Call or email us anytime
(805) 484-0333
Search Guide
Today is Thursday, June 20, 2024 -

Industry Insights

Snyder: When Claims and Counsel Aren't Communicating

  • National
  • -  0 shares

A recent CLM Magazine article listed multiple reasons for claim processing inefficiencies. One was “unresponsive counsel.”

Teddy Snyder

Teddy Snyder

That got me thinking about why this should be.

Staff counsel

Everyone is on the same team. Staff counsel have no motive to perform work to increase billings. Theoretically, at least, communication between claims and staff counsel should be seamless.

Outside counsel

Outside counsel who have secured a place on a carrier’s approved panel cannot rest on their laurels. These panels are routinely reviewed. Many carriers maintain departments or hire outside contractors to conduct deep-dive audits of panel counsel performance.

Panel counsel firms survive on income from their carrier clients. When panel counsel cannot handle the case due to a conflict of interest or geographic issues, outside counsel not on the panel may be appointed. They, too, want to keep getting these assignments.

So why would they put that at risk by failing to respond to client inquiries?

Cumis counsel

The insurer has the least amount of control over the activities of outside counsel who was chosen by the insured because of a potential coverage conflict of interest. It may be difficult to obtain comprehensive reports because of the need to protect the insured’s continuing access to benefits from the insurer’s duty to defend.

Possible reasons

Just as claims reps may be overburdened, so are their counsel. Many attorneys are juggling heavy caseloads that hinder their ability to respond promptly. Sometimes they automate their reporting by repeatedly sending in the same report with hardly any revision. If we’re being honest, let’s admit that some claims reps “check the box” that a report was received without drilling down to see if the case is progressing as it should.

Rather than creating a litigation plan unique to the case, many insurance defense attorneys defend on autopilot. They send out irrelevant discovery or concentrate on battening down facts when there is a dispositive legal issue applicable to the facts already known. I have also had claims reps tell me that their counsel ignore their directions.

Believe it or not, another reason may be that internal firm politics are getting in the way of efficient reporting.

A solution for settlement

We know that approximately 96% of all cases settle. I have reviewed many insurers’ litigation guidelines. Hardly any of them set rules about when to initiate mediation.
 
The earlier that parties start talking about mediation, the earlier the case is likely to settle. Revising guidelines to define events, such as deposition of the plaintiff, which triggers evaluation of mediation at this time, would be helpful.

If counsel (and perhaps claims) ignore the litigation guidelines, revision will be of little help. Of course, claims and defense counsel must cooperate to pay attention to their shared goal. Communication among all the players closes cases faster.

Attorney Teddy Snyder mediates workers' compensation cases throughout California. She can be contacted through snydermediations.com.

No Comments

Log in to post a comment

Close


Do not post libelous remarks. You are solely responsible for the postings you input. By posting here you agree to hold harmless and indemnify WorkCompCentral for any damages and actions your post may cause.

Advertisements

Upcoming Events

  • Jun 20-23, 2024

    California Applicants' Attorne

    Attendee Registration Opens Tuesday, April 9th @ 9:30 AM Sponsorships & Exhibitor Applications …

  • Jul 29 – Aug 2, 2024

    76th Annual SAWCA Convention

    SAVE THE DATE! 76th Annual SAWCA Convention July 29 – August 2, 2024 Hotel Effie Sandestin 1 Grand …

  • Aug 14-17, 2024

    CSIMS 2024 Annual Dual Track C

    California Society of Industrial Medicine and Surgery (CSIMS) is combining its two conferences, PI …

Workers' Compensation Events

Social Media Links


WorkCompCentral
c/o Business Insurance Holdings, Inc.
PO Box 1010
Greenwich, CT 06836
(805) 484-0333