper. There can be no substitute for seeing and working directly on the vehicle. There is only so much you can see on a DWE entry screen.
Let's take a look at a common reason for claim adjustment; "parts not necessary to the repair performed". Now assume that the assessor is looking at a claim for a water pump replacement and there are wiper blades charged out on the claim. It doesn't make sense, until you read the actual repair order and it says water pump seal burst, sent coolant onto windshield, wipers streak from being soaked with coolant and customer demanded replacement.
If the assessor had requested the additional documentation, reviewed it, and then made an adjustment, that would be at least partially understandable. But many of these adjustments are made just by the claim entry screen and your claim will be adjusted and paid for something less than claimed.
There are four possible outcomes of a claim placed under review;
u Claim Paid as Submitted - The assessor agrees with the claim and pays it for the amount you submitted.
u Returned - The assessor returns the claim, usually to request more information to clarify the repair.
u Adjusted Claim - The payment amount is adjusted from the amount claimed by the dealership to the amount the assessor deems appropriate.
u Denied Claim - The claim is paid at zero dollars, meaning no correction and resubmission is possible, you must do an appeal.
Fighting the fight through appeals
To get better ideas on fighting for your money, I called the Zen-master of claim appeals, Brad Summers who runs Summers Dealer Services in Michigan (they do warranty claim processing for dealerships and you can reach them at 800-361-1449).
"I have claims that I've appealed three or four times with sending documentation back and forth. For example, I got one here that they've sent back three times saying they can't read the time punch. I look at it and it is clear as day. You just have to be prepared to play the game and jump through the hoops to get your money," Brad told me.
"It can wear you down with frustration, like the assessors saying the documents weren't received. They'll request four pages of documentation, you send it all in the same envelope and they say they did not get the fourth page."
This just causes Brad to dig in even deeper. "I don't let it wear me down and neither should dealers. You just have to play the game back and forth." He also suggested that you be very clear about your comments back to the assessor when making appeals online or mailing in documents. "I am not rude, but I do try to make clear our response to their questions. When typing in additional information or answers, I'll put asterisks (*) at the start and end so they can easily see the new information."
Make sure your technician documentation and supporting materials are rock solid. In other words, if you want to get paid for six hours of M-time, the tech better have a six-hour story. Time punches alone are not enough to support the request for time. The tech's story should relate to job tasks that would consume the amount of time being requested.
Persistence is the key. If you know you're right, and the shop and technicians made the right decision in the repair, then keep fighting it until the assessors won't hear it anymore. Then turn to someone who will.
"Occasionally we have to get the dealer's DOM involved to get paid. They just end up paying it out of P01 money," Brad told me. It makes sense because the claims that the assessors seem to have the most problems with are those involving difficult situations where several hours of MT time is being requested. In a number of these cases, your DOM was probably already aware of the vehicle's troubles.
"You need to contact the DOM because another frustrating part of the process is there is no other lifeline to reach out for help. There isn't a phone number you can call and speak with the assessor; it is all mail, fax, and e-mail." That is probably by design.
Appeals get worked over
There are times when you might make a mistake and leave something off a claim. You are allowed to add to a paid claim by appealing for the missing amount. But expect to receive even more grief.
It seems that claims asking for additional amounts are given a greater amount of attention from Ford's assessors.
If you are requesting money to be added to a claim, make sure you take extra time to explain the situation and need for the payment. It might save you from having to go through more hassle to get paid.
When to appeal
An appeal is you asking Ford to reconsider a claim decision because either:
n A labor operation, part, or any amount was mistakenly left off the initial claim submission.
n You disagree with a claim adjustment or denial.
Just because you can initiate an appeal, doesn't mean you should. Ford suggests that you consider the following three questions when deciding to appeal a claim.
o Does the claim meet the requirements of published Ford Warranty Policy?
o Was the information provided in the first submission misunderstood or will additional information clarify the dealership position?
o Is this the first appeal on this claim (if second or more appeals for assessor adjusted claim refer to web based Appeal Evaluation)?
Level 1 on a level playing field
Ford rewards the best warranty performance dealer- ships with level one status, granting the dealership certain authorities and rights that allow the shop to make on the spot decisions about repairs and allow the warranty administrator to bypass several pre-approval steps to get claims paid. It makes sense, the dealership has a track record of good warranty claim management, therefore they should be trusted with greater authority.
Achieving level 1 status does not seem to mean much to the assessor. Level 1 stores are just as likely to get claims reviewed as other shops. It seems like an end-run around the reward program. Sure you don't have to call up for prior approval, but if the assessors deny certain parts or request more documentation, is it any better?
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