Valuing Honesty, Integrity

Equally important are honesty and integrity. If a person is partially at fault for an accident, this needs to be explained as soon as the determination is made. Sometimes this is an uncomfortable conversation, but when done honestly with all of the factual supports being clearly explained, the outcome is going to be far superior to springing it at the last minute like some type of October surprise.

The dealings with customers don't have to be adversarial, either. Just as the voters are often a little leery of politicians, claimants may have some reservations about their adjusters. By presenting positively and professionally, it becomes possible to lay out the case in a manner that makes logical sense.

Of course, like politics, there will be times when “we simply agree to disagree.” Arguably, this is why we have the courts and other means for dispute resolution. Fortunately, most claims don't resolve in that manner, as fairer heads tend to prevail.

In a sense, handling claims are much like reaching across the aisle. While we may strongly believe our position as it relates to the case, it is important to remember that the body shop, claimant or attorney has an equally strong position. But that gap can often be bridged through effective negotiations.

Successful Negotiations

The key to success in negotiations is to understanding not only your own position, but that of the other party. Attorneys are well aware that adjusters are very busy, often to the point of being overworked. The same often holds true for attorneys, who often use a staff of associates, or negotiators, to push through an even greater volume of work. Fortunately, this latter bit of information can be of invaluable assistance when evaluating and negotiating injury claims.

When doing due diligence, taking the additional time to research all possible scenarios is time well spent. This is especially true for injury claims, where a few critical building blocks can be the difference in millions of dollars annually. Consider the following:

Police report. Was there any mention of injury at the scene? Which parties were cited as well as listed for contributing factors, which often don't result in a citation. These facts are critical for establishing both liability and damages.

Vehicle photographs (auto claims). Does the damage match? Are there paint transfers? What is the directional force of impact? Was there a mechanism for injury?

Accident scene. Are there any other potential tortfeasors? Overgrown bushes, signal outages, missing or blocked signage, absentee third parties, and so on.

Emergency Room records. What does the admission statement say? What type of pain was related to the treating physician? Was there a mention of symptoms other than what may be related to the accident? Is there evidence of a pre-existing condition or intervening cause?

Treatment patterns. How soon did treatment start? Were there gaps? Was there treatment on evenings and/or weekends?

Provider type. Was the claimant seen by a chiropractor or medical doctor. If the latter, then what was the specialty? What are their credentials? Are the licensures current? Are there any prior or pending disciplinary actions with their current state, or prior states?

Duration and frequency. When did treatment start? How long did it last? Was it active or passive? Was it longer than an anticipated expected recovery date among the general population for a similar complaint?

Objectivity. Where there objective findings, such as those from an x-ray, MRI, or CT scan? Were the records and films obtained and reviewed by an independent medical expert?

Pain Management. Did the doctor prescribe medication to ease the complaints of pain? What type (analgesics, prescriptions, injections)? Did the injury have any impact on the claimant's lifestyle?

“SOAP” Notes. Does the treatment being charged match the medical providers' subjective, objective, assessment, plan (SOAP) notes? These notes can often provide a great indicator of not only what treatment really occurred, but also a red flag for CPT coding modifier abuse. These can be a great source for identifying upcoding, unbundling, or other deceptive medical billing practices.

While these are just a few of the many considerations in claims, they are important because different parties may have different opinions. It is all but certain that the perspective of the insurer and the claimant or trial lawyer will begin diametrically opposed. After all, who really admits to being at fault for an accident?

It is only through effective negotiations that there will be a convergence of agreement as to the acceptable liability and damages. This is precisely why having a well planned negotiation strategy is of critical importance.

Like an effective campaign, the most effective negotiation strategy requires knowledge of the facts and of the other side's potential vulnerabilities. By capitalizing on opportunities, it becomes possible to leverage winning arguments to effectively position the claim for the most accurate resolution. It is this mastery of the art of negotiation that separates the extraordinary from the ordinary.