Table of Contents
Introduction: The Burnout Paradox: When Doing Everything Right Goes Wrong
For the first decade of my fifteen years in the insurance world, I saw my job as a craft.
I started as a staff adjuster, learning the ropes inside a large carrier, before becoming an independent expert.
I took pride in being what the industry calls the “eyes and ears on the ground”.1
My role was to be a “Swiss Army knife,” a professional capable of meticulously investigating property damage, untangling complex liability scenarios, gathering evidence, documenting every detail, and negotiating fair settlements.1
I was the person sent to bring order to chaos, to apply the logic of the policy to the messiness of a real-world loss.
And for a long time, I believed that success was a direct function of diligence.
If I followed the protocols, mastered the estimating software, and managed my time with ruthless efficiency, I would succeed.
But a strange thing started to happen.
The harder I worked and the more diligently I followed the “standard advice,” the more I struggled.
The volume and complexity of claims seemed to be in a constant state of acceleration.4
I was drowning in a sea of high-priority files, each demanding immediate attention.5
I found myself in a state of perpetual reaction, bouncing from one crisis to another, feeling less like a skilled professional and more like a cog in a vast, broken machine.
The pressure was immense, not just from the sheer workload, but from the emotional weight of dealing with claimants in distress, navigating difficult conversations, and trying to mediate between the needs of the policyholder and the obligations of the insurer.5
I was experiencing a profound sense of burnout, a condition I now see is rampant in our profession, fueled by irregular workloads, tight deadlines, and the systemic pressures that define our work.6
This led me to what I call the Burnout Paradox.
The industry’s conventional wisdom—be more organized, communicate better, manage your time—wasn’t just failing to solve my problem; it felt like it was the problem.
I was already doing all those things.
The more I optimized my linear, checklist-driven process, the more overwhelmed and less effective I became.
I came to realize that the burnout I was experiencing wasn’t a personal failing of discipline or resilience.
It was a predictable, systemic outcome.
The industry hands us a complex, high-pressure environment, often with conflicting directives and a lack of real authority, and then advises us to solve the resulting stress with individual time management—a strategy doomed to fail.5
The core problem isn’t the adjuster; it’s the outdated operating system the adjuster is forced to use.
I knew I needed a new one.
Part I: The Anatomy of a Failure: A Case Study in a Broken System
The moment my old operating system crashed for good came in the form of a complex commercial property claim.
It was the kind of file that looks manageable on the surface but hides a tangle of complexities just beneath.
A mid-sized manufacturing business, the lifeblood of a small town, had suffered a significant fire.
My job was to handle the property damage and the resulting Business Interruption (BI) claim.
This case became the catalyst that forced me to confront the profound inadequacy of the conventional approach.
The Linear Approach
I tackled the claim exactly as I had been trained.
I was the model of procedural correctness.
My first priority was the direct physical loss, the trigger for any BI coverage.9
I was on-site within 24 hours, meticulously documenting the structural damage to the building and the destruction of specialized machinery.
I took hundreds of photos, got multiple contractor estimates, and started the process of valuing the lost equipment.
Simultaneously, I began the BI investigation, gathering years of financial records—profit and loss statements, sales projections, and fixed expense reports—to begin the arduous task of calculating the lost income during the period of restoration.9
I was following the standard playbook to the letter, creating a clear, linear path: assess physical damage, calculate BI based on that damage, pay the claim, close the file.
It was logical, defensible, and completely wrong.
The Unraveling: Where the Checklist Failed
The claim began to unravel not because of a single mistake, but because my linear, component-focused model was blind to the interconnected, cascading nature of the real-world loss.
The business wasn’t just a building with machines in it; it was a living system, and the fire had sent shockwaves through its entire structure.
First, I discovered a hidden interconnection that my checklist hadn’t prompted me to look for.
The fire hadn’t just damaged standard equipment; it had vaporized a critical, custom-fabricated component that was the heart of their manufacturing line.
This part was made by a single, niche supplier in another state.
Suddenly, the “period of restoration” wasn’t about how fast a local contractor could rebuild the walls; it was dependent on a third party’s production schedule.
This introduced a Contingent Business Interruption (CBI) element, as the supplier was facing their own delays.11
My by-the-book approach treated this as a separate, secondary issue, a complication to be dealt with later.
I failed to see it was the central nervous system of the entire claim.
Next came a non-linear effect.
A week after the fire, the local environmental agency issued a civil authority order, prohibiting access to the site and a two-block radius due to concerns about airborne contaminants from the burned materials.9
Even though the business’s property was the source, the order was a separate event.
For seven critical days, no cleanup or assessment work could be done.
This delay wasn’t direct physical damage, but it had a massive, disproportionate impact on the final BI calculation.
My rigid framework, which demanded a direct causal link between physical damage and income loss, struggled to properly account for this external shock.
These two issues created a vicious feedback loop.
The delay in sourcing the custom part from the sole supplier (the CBI issue) massively extended the restoration timeline.
This, in turn, caused the BI losses to mount exponentially, far beyond what a simple per-diem calculation would suggest.
The mounting financial pressure on the business owner led to frustration and distrust.
His communication became more hostile, which caused my desk examiner to become more defensive and demand more documentation.
This cycle of delay, financial loss, and eroding trust became a self-reinforcing “doom loop.” Legal counsel was engaged, threats were made, and the collaborative spirit was replaced by an adversarial standoff.
The Outcome
The claim, which should have been a story of recovery, became a protracted nightmare.
It dragged on for nearly a year.
The final payout for the Business Interruption was astronomical, far exceeding initial projections, representing a massive financial loss for the insurer.
The client, despite eventually being paid, was left financially crippled and deeply embittered by a process they felt was blind to the reality of their business’s collapse.
It was a textbook failure.
I had followed every rule, checked every box, and in doing so, had completely failed to see the whole picture.
The problem wasn’t in the details of the policy; it was in the mental model used to apply it.
This failure forced me to confront a difficult truth.
The industry’s foundational trigger for business interruption—”direct physical loss”—is a mental model built for a bygone era, a time when a business’s value was primarily tied to its physical plant and inventory.10
In today’s hyper-connected economy, a business’s true value often lies in its intangible assets: its processes, its supply chain, its customer relationships, its operational momentum.
The fire was the
catalyst, but the real damage was the catastrophic disruption of this complex, interconnected system.
My failure wasn’t in misinterpreting the policy’s words, but in clinging to an outdated logic that no longer reflects the nature of modern commercial risk.
The true loss was systemic, and my linear tools were simply not designed to see it, let alone manage it.
Part II: The Epiphany in the Ecosystem: A New Way to See
The fallout from that commercial claim left me deeply disillusioned.
I had dedicated my career to a craft I believed in, only to find that its foundational principles were failing in the face of modern complexity.
I knew the standard approach was broken, but I had no alternative.
This sent me on a search for answers, a search that led me far outside the familiar corridors of the insurance industry and into the seemingly unrelated world of theoretical ecology.
It was there, in the study of how natural systems respond to shock, that I found the key to a new way of thinking.
The Core Analogy: Engineering vs. Ecological Resilience
The breakthrough came when I encountered two competing definitions of “resilience.” The first, known as engineering resilience, describes how man-made structures are designed.12
Think of a bridge.
It is engineered with a specific capacity to withstand stress—wind, weight, vibration—and to return to its original, single, stable state after the stress is removed.
Its resilience is in its rigidity and its ability to “snap back” to equilibrium.
If the stress exceeds its design limits, it doesn’t adapt; it breaks.
It fails catastrophically.12
I realized instantly that this was how I had been trained to see claims: a problem to be “fixed” and restored to a precise pre-loss condition, a broken bridge to be rebuilt.
The second concept was ecological resilience.
This describes the capacity of a living system, like a forest, to respond to a major disturbance.14
When a forest burns, it doesn’t just “snap back” to its previous state.
It
absorbs the disturbance and reorganizes itself.
It retains its essential function and identity—it is still a forest—but it may shift to a new, stable state, perhaps with a different mix of trees and undergrowth better adapted to the new conditions.14
Its resilience lies not in rigidity, but in its capacity to adapt, reorganize, and transform while maintaining its core purpose.13
The Epiphany
Reading this was like a lightning strike.
The profound, career-altering epiphany was this: A complex insurance claim is not a bridge; it’s a forest fire.
My job was not to be a rigid engineer, trying to force a broken system back to its exact prior specifications.
That approach was brittle and prone to catastrophic failure, as my commercial BI claim had proven.
My true role was to be a steward of the “claim ecosystem.” A claim, like a forest after a fire, is a system thrown into chaos.
It will never be exactly what it was before.
My purpose was to understand its dynamics, identify the key forces at play, and guide it as it reorganized toward a new, stable state—a state we call resolution.
This single shift in metaphor reframed my entire professional identity, from a reactive repairman to a proactive systems facilitator.
This new paradigm required a complete overhaul of my thinking, as summarized in the table below.
Table 1: The Old vs. New Paradigm of Claims Adjusting
| Feature | The Old Paradigm (Engineering Resilience) | The New Paradigm (Ecological Resilience) |
| Metaphor | The Claim as a Broken Machine/Structure | The Claim as a Disturbed Ecosystem |
| Goal | Restore to pre-loss state (static equilibrium) | Guide to resolution (a new stable state) |
| Approach | Linear, sequential, checklist-driven | Holistic, adaptive, iterative |
| Focus | Individual components, direct cause-and-effect | Interconnections, feedback loops, system dynamics |
| Role of Adjuster | Investigator & Repairman (Reactive) | Steward & Facilitator (Proactive) |
| View of Complexity | A problem to be simplified and controlled | An inherent property to be navigated |
| Measure of Success | Procedural correctness, closing the file | System stability, stakeholder satisfaction, efficiency |
Part III: The Claims Ecosystem Framework: A Practical Guide to Navigating Complexity
This new perspective was liberating, but an analogy alone isn’t a strategy.
I needed a practical way to apply this “ecological” view to my daily work.
The answer lay in the science that underpins ecological resilience: the study of Complex Adaptive Systems (CAS).
A CAS is a system composed of many independent agents whose collective behavior emerges from their interactions, and the system as a whole can learn and adapt over time.16
A flock of birds, a city, a stock market—and, I realized, an insurance claim—are all examples of a CAS.
Drawing from the core principles of CAS thinking, I developed a practical methodology I call the “Claims Ecosystem Framework.” It’s not a rigid set of steps, but rather a set of four distinct lenses through which to analyze and manage any claim.
These lenses, adapted from a practical CAS analysis model, provide a structured way to see the whole system and act more effectively within it.18
Pillar 1: Mapping the ‘Multiple Perspectives’ (The Agents of the System)
The first principle of a CAS is that it is composed of multiple, autonomous, interacting agents, each with its own internal rules and goals.16
The first lens, therefore, requires you to move beyond a simple cast of characters and map the true ecosystem of agents.
In practice, this means identifying every individual and organization with a stake in the claim’s outcome.
This list goes far beyond just “claimant” and “insurer.” It includes the policyholder and their family, their attorney, the third-party claimant and their attorney, the insurer’s in-house counsel, the desk examiner, various vendors like contractors and engineers, expert witnesses, and even lienholders or medical providers.19
For each of these agents, you must ask a critical set of questions based on their unique perspective: What is their primary goal (e.g., financial compensation, reputational protection, fee generation, speedy closure)? What pressures are they operating under? What does a “successful” resolution look like from their point of view?18
Applying this lens prevents the critical error of assuming all parties are playing the same game.
A plaintiff’s attorney, driven by a contingency fee and the need to maximize a settlement, has a fundamentally different set of incentives than a contractor who needs to get a repair job approved and paid quickly.
The desk examiner, tasked with managing costs and ensuring compliance, has different pressures than the field adjuster trying to build rapport with a distraught policyholder.6
Recognizing that the claim ecosystem contains these diverse, and often competing, worldviews is the essential first step to managing the system instead of being constantly surprised by its emergent behavior.18
Pillar 2: Identifying the ‘Influences’ (The Forces Shaping the System)
Complex systems are not just a collection of agents; they are shaped by a web of influences—drivers, barriers, and leverage points that dictate the system’s behavior.18
Small changes in these key areas can produce large, non-linear effects.16
The second lens is about identifying these powerful forces.
This means looking past the surface-level arguments to understand the true dynamics at play.
What are the real barriers to resolution? Is it truly a dispute over the cost of repairs, or is the real barrier a profound lack of trust between the parties? What are the underlying drivers of the conflict? Is it a genuine need for indemnity as defined by the policy, or is it a claimant’s desire for retribution or validation after a traumatic event?
Most importantly, this lens forces you to search for leverage points.
A leverage point is an area in a complex system where a small, targeted intervention can yield a large, positive change throughout the system.22
It is often not the biggest or most obvious problem.
In a traditional adjusting model, the focus is almost always on the biggest number—the total dollar amount of the dispute.
But a systems approach reveals that the true point of leverage might be something else entirely.
In a highly contentious claim, for instance, the leverage point might not be arguing over the final $10,000, but rather making a small, upfront advance payment to an undisputed portion of the claim.
This single act can signal good faith, rebuild a sliver of trust, and change the entire emotional tenor of the negotiation, making the larger financial dispute vastly easier to resolve.
This is about finding the “slow variables” that govern the system’s health, like trust and communication, rather than getting bogged down in the “fast variables” of day-to-day tactical disputes.24
Pillar 3: Tracing the ‘Interconnections’ (The Web of Causality)
The most significant departure from traditional, linear thinking comes with the third lens: tracing the interconnections.
The defining characteristic of a complex system is that the whole is greater than the sum of its parts.25
This is because the system’s overall behavior—what is known as
emergence—arises from the rich, non-linear web of interactions and feedback loops among the agents.16
Instead of thinking in a simple A -> B -> C causal chain, the systems-thinking adjuster must learn to see the entire web. This means asking questions like: How does a two-week delay in scheduling an independent medical examination (A) impact the claimant’s financial stability as they remain out of work (B)? How does that increased financial pressure affect their emotional distress and anxiety (C)? How does that distress lead them to hire a more aggressive attorney who employs hardball tactics (D)? And how do those tactics cause the insurance carrier to adopt a more defensive, siege-mentality posture (E), which in turn creates further delays and erodes trust even more? This is a classic negative feedback loop, a “doom loop” where the system’s own actions reinforce and escalate the conflict.
The job of the adjuster, then, is transformed.
It is no longer about simply executing a series of tasks.
The adjuster’s primary job is to become a manager of feedback loops.
A negative feedback loop, like the one described, is a cycle of escalating conflict that must be identified and intentionally disrupted.
A positive feedback loop is a cycle of progress that should be nurtured.
For example, providing a claimant with a clear, realistic timeline and sticking to it (Action) builds trust (Effect).
That trust encourages more open and honest communication (New Action), which speeds up the information-gathering process (New Effect), leading to a faster, fairer resolution for everyone.
The master adjuster is not the one who just follows the steps, but the one who can see these causal webs and intervene strategically to disrupt negative cycles and foster positive ones.
Pillar 4: Defining the ‘Boundaries’ (Scoping the System)
The final lens provides a crucial element of practical discipline.
While systems are infinitely interconnected, to act effectively, one must define the boundaries of the specific system-of-interest (SoI) you are trying to manage.18
You must make a conscious decision about what is
inside your system and what belongs to the external environment.
In the context of a claim, this is the art of scoping the problem.
What is the core issue to be resolved? In a multi-vehicle accident, for instance, the immediate facts of the crash and the resulting damages and injuries are clearly inside the boundary.
The fact that the drivers of two of the vehicles have a long-standing personal feud is important context from the external environment, but trying to solve their personal relationship issues is likely outside the scope of the claim.
The art lies in drawing the boundary wide enough to include all the truly relevant, interconnected factors (like the supplier issue in my failed BI claim) but not so wide that the problem becomes impossibly large and unmanageable.
This principle echoes the wisdom of the heuristic: “In order to understand anything, you must not try to understand everything”.26
Poor boundary definition is a primary cause of claim failure.
The rigid, by-the-book approach often draws the boundaries far too narrowly, focusing only on the four corners of the damaged property and ignoring the critical business or personal systems that were disrupted.
This was my mistake in the BI claim.
Conversely, an inexperienced or undisciplined adjuster might draw the boundaries too widely, getting sucked into personal dramas or irrelevant side-issues that drain time and resources.
Skillful boundary setting is not a one-time decision but a dynamic process of maintaining strategic focus throughout the life of the claim.
Part IV: The Framework in Action: A Case Study in Collaborative Resolution
Armed with this new framework, I had the chance to test it on the exact type of file that would have previously sent me spiraling toward burnout: a complex, multi-party liability claim.
The incident occurred on a large construction site where a scaffolding collapse resulted in a significant injury to a worker.
The immediate aftermath was a chaotic storm of finger-pointing.
The injured worker filed suit against the general contractor (GC), who in turn filed third-party actions against the scaffolding subcontractor, the site engineer, and another trade whose work was adjacent to the collapse.
It was a classic “spiderweb of liability,” with at least four different defendants and their respective insurance carriers all denying responsibility.20
This case had all the hallmarks of a “wicked problem”—poorly defined, multiple stakeholders with conflicting interests, and no obvious solution—and was destined for years of depositions, motions, and exorbitant legal fees.18
Applying the Framework
Instead of jumping into the adversarial fray, I deployed the Claims Ecosystem Framework to see the situation differently.
1.
Mapping Perspectives: My first step was to understand the agents.
I didn’t just review the pleadings; I initiated pre-mediation conferences, a technique borrowed from the world of alternative dispute resolution, with the legal counsel and insurance representatives for each defendant separately.29
This allowed me to map out not just their legal positions, but their true underlying interests.
I created a confidential matrix detailing their respective layers of insurance coverage, their potential financial exposure, their ongoing business relationships with each other, and their biggest fears.31
I discovered that the small scaffolding subcontractor was terrified of a reputational hit that could bankrupt them, regardless of the legal outcome.
The large GC, conversely, was less concerned about this single payment and more worried about setting a negative legal precedent for future projects.
The engineer’s insurer was focused on a highly technical, narrow defense.
They weren’t just defendants; they were distinct agents with unique definitions of “winning.”
2.
Identifying Influences (Finding the Leverage Point): With this map of perspectives, I could search for the true influences on the system.
While their public posture was one of conflict, my private conversations revealed a powerful, shared driver: every single defendant was terrified of the “nuclear option” of putting their fate in the hands of a jury.
The true leverage point was not the strength of any single legal argument, but their collective, overwhelming desire to avoid the uncertainty, expense, and distraction of open-ended litigation.22
Their shared interest in achieving cost-certainty was the powerful force I could use to shift the system’s dynamic from adversarial to collaborative.
3.
Tracing Interconnections (Exposing the Doom Loop): My next move was to make the system visible to itself.
I convened a “defendants-only” joint session, another ADR strategy designed to foster cooperation away from the plaintiff.31
On a large whiteboard, I visually mapped out the “litigation doom loop” they were all trapped in.
I showed them, with estimated figures, how Defendant A’s refusal to share a key document forced Defendant B to file an expensive motion to compel.
This action caused Defendant C’s insurer to increase its legal expense reserves, which in turn reduced the amount of money available for an eventual settlement, making a resolution less likely for everyone.
They could
see, in stark black and white, how their individual defensive strategies were creating a collective disaster.
The focus in the room palpably shifted from blaming each other to blaming the dysfunctional process they were all participating in.33
4.
Defining Boundaries: Throughout this process, I was relentless in maintaining the system’s boundaries.
When one contractor tried to bring up a payment dispute from a different project, I gently but firmly steered the conversation back.
The problem we were there to solve was not “who is a good or bad contractor,” but a much more focused one: “How do we, as a group, collectively fund a fair and reasonable settlement for the injured worker in this specific incident?” By defining the problem in this way, I made it solvable.
We were not trying to fix all their historical grievances; we were trying to close one very expensive file.
The Outcome
The effect was transformative.
By making the system’s dynamics and shared interests visible to the participants, I had changed the game.
The defendants, now seeing their interconnected fate, began negotiating a contribution agreement amongst themselves.
The conversation shifted from “I’m not paying a dime” to “What is my fair share of the pot?” Within a matter of weeks, they had hammered out an agreement.
We were able to approach the plaintiff’s attorney not as a fractured group of squabbling defendants, but with a unified, substantial settlement offer.
The case was resolved quickly, litigation was avoided, and while no party was happy to be paying, all were immensely relieved to have achieved a swift, predictable, and cost-effective resolution.
This success was a direct result of moving beyond the traditional role of an adjuster.
In a complex, multi-party claim, the adjuster’s primary duty to their principal—to achieve a fair and efficient resolution—is not best served by engaging in zero-sum competition.
It is best served by becoming a systems-aware facilitator who can steer the entire ecosystem away from its most destructive and expensive state (litigation) and toward a new, stable equilibrium (settlement).
My value to my insurer was not in “winning” a battle against the other carriers, but in architecting a peace that saved everyone millions in potential legal fees.
Conclusion: From Adjuster to Ecosystem Architect
I often think back to the person I was a decade ago, meticulously organizing my files, color-coding my checklists, and burning out at my desk.
I was trying to impose a simple, linear order on a world that is inherently complex, interconnected, and dynamic.
The shift to a systems-thinking approach didn’t just make me a more effective adjuster; it restored my sense of professional purpose and intellectual engagement with my work.
I was no longer just processing files according to a rigid protocol.
I was diagnosing living systems, identifying leverage points, and architecting resolutions.
This is not a call to abandon the foundational skills of our profession.
Diligence, deep policy knowledge, and integrity remain the bedrock of good adjusting.
Rather, this is a call to add a new, powerful layer of strategic perspective on top of those skills.
It is an invitation to see our claims not as a series of isolated tasks on a checklist, but as dynamic ecosystems teeming with agents, influences, and interconnections.
It is a shift from being a technician to being a strategist.
The future of claims adjusting, especially for the high-value, complex, and catastrophe claims that are becoming more common, lies in this capacity to navigate complexity, not just follow procedure.
By embracing the role of an ecosystem steward, we can not only achieve faster, fairer, and more efficient outcomes for all stakeholders, but we can also build a more resilient, intellectually stimulating, and rewarding profession for ourselves.
The first step is simply to ask a different set of questions.
Table 2: The Claims Ecosystem Toolkit: Key Questions for the Systems-Thinking Adjuster
| Framework Pillar | Key Questions to Ask |
| 1. Mapping Perspectives | – Who are all the agents (people, organizations) with a stake in this claim? – What are the stated goals and hidden interests of each agent? – What pressures (financial, reputational, legal) is each agent facing? – Whose perspective is missing from my current understanding? |
| 2. Identifying Influences | – What are the one or two factors that, if changed, would change the entire dynamic of the claim? (Leverage Points) – What are the biggest obstacles preventing a smooth resolution? Are they factual, emotional, or procedural? – What are the underlying forces driving the conflict or delay? (e.g., lack of trust, fear of precedent, misaligned incentives) |
| 3. Tracing Interconnections | – How would a delay in Part A of the claim affect the cost and timeline of Part B and Part C? – What are the current feedback loops? Is communication building trust (positive loop) or creating defensiveness (negative loop)? – If I take action X, what are the likely first, second, and third-order consequences across the entire system? |
| 4. Defining Boundaries | – What is the core problem I am trying to solve with this claim? – What related issues are “in scope” and must be addressed? – What related issues are “out of scope” and should be intentionally excluded to maintain focus? – How is this claim system being influenced by its external environment (e.g., new legal rulings, media attention, economic downturn)? |
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