As a claim-handling professional, you may have more than 100 pending claims. You receive calls and letters every day on various files. There just doesn't seem to be enough time in the day. In the perfect world, every claim would be handled with no mistakes. Every phone call would be returned immediately. Is it possible?

The following article will discuss some of the basics of handling a claim investigation. While it is not possible to work every file perfectly every time, a claim handler who follows the steps listed below will ensure that, on most days, they are resolving their claims in the most expeditious (and economical) manner possible.

The First 48 Hours

In the hustle and bustle of handling claims, adjusters often overlook important investigatory steps. Usually, good results can still be achieved, despite such inactivity. Oftentimes, this inactivity occurs because we forget the basics of claim investigations.

The first 48 hours after any accident is golden time. If you are going to find any witnesses or make any favorable discoveries, it generally occurs during this time period. Making valuable discoveries after this period will be a combination of hard work and good luck. This first two days after an accident is also the time when you are going to find out information that adversely affects exposure on a claim. Find out this information sooner than later, because no one likes last-minute surprises.

Looking ahead, the work accomplished during the first 48 hours could be incredibly helpful to a hired defense lawyer should the case go into litigation. The claim adjuster is literally the eyes and ears of the defense attorney. If the basics are not covered early on, the defense attorney is going to have to make these things happen. Guess what that does to your litigation costs? That's correct; it will send them right through the roof. Why pay a defense lawyer to do the things that you can easily accomplish yourself?

Be Systematic

All claim professionals have a system by which they handle claims, and it should be followed every time. Even though no two claims are exactly alike, the same basic steps should be taken because this ensures that critical steps are not missed. Also, when an adjuster has to review an on-going file, knowing that appropriate steps have been taken will make the process easier. Any adjuster who has inherited a file that appears to have ridden around in the trunk for several months of another adjuster will understand why. It reinforces the importance of having a system by which you work files the same way every time.

If you have a systematic approach to investigating, the chances of settling the claim are maximized because the more you know about the claim, the claimant, and your insured, the better you understand the big picture. This should help claim professionals determine the true value of the claim sooner than later because all of the players and facts are known. With this information, an adjuster will be in a better position to resolve the claim while both parties' costs remain relatively low.

We can all agree that the best claim is a closed claim. However, settling claims for its true value is a very different approach than settling claims just to be able to close them. Settling claims for its true value typically will satisfy your clients more because, at the end of the day, less money is being paid out. That means fewer cases go into litigation and legal expenses will drop. This, in turn, could mean more business for a company because the clients are happy.

Obsessively Document

Remember, if any action in a file is taken, you must document it. If the activity has not been documented in the file and someone else looks at it, the activity might as well have never occurred. This is an important step, especially in litigation, because no one is left wondering what has been done, and no one has to reinvent the wheel.

Next, a claim handler should always have photographs taken of the accident scene. Remember the movie, My Cousin Vinny? If so, you should recall the importance of taking as many pictures of the scene as possible. If you don't, chances are it will change within hours of the accident. Don't be frugal with your pictures. Take as many photographs as needed to capture the scene. Any camera will do the job (especially digital). Also make sure that the photographs are dated and time stamped. Finally, if using film, it is always a good idea to keep the negatives so you can use them in the future.

Also, if possible, be sure to photograph the claimant; these photos can be used to verify targets for surveillance. Oftentimes, investigators do not know what a claimant looks like, so having a photo reduces the chances of an investigator ending up with six hours of great footage — of the wrong person!

Recorded statements, if done properly, can be a great asset to a case. If not done properly, however, they are a waste of time and a source of frustration. To avoid this problem, make sure to get clear answers from the speaker. Make sure to stay on top of the claimant if they answer questions with “uh-uh” or “huh-uh.” Nail them down to verbal responses like “yes,” and “no.” This saves headaches down the road when folks are trying to figure out if the claimant meant “yes,” or “no,” to an answer. Answers like this give claimants an incredible amount of wiggle room when confronted with their statements during cross-examinations.

And do not forget that under the Texas rules of civil procedure, any witness statement must be turned over during litigation. Therefore, be cautious about the statements taken. Ask yourself this: Do I want to have to turn this statement over to opposing counsel? If you don't, then don't take it.

Keep in mind the important information that you need to obtain, such as a claimant's complaints and damages. Try to be specific and verify their exact injuries and damages. What doctors have they seen? What hospital did they go to? What treatments have they received? Should they file suit, you can order up their medical records and get a better sense of their damages. By using your statement outline as a “go by,” you won't forget to cover the important points.

Make sure to be clear about who the claimant is talking about. If a claimant is excessively using pronouns, clarify whom are they talking about. By making sure that everyone is clearly identified, you will reduce confusion down the road. Also, having an outline of points or questions that need to be covered during the statement is a good idea because it reduces the chances that you will forget to ask a certain question or cover an issue. Do not use your outline as a script, but rather as a guide. When you think you are almost done with your questions, look over your outline to make sure that you have covered everything.

Also, be sure to listen to what the claimant is telling you. Do not gloss over answers just to get to the next question. You may learn some very valuable information by following their leads and asking them questions about what they are talking about.

Make sure that a list of witnesses and people with knowledge is kept. You or your defense counsel may need to revisit them down the road to find out what kind of witnesses they will make with a jury and whether they have changed their stories. If a witness is favorable to your position, ask the witness for the name and number of someone who will always know how to contact them. It may be more than two years until a case goes into litigation and that witness may be very important to your defense. Finding a way to keep tabs on a witness increases the chances of being able to utilize them in the future.

When handling claims, be responsive to information. It is easy to fall into a trap of drawing a line in the sand when confronted with a certain type of claimant, attorney, or treating physician. The ability to handle the claim, and ultimately the case, will be harmed if you are not careful. Instead, remember that information equals knowledge, which equals an informed evaluation, which equals a better settlement. This includes listening — rather than just hearing — what people have to say. Knowing the difference between listening and hearing is important; increasing your listening skills will increase your effectiveness.

Finally, keep the ball in the claimant's or attorney's court. For example, what if an attorney sends you a demand for settlement, but does not give you all the information that you need? Send the attorney a letter requesting the missing information as soon as possible. This puts the ball back in his court to give you what you need to move the claim. It also shows good faith in adjusting the claim.

Mike H. Bassett is a partner and Jennifer Eldridge is an associate at The Bassett Firm, a litigation firm that focuses on transportation litigation and premises liability. They may be reached at 214-219-9900, www.thebassettfirm.com.

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