Claim Handler and Defense Counsel: The Symbian Circle of Claims

Claim handlers and defense counsel rely on each other regarding reducing workers’ compensation program costs and moving matters toward settlement. They create a Symbian circle – two different and distinct stakeholders in the workers’ compensation claims process that rely on each other for growth and sustainability. Without each other, the claim will go nowhere and not reach the best-desired outcome – settlement of the claim.

The relationship between these two stakeholders can be complicated. Now is the time for members of the claim management team and defense counsel to understand how to work together best to create a sustainable circle.

Streamlined Communications

Modern technology has been a blessing and curse. The easy exchange of information makes communication easy, but sometimes, ensuring ideas are clear and without misunderstanding is challenging. A perfect example of this is email. It is cheap and easy to send. However, complicated thoughts are sometimes complex to send in an efficient manner. The result is frustration and delay.

• Claim Handler: Make the extra effort to be available for telephone calls. Consider letting defense counsel know when you are available and able to talk on the telephone. Be responsive to counsel on information requests and promptly provide settlement authority.

• Defense Counsel: Consistent and frequent status reporting is a must. The claim handler needs to know what is going on. Consider sending a report at the time of file opening, immediately after any development of significance, and before settlement. Cover such things as the facts of the case, legal analysis/discussion of defenses, and bullet-pointed recommendations for further handling.

The file review concept is an excellent opportunity to accomplish many things. Consider having a consistent schedule during the year. Make the environment friendly and non-confrontational. Never place blame – have the goal and mindset of reaching conclusions and using time effectively. Meetings in person can be beneficial.

Align Strategies and Settlement Outcomes

Workers’ compensation litigation is fast-paced and driven by volume. This is compounded by statutory deadlines that require attention to multiple issues and concerns. The claim file that collects dust is the claim file that causes problems.

• Claim Handler: Keep a clean email inbox and ensure that voicemails are followed up upon in a timely manner. Never forget critical dates, such as mediations, and ensure you are available if additional authority is needed. Consider the risks of litigation and never pass up a chance to settle a claim when it is reasonable.
• Defense Counsel: Never forget your professional and ethical responsibilities to keep your client(s) updated on case developments. This includes changing your voicemail greeting daily to let your clients know where you are and when they can expect a return call. The same holds true for using the “Out of Office” notice on email. All files are essential.

When involved in protected litigation, losing sight of the goal is sometimes easy. Organization is crucial when handling the high volume of files (and often multiple jurisdictions) in workers’ compensation. Refuse to irritate; refuse to be irritated.

Billing Guidelines and Litigation Budgets

The costs of workers’ compensation litigation have increased over the years due to many factors. The reasons include economic pressures, costs associated with medical care, and statutory increases in indemnity claims. The result is a demand for billing guidelines and proposed litigation budgets on all files referred to counsel.

• Claim Handler: Demand value for all legal services provided but have flexibility. Modern litigation and other demands require associate attorneys and legal staff to perform functions. Have open lines of communication and refrain from being accusatory when a bill or line item seems excessive.

• Defense Counsel: Avoid the tyranny of the job by maintaining focus while working on a file. Prepare and explain proposed litigation budgets that minimize overruns. Anticipate additional costs and be proactive when making additional requests.

Management of litigation expenses requires all interested stakeholders to be creative and flexible. The claim handler and defense counsel must communicate and advance claims with steps that drive them toward settlement.

Conclusions

The relationship between claim handlers and defense counsel is a Symbian Circle – two different creatures who rely on each other to resolve workers’ compensation claims effectively and efficiently. In order for this circle to work and achieve complex goals, there is a need for the two to streamline communications and align strategies. It is also crucial to use the tool of litigation budgets with flexibility. When implemented correctly, claims can be resolved, which reduces program costs.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: [email protected].

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