tion, especially if they fear they do not
understand enough about the process to
effectively present their case and negotiate a settlement themselves. Those in the
claims arena understand what is needed
to present a claim, but it is a confusing
process for anyone who has not been
trained in claims management.
This uncertainty in an employee’s or
claimant’s mind is a frequent reason for
the involvement of plaintiff’s attorneys.
They focus on fears that the insurance
companies are just out to make more
money, inferring that they will settle for
less than they should, and that they have
big pockets. They will also throw out alleged examples of big awards or settlements they have reached without clarifying whether the award or settlement was
really an increase over what the claimant
would have received anyway. This is precisely why it is important to address the
claimant’s concerns and fears.
The “I wills”
It is important to start with some basic
assumptions and commitments, which I
refer to as the “I wills.”
• Deal honestly and ethically with every-
one involved in this claim.
• Treat everyone with respect.
• Promptly contact all parties involved in a
claim within one workday of assignment.
• Initiate the investigation at the time
of first contact, follow through on additional investigation that may be required, and reach an early decision of
acceptance, denial or compromise.
• Notify the claimant as soon as I have
made a decision about accepting com-pensability or liability, regardless of the
• Inform the claimant of the information
and proof that is needed to consider all
aspects of their accepted claim.
A Proactive Approach to
Reducing Claims Litigation
Those in claims management agree on one thing — litigation, or even attorney representation, leads to greater claims and expense costs than would otherwise occur. And in Workers’
Compensation circles, an attorney may actually reduce the employee’s
compensation rather than add to it.
This may occur because:
• The statutory benefits are clear and can-
not be increased for any reason, and an
attorney receiving these benefits reduc-
es the amount of money remaining for
• The claimant’s attorney is inexperi-
enced in Workers’ Compensation and
may settle for less than the adjuster
would have otherwise settled.
The reduced payment to the employee
or a liability claimant may also occur be-
cause claimants may try to negotiate a
settlement themselves initially but hire
an attorney later in the process. If the
claimants eventually pay the attorney a
percentage of the full settlement rather
than just a percentage of the incremental
award created by the attorney’s involve-
ment, then the claimant’s financial out-
come is reduced.
This does not mean there is no place
for claimants to obtain legal representation. Some insurers, third-party administrators and companies have inadequately
or improperly managed claims, causing
some claimants or plaintiff’s attorneys
to view insurers negatively. Some claims
are appropriately denied and a claimant’s
disagreement with the denial will lead to
Employees or claimants with bodily
injury claims may seek legal representa-