Use team effort claims handling to reduce litigation, attorney suggests

The assembly line methodology of claims handling is outdated, according to attorney Tricia G. Bellich. By empowering all parties involved at the beginning and using some inexpensive resources, corporations can mitigate the costs and risks associated with litigation.

Bellich, a partner in the Crown Point, Ind., office of Kopka, Pinkus, Dolin & Eads LLC, advises pulling together claims adjusters, human resources, and nurse case managers to establish a team mentality at the beginning of a claim.

"We want the adjusters to dig into the guts of their file as soon as they get it. And then pull out the areas we might want to investigate," she said. "What helps them is cutting to the heart of the matter and [explaining] why we are denying or questioning this claim."

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Empowering the claims handling team is key because they are on the front line and can be a useful resource, she said. Nurse case managers, for example, are often overlooked as a source of claims investigation, Bellich explained. They can go to a doctor's office where a claimant has an appointment.

"They've seen people walking in with a limp and after the exam walking out without difficulty," she said. "That could be cause to terminate benefits or at least take pause and see if we should consider termination of benefits."

Adjusters can learn valuable information using simple tools. For example, if one of the members of the team knows a claimant is on a softball league, he can easily research that on the Internet.

Bellich related a situation where an adjuster perusing social media sites discovered a claimant was in a band.

"The adjuster forwarded information about the band. He didn't search all the tour dates, but I certainly did," she said. "If he didn't pass on that information I never would have been aware of it -- it doesn't occur in the normal course of discovery."

Social media has become a vital tool to quickly and easily locate information about claimants. "Social networking historically started as university groups for people with similar interests. So you'll see people with similar interests and track what people are doing," Bellich said. "It's amazing the information that's been found that has been introduced in court and swayed a case."

Bellich explained that using social media sites to track claimants' activities should be done with care, so any evidence uncovered is admissible and does not constitute entrapment. She advises using only publicly available information.

"Don't create a user account and friend someone you're investigating," she said. "We don't want to engage with the plaintiff under false pretense."

Read more at the WorkersComp Forum homepage.

December 6, 2010

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