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Top 10 Claims File Wishlist Explored at 2023 Claims and Litigation Management Conference

insurance claim 7731980 640

Chicago, IL ( -- The 2023 Claims and Litigation Management Workers' Compensation, Casualty, and Risk Management Conference wrapped up day two of its robust program at The Westin Magnificent Mile in Chicago, Ill. The final session on Thursday, perhaps one of the most insightful, revolved around a complete wish list of ten essential items that attorneys and adjusters desire in a claims file.

The panel comprised some notable figures in the industry, including James Poerio, Esq., Shareholder at Poerio & Walter, Inc., Stefanie Neuenfeldt, Regional Workers' Compensation Claims Director at EMC Insurance Companies, and Dr. Claire Muselman, a Professor at Drake University. Brian Sumner, Esq., an Associate at German, Gallagher, and Murtagh, P.C., who adeptly played the role of moderator, guided the panel through a rich and thought-provoking discussion.

Before embarking on the detailed journey through the top ten, Dr. Claire Muselman and Stefanie Neuenfeldt underscored the importance of verifying and re-verifying coverage. This step, they explained, is crucial to complete before referring files to defense counsel. The panelists shared experiences where the need for a more in-depth coverage analysis emerged much later, creating potential hindrances.

The panel also pressed the importance of establishing a solid attorney-adjuster partnership and suggested that this relationship should ideally be formed even before a claim arises. This preemptive step, the panel explained, ensures that all stakeholders are educated about their roles, responsibilities, and the overall process, leading to a smoother, conflict-free experience when litigation is filed.

Concerning the inclusion of claim file notes, the panel members issued words of caution. Specifically, they warned against including leader notes, as these notes, if left unactioned, could expose the insurance company to bad faith claims and put the firm at risk. They stressed that one must be aware of the material included and requested in the adjuster claim notes. However, despite this inherent risk, the panel acknowledged the potential treasure trove that these adjuster claim notes could represent, offering critical insight into the trajectory of a case and shining a light on what steps should be taken next.

The panelists then presented a comprehensive and deeply insightful top ten wish list for a claims file, as follows:

(1) Detailed Referral with Directions from the Carrier: The panelists stressed that the carrier must provide detailed instructions and set clear expectations for the representation. These expectations act as a guidepost for the attorney's actions. In addition, carriers should empower their adjusting teams to exercise critical thinking and make important decisions, building confidence and fostering a sense of ownership.

(2) Legal Pleadings for Claims: This document serves as the cornerstone of litigation and outlines the claims being made. It's time-sensitive and helps establish the parameters of litigation. Being aware of the specifics of the employer name, entity, organizational structure, and contact person for litigation is vital.

(3) First Report of Loss: The panel stressed the importance of the initial account of the loss event. This document can offer invaluable information for identifying witnesses, preserving evidence, and strategizing possible defenses. The first report of loss often provides the most refined version of the events; hence, its importance must be balanced.

(4) Letters or Demands From the Injured Worker or Counsel: The injured worker's requests or demands are crucial as they provide an insight into what the opposing party seeks regarding medical or wage loss benefits. Understanding these expectations helps negotiate a settlement and steer toward the claim's final resolution.

(5) Investigative and Police Reports: These records establish the timeline of events and identify witnesses and at-fault parties. They can also shed light on potential defenses or credits against eventual settlement. The panel further emphasized the importance of being curious and obtaining statements from the injured worker and witnesses as soon as possible.

(6) Contact Information for the Insured: The importance of accurate contact information was stressed, as it enables the attorney to conduct their investigation, corroborate information, and coordinate testimony. A clear understanding of the organizational structure can assist in clarifying the employer entity, especially if parent companies are named or involved.

(7) Medical and Other Records: Medical records provide a snapshot of the injuries and treatment. They and other pertinent documents, such as property damage reports, can be instrumental in formulating the litigation plan. Furthermore, keeping medical records separate from personnel files was suggested for better organization.

(8) Litigation Plan: The panel wanted attorneys to provide a roadmap outlining how they anticipate the litigation to proceed. Though this plan may require changes as the case unfolds, a preliminary outline can prove invaluable.

(10) Litigation Budget: The panel also encouraged the provision of an estimate of the costs associated with achieving the desired outcome. While this budget might be subject to change, it's vital for setting expectations and planning resources.

(11) Detailed Assessment of the File: Lastly, a comprehensive narrative assessment from the attorney was desired. This assessment should outline legal claims, litigation posture, basic facts, initial exposure analysis, and recommendations for handling. It acts as a strategic guidebook for the entire case.

To sum up, the panel pressed that the work carried out by claims professionals serves as the bedrock upon which attorneys' success is built. This shared understanding, rooted in the complementary nature of the work performed by claims professionals and attorneys, can revolutionize claims and litigation management. Ensuring that the wheels of justice not only turn but also remain well-greased for a smooth journey is essential, and the insights shared at this conference are likely to be pivotal in achieving that goal.

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