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Beat the Waiting Game

Tips for getting stalled claims moving again

December 06, 2019 Photo

“Well? We’re waiting!” goes the infamous line groaned by Judge Smails to Ty Webb in “Caddyshack” while he waits to find out how much money his golf bet is going to cost him. Many insurance clients utter this same frustrated groan to claims professionals handling their stalled loss payouts.

For the claims professionals, we’re waiting, too—for medical records, for a demand, for the claimant to finish treating, for the attorney to return phone calls, for a full moon—we’re always waiting for something in this industry, aren’t we? The good news is that we don’t have to wait anymore, and neither do our clients. There are strategies to get past the blockades that seem to be anchored to circumstances over which we have no control.

Don’t Let “No” Fool You

I like to think of the cold shoulder as an opportunity to talk to someone else. When attempting to navigate around an attorney blockade—and when phoning the paralegal and legal assistant isn’t getting you anywhere—try chatting up the receptionist, the true masthead of any law office. They will often take pity on you and help you get past the obstruction. If that still doesn’t work, the old-fashioned cold call will have to be employed. Pack a snack, it may be a long wait.

Alternatively, see if the claimant’s counsel (or the claimant, if he is pro se), will agree to provide signed authorizations so you can get the records yourself. Always ask for the name and address of the primary care physician. See if the claimant will agree to sign an authorization for pharmaceutical records.

The old adage was that since claimants have the burden of proof, it was wise to sit back and let them build their claims. That standard is changing as the industry becomes increasingly streamlined to provide faster progress and resolution. Frequently, there is a productivity benefit to closing claims as quickly as is feasible. There certainly is a client-service benefit to faster closures.

I try to walk the thin line between being a claims professional who an attorney likes but wants to get off her radar, and a claims professional who an attorney hates and wants to get off her planet. Try to stay on the attorney’s good side, but gently remind her that your frequent calls will stop if she helps you settle the claim.

If you have a claimant who has a more serious injury that may continue to require protracted medical treatment, offer to structure a settlement with an income-bearing annuity to pay future medical bills. For a claimant with a lesser injury but still an allegation of future medical bills, enlist counsel to prepare a release that includes language to agree to pay incident-related medical bills for a specific time period. This is particularly effective with a pro se claimant who may feel he is not able to agree to sign a release until he is feeling completely whole again. Having such a clause in the release permits him to have the comfort of knowing that if he does suffer a relapse, there will be funds available to pay for it.

Lastly, you might try contacting the subrogation professional for the claimant’s property damage or PIP carrier to see if they can give you some idea of what medical bills have been turned into PIP or other information they have received concerning the claimant’s medical condition.

Know the Claimant

Who is he? Does he have children? Is the car a total loss? Maybe your claimant has three children who play soccer and he needs to ferry them, their friends, and loads of sports equipment back and forth to practice. That settlement you may offer can help the family get back on its feet and, more importantly, back on schedule. Make the offer in writing so that counsel will have to forward the correspondence to the claimant. Once the claimant sees money on the table, he will be more engaged with his counsel to seek resolution. Claims bottlenecking in attorneys’ offices frequently has more to do with staffing and workload than whether the claimant is still treating.

When you do finally get someone on the phone, explain the reserve process and advise that you are completely unable to set a reserve because you have no idea what you are looking at. Familiarize yourself with the cost of standard medical care. An emergency room visit with X-rays can cost anywhere from $1,200 to $8,000, depending on the number of diagnostic studies on multiple body parts. An MRI could be from $1,200 to $2,500; an ambulance is usually $800 to $1,000; physical therapy and/or chiropractic care can be from $4,000 to $5,000.

If you have a soft-tissue injury, you can pretty much guess at how much the attorney is going to assert is the pure value of her client’s medicals. I will often say to an attorney, “So, if your client has only had X-rays and physical therapy, I know his bills are under $10,000 and I can reserve accordingly.”

To an attorney, though, $10,000 is not a lot of medical value. The attorney will expect that maybe she can get $15,000, reduce the bills to $5,000 or under, and then she gets her 33 1/3 percent and the claimant walks away with $5,000. She knows her client; I haven’t met him yet. The attorney has a much better idea of whether the claimant is going to be happy with $5,000. And, let’s be honest, in these days of billboard attorneys, how many represented claimants are going to balk at $5,000?

At this point, the attorney is very motivated to discover whether her claim can be quickly settled without a lot of additional time and expense. Or, perhaps, is the claim not a basic soft-tissue claim but actually a claim with greater medical value and, therefore, greater overall value?

Humanize Your Client

“My client, ABC Company, is a very family-oriented company and they would like me to work with you to get the claimant back in the soccer carpool rotation as quickly as possible.” Sometimes it can help to bridge the “your side versus my side” gap if you convey humanistic qualities that soften the playing field. There can initially be an adversarial atmosphere between an attorney and claims professional. I find that humanizing and softening that environment leads to a dialogue that is less contentious and more about resolution.

The bottom line is, just because you hit a blockade does not mean it cannot be breached. We’re living in an age in which we have to think outside the box and find new, creative ways to meet the growing need for faster satisfaction in the client-service realm of what we do in claims handling. Ultimately, when we can get the soccer parent and his kids quickly back on track, we bring the comfort of insurance back to the valued solution that it was always intended to provide.

About The Authors
Michelle A. Maggs

Michelle A. Maggs, AIC, is senior casualty adjuster at Crawford & Co.  michelle_maggs@us.crawco.com

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