Transparency and Communication: Avoiding Coverage Disputes Before the Claim is Filed CLM007

Transcription

1 Transparency and Communication: Avoiding Coverage Disputes Before the Claim is Filed CLM007 Speakers: Mark S. Humphreys, Vice President/Litigation and Risk Management, Watt Companies, Inc. Thomas O. Myers, Esq., Partner, Smith & Myers LLP

2 Learning Objectives At the end of this session, you will have learned how to: Recognize the tone of cooperation you should set with your carrier. Assemble steps to protect your coverage position while retaining the goodwill of the adjuster. Employ a strategy that uses patience and timing to bring home a global settlement.

3 The Parable of the Vanishing $50,000 OR: How Years of Partnership and Relationship Building Saved the Day A tough-as-nails carrier coverage attorney A complex construction defect case with real coverage issues An Insured with limited cash on hand A $50,000 deductible that the carrier walked away from!

4 The Basics Part One: The Concept of Partnership You re right! The insurance contract says what it says but remember that your carrier believes the same thing. Always taking a hard-nosed stance on coverage suing (or threatening to sue) can backfire quickly and in any event usually delays the ultimate goal: resolution. Treating your carrier as your partner working proactively and cooperatively, acting with openness and transparency almost always results in reciprocal treatment.

5 The Basics Part Two: It All Starts at the Start DURING UNDERWRITING: Meet with and get to know the underwriter(s) and the adjusting team for your policy before it s bound. Request a single adjuster to handle all claims on the policy. Request specific, preferred defense counsel to be endorsed onto the policy.

6 The Basics Part Three: Relationship Building Remind your carrier partners about you and your organization by meeting with underwriters regularly. Seek out new relationships by being open to introducing yourself and your firm to new markets. The insurance business is unique: personal relationships still matter. Remind the carrier what a great client you are by telling your story and remaining honest and transparent.

7 The Claim Part One: Notification and Tendering Don t wait! Notify the carrier as soon as you re aware of an actual - or potential - serious claim. Ask to immediately begin incurring costs toward any SIR. Get an adjuster appointed as quickly as possible even if a formal claim has yet to be made. Request appointment of your preferred defense counsel. If your preferred law firm is not pre-approved or panel counsel: Inform the carrier that your preferred counsel has been retained. Discuss/resolve hourly rate issues. Make sure your preferred counsel develops a strong working relationship with the adjuster.

8 The Claim Part Two: Cooperation With Your Adjuster Instead of assuming the adjuster is only there to say no, start by considering your adjuster as the person who CAN say YES. Make the adjuster part of your team. Include the adjuster in conference calls with you, your consultants and your counsel when discussing case strategy. Allow the adjuster access to consultant reports and direct access to consultants if requested. Access and transparency encourage trust and a higher level of cooperation. Remember: Cooperation does NOT mean you surrender your coverage position or your rights under your policy. The key is to know when and how to hold your ground.

9 The Claim Part Three: How to Get What You Want Diplomacy is the art of letting someone else have your way. Daniele Vare FIRST PRINCIPLE: Start by ASKING rather than telling. Successful claims can often be controlled by tone. Being strong and conciliatory are not mutually exclusive concepts. Do what you can to give the adjuster/decision maker what they need to give you what you want. Be patient. Yours is not the only agenda the adjuster is hearing. Being aware and sympathetic to this goes a long way. Unexpected expenses should be presented as here s what we re doing let us know what you think. Beware of burning bridges by taking a strong public position without first seeking a private conversation with the adjuster.

10 The Claim Part Four: Avoid War! Remember that it s not always possible to get 100% of what we want. Don t go to war over every issue Keep in mind that closure is the ultimate goal. Constantly assess risk vs. reward when considering coverage battles. Your relationship with your carrier is ongoing there will be other claims you ll need a strong partner then too. Take a deep breath when: The carrier refuses to pay certain types of bills The carrier won t pay the full attorney fee rate of your preferred counsel It might be a better plan to consider chipping in a portion of settlement dollars

11 The Value of Partnership Remember that our job as risk managers is to bring value to our stakeholders. Sometimes value comes not in the form of winning an argument, but in saving man-hours and dollars to resolve a matter without the extra expense of fighting on two fronts with the claimant and with your carrier. Value is also ensuring that your company maintains excellent working relationships with your carriers which are, after all, your partners in problem solving. Maintaining those partners as partners, rather than adversaries, benefits everyone, and ultimately makes our jobs easier.

12 Questions