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Today’s handouts: http://www.plrb.org/public2/BI-Handout.pdf http://www.plrb.org/public2/BI-PPT.pdf
If you can't hear during the webinar: • Telephone users: Hang up and dial back in. • VoIP users: o Test your Speakers setup. Click Audio Setup in the Audio pane to select the correct device. o (Mac users: Click the speaker icon in the Audio pane to select the correct device.) o Check the volume setting in Audio Setup. Under Speakers Setup, click Play Sound and adjust the
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YOUR WEBINAR WILL BEGIN AT 11 A.M. CENTRAL TIME (NOON EASTERN)
Thanks to PLRB’s 2015 Online Education Sponsor
For sponsorship opportunities, please contact Tom O’Dowd at 630-724-2224 or [email protected]
Bodily Injury: Handling High-Value Claims
Moderated by: Scott Powell Vice President of Educational and Technical Services Property & Liability Resource Bureau
Produced by: Teresa Arnold, Tonda Lee, & Ransella Wagner Property & Liability Resource Bureau
Bodily Injury: Handling High-Value Claims
Bodily Injury: Handling High-Value Claims
DAN LONGO Senior Partner Murchison & Cumming, LLP
JAMES SHELLEY Director of Quality Assurance Liberty Mutual Insurance Company
1. Each program will last 60-75 minutes
2. Download the handouts:
http://www.plrb.org/public2/BI-
Handout.pdf
http://www.plrb.org/public2/BI-PPT.pdf
3. Use the “Questions” pane on the right to
provide comments or ask questions
4. All recorded webinars can be found on our
website http://www.plrb.org under “Online CE”
Ground Rules
Bodily Injury: Handling High-Value Claims
Presented by Dan Longo and James Shelley
Bios • James Shelley: Director of Quality Assurance/Manager
of Audit – Liberty Mutual Insurance Company
Education • Adelphi University, Garden City New York • Master of Business Administration, Spring 2012 • Concentration: Management • University at Albany, State University of New York • Bachelor of Science Business Administration and
Communications, May 2003 • Concentrations: Management/Marketing
6
Bios • Dan Longo: Managing Partner, Murchison &
Cumming LLP Irvine, CA.
Education • Loyola Law School, Los Angeles , CA. • J.D. 1982 • University of Southern California • B.A. History 1978
7
A Civil Action “It's like this. A dead plaintiff is rarely worth more than a
living severely-maimed plaintiff. However, if it's a long, slow, agonizing death as opposed to a quick drowning or car wreck, the value can rise considerably. A dead adult in his 20s is generally worth less than one who is middle aged. A dead woman less than a dead man. A single adult less than one who's married. Black less than white. Poor less than rich. The perfect victim is a white male professional, 40 years old, at the height of his earning power, struck down at his prime. And the most imperfect: well, in the calculus of personal injury law, a dead child is worth the least of all.” ~ Jan Schlichtmann (A Civil Action 1998)
8
How many years of claims experience do you have?
A. 1 – 2 years B. 2 – 5 years C. 5 – 8 years D. 10 – 15 years E. 15 plus
9
Initial Investigations
• Not all claims start out as high value or complicated claims
• An in-depth up front investigation can only help
10
A Picture is worth 1,000 words
11
Coverage & Liability
Detailed Statements
Policy Analysis
Definition of a covered person Excess or Catastrophe Coverage
Coverage Detailed Statements
Vehicle Photos
Scene Photos
Police Reports
Live Video Feeds/Tapes
Preservation of Evidence
Liability
12
Expert Usage Early On • Depending on the initial accident facts a case may
warrant retaining an expert early on
1.
Accident Reconstructionist
2.
Independent Medical Doctor
3.
Surveillance
13
Injury Investigations • Know the difference between an upfront high value
claim vs. one that develops
• Questions to Consider o What factors can determine your initial injury investigation strategy? o How often should you follow up on injuries? o What are my sources of injury information?
• Injury Investigations Impact on Reserving
14
General Damages
Defined - monetary recovery (money won) in a claim for injuries suffered (such as pain, suffering, inability to perform certain functions).
15
Special Damages Defined - damages claimed and/or awarded in
which there are out-of-pocket costs directly as the result of the breach of contract, negligence, or other wrongful act by the defendant. Special damages can include medical bills, repairs and replacement of property, loss of wages, and other damages which are not speculative or subjective. They are distinguished from general damages, in which there is no evidence of a specific dollar figure.
16
Strategies for Breaking Down Demand Packages
Breakdown and Assess •Utilize Word, OneNote,
PPT •Organize by treatment
provider
Organize and Summarize •Discard duplicate records •Be short, concise, and
strategic
Determine Next Steps and Follow Up Items •What am I missing? •Do I have authorizations? •Does legal counsel need to
be involved?
17
Tools To Aid Demand Package Assessment
• Medical Bill Review Software • Nurse Reviews • Independent Medical Doctor Reviews • Co-Workers • Management • Legal Partners
18
Special Damages
Special Damages
Medical Bills
Lost Wages
Future Care
Know the Impact Of: • No Fault
States • Non PIP
Venues • Liens
19
Additional Factors to Consider
Prior Loss History
Future Prognosis
Intangible Factors
Expert Witness Credibility
20
Total Case Value – Bringing It All Together
Generals Specials Additional Factors
Full Case Value
21
What types of negotiation strategies do you find
most effective?
22
Common Types of High Value Claims
• Death/Disfigurement/Dismemberment • Surgeries
o Fusions and Discectomies o Arthroscopic Surgeries
• Open Fractures with and without Surgery • Significant Lost Wages • Head Injuries • Burns • RSD
23
Negotiation Best Practices • Know your strengths
• Know your opponents strengths
• Be the expert
• Have a plan
24
Negotiation Strategies for High Value Claims
In Person
Arbitration
Paced
Mediation
Via Defense Counsel
Leverage Agency
25
Litigation and Handling High Value Claims
Presented by Dan Longo
26
Have you handled a claim through verdict?
A. Yes
B. No
C. Attended trial but no verdict rendered
27
Discovery • Request For Production of Documents • Contention Interrogatories • Requests For Admission • Videotape Depositions
28
Pre-Trial Issues • Motions In Limine • Trial Brief • Preview issues for trial judge • Attack plaintiffs use of “Reptile Theory” • Lay groundwork for appeal • Out of court preparation such as mock trial or focus
groups
29
Trial Activities • Voir Dire
• Opening Argument (Not Statement)
• Effective Use of Technology
• Cross Examination Techniques
• Closing Argument-The Wrap Up
30
Venue and Opposing Counsel
• Jury Verdict Reports
• Talk To Your Colleagues
• Changing Demographics
• Judicial Hellholes
• Dealing With Top Notch Opposing Counsel
31
Expert Witnesses • Is This A Case Where An Expert Is Really
Necessary?
• Selecting The Best Expert For The Case
• What Do You Expect The Expert To Do?
• Budgets and Reports
• Attacking Opposing Experts 32
Types Of Trials • Jury Trial vs. Court Trial (be careful what you wish
for)
• High-low floors and caps
• Admitting liability
• Bifurcation
33
Case Pricing Exercise Please see handout
34
Case Pricing Exercise
35
Facts of Loss: • Intersection accident that occurred on October 1, 2012. • The intersection is controlled by stop signs in one
direction and no traffic controls in the other. • Your insured was proceeding through the intersection
and had the stop sign. • The claimant vehicle was proceeding with the right of
way. • Police responded to the scene along with an
ambulance. Both your insured and the claimant were transported to the hospital from the scene.
Case Pricing Exercise
36
Vehicle Damage: • The insured’s vehicle is a 2009 Nissan Maxima and
sustained heavy front end damage. • The estimate came in at $8,980. • The claimants vehicle is a 2001 Chevy Impala. The
vehicle was deemed a total loss. Book value on the vehicle was $5,595
Case Pricing Exercise
37
Claimant Profile: • The claimant is a 42 year old married male with
dependent age children. • The claimant is employed as a Police Officer
making $82,000 per year. • He was out of work for the following periods of
time: o 10/1/2012 – 1/30/2013 o 2/12/2013 – 5/12/2013 o 9/1/2013 – 12/31/2013 o 1/2/2014 - Returned to work full duty. Some noted restrictions but
all signs point to a full return to work and full duty.
Case Pricing Exercise
38
Claimant’s Injuries: • Emergency Room 10/1/2012 – Noted complaints of full
body pain. All x-rays normal. Treated and released. Follow up with GP ASAP.
• MRI C-spine: Bulges with degeneration at C3-4, C4-5, and C5-6
• MRI L-spine: Herniation with impingement L4-5 • Needle EMG Upper: Normal • Needle EMG Lower: Radiculopathy L4-5 • Physical Therapy 10/8/2012 – 12/2013 • Epidural Steroid Injections 2/12/2013 & 4/12/2013 • Lumbar Discectomy 9/1/2013
Case Pricing Exercise
39
Prior Loss History: • The claimant has one prior loss, which was a
workers’ compensation claim 2 years ago. • Indications are of a neck and back sprain/strain • Claimant indicated that MRIs were performed but
those medical records are either missing or not obtainable.
How much would you value this case for
settlement? A. $0 - $25k B. $25k - $50k C. $50k - $75k D. $75k - $150k E. $150k +
40
What were some of the factors driving your
evaluation of this claim?
41
Appeals • Make Your Record
• Make Your Record
• Make Your Record
• Testimony vs. Documentary Evidence
42
In Conclusion
• Leverage your peers and colleagues
• Learn from previous experiences
• Case pricing and evaluation is an art not a science
• Put yourself in the best position possible to protect your policyholder and come to a fair and reasonable settlement
43