When Claims Turn Litigious, don’t Lose Sight of Human Element: WCI Panel

Conference Recap

When an injured worker hires an attorney, many employers and insurers instinctively shift into litigation mode. But according to panelists at WCI, the best outcomes often come from focusing on partnership, communication, and keeping the employee at the center of the claim.

During a session featuring Nichole DuShane of Summitt Holdings, Becky Hillhouse of Ascot, and Melissa Spurlock of Select Medical Corporation, the discussion focused on selecting defense counsel, managing attorney relationships, avoiding unnecessary litigation, and improving the injured worker experience.

What's a Good Defense Attorney?

In workers' compensation, the ability to provide candid assessments, identify risks early, and align legal strategy with the employer's goals may be more valuable than aggressive litigation tactics.

Hillhouse explained that Ascot wants to work with an attorney who's willing to put in the work and have the courage to be direct.

"We look for an attorney who won't just conduct generic discovery," Hillhouse said. "Sometimes you need an IME so you have a card in hand, but don't just tell me what you think I want to hear; tell me the truth."

Spurlock said that with a 40-state operation, she's learned that it's important to pick good partners who can help everyone stay on the same page.

"It's someone who helps me make better decisions," she said. "I value aligning with our business and doing what's best for our employees."

Spurlock said that the concept of relationship building and preservation should be present from the earliest contact with legal representation and knowing who the attorney is foundational.

"It can't just be reactive," she said. "I'm picking the attorney, not the firm."

Managing Problems

Not all attorney-client relationships work out, so what happens when things hit bumps in the road. Sometimes, you have to move on.

"Replacing counsel? At what point do you fire them?" Hillhouse asked. "I have a zero-tolerance policy, so if they're not responsive, I'm going to call them, and if there's a repeated issue or a competency failure, you're out."

Before reaching the point of moving on from an attorney, setting expectations at the outset can establish a good partnership.

"I set expectations right away, and I'll tell them I'll take calls on weekends, evenings, whatever, so if you're not responsive, that's not going to work," Spurlock said. "I'm doing everything I can, cc'ing paralegals, legal assistants, so communication is non-negotiable."

Hillhouse also emphasized the importance of expectations.

"I want to make clear what my expectations are," she said.

Avoiding Litigation

No one wants a workers' compensation claim to turn into a court case, so keeping litigation at bay is always a valuable strategy. Both Hillhouse and Spurlock suggested that many litigation challenges can be traced back to communication failures, delayed responses, or unresolved employee concerns that could have been addressed earlier in the life of the claim.

"Avoiding litigation is the way you prevent litigation problems," Hillhouse said. "Why was the petition filed in the first place? Why is there a lawsuit? If there is something we can do to resolve the issue, that needs to be the strategy."

And although claims, especially those that are litigated, can feel adversarial, that doesn't mean mutually beneficial outcomes are impossible.

"How do you position a claim for a win-win?" Hillhouse said. "What's the best outcome? What's the worst outcome? What does the claimant want? That's how you strategize."

Keeping it Human

Ultimately, insurers and employers want a claim that is resolved and a worker that's back on the job. There might be simple strategies to help that happen faster. Workers' compensation is fundamentally about helping injured employees recover and return to productive lives. While legal issues and claim costs matter, keeping focus on the person behind the claim often leads to better outcomes for all parties involved.

"How would you treat your grandmother?" Hillhouse asked. "There are many strategies to solve a claim, and they can change throughout the life of a claim."

Spurlock also cautioned that an injured worker needs to feel like a human first and not be reduced to a file.

"Think about the employee experience," she said. "One day, they walked in like any other day, and that day changed everything. Resolving a claim is really getting that person back to the life they know."

Additionally, keeping an open mind could be an underappreciated strategy for better workers' compensation experiences. As Hillhouse reminded attendees, workers' compensation is a constantly evolving field.

"Be curious," Hillhouse advised. "In workers' comp, you're never going to know it all."

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