Unfortunately, this doesn't always happen. The fact is adjusters and attorneys don't always communicate well with each other, which creates gaps in claims handling and drives up costs for the employer and its insurer. Why does this happen, and more importantly, what can be done to improve communication and prevent gaps in claims handling?

For one thing, inadequate communication and miscommunication between attorneys and examiners typically stems from a lack of training. Attorneys are trained to litigate: they do not know nor utilize the terminology spoken in the claims world relative to the valuation of a claim's potential cost or appropriate settlement authority.

This is compounded by the fact that claims examiners often fail to let attorneys know precisely what information they need and the level of detail required for the examiners to value a claim accurately and on a timely basis. This is a precursor for the purpose of granting settlement authority.

In an industry that invests hundreds of millions of dollars annually in training, effective communication is one of the most important, yet often overlooked, topics of continuing education.

Intensive programs must be created to ensure both the attorney and claims examiner understand and utilize each other's language.

Improving Information Flows

There are a number of best practices for improving communication between claim administrators, adjusters and attorneys that will help bring greater efficiency to the overall claim management process and help generate better outcomes – both for the employer, its insurer and the injured worker. The following practices will help improve the communication and better position the file for an expedited resolution.

• Use standard forms and manage to quality. Most claims administrators have standard forms, but fail to hold adjusters and attorneys accountable for using them. An effective form allows for a quick view and a valuable analysis of the claim. To be effective the forms must provide pertinent information in a succinct manner.

• Use actual percentages to facilitate common understanding. Frequently used terms, such as “likely,” “remotely,” “probable,” and “possible,” etc., mean different things to different people. It is difficult to compute a dollar figure while utilizing these terms. A preferred approach, for example, would be “we have a 50% chance of prevailing.”

• Mandate the use of phone calls or conferences at key points. At the beginning of the litigation the claims examiner and defense attorney should thoroughly discuss the evidentiary record in existence at that time and the plan of action for each of them relative to moving the matter to resolution as expeditiously as possible. Further, prior to attorney appearances – whether in court or depositions – further discussions should take place regarding the expectations of both parties relating to the proceedings. Finally, any key changes to the evidentiary record should likewise require a telephonic or in-person conference.

• Track all requests. Failure of the claims legal team to provide information on a timely basis may very well result in an under or overvaluation of a case resulting in excessive or inadequate settlement authority – and ultimately a lost opportunity to settle the claim in an optimal fashion. A lost opportunity to settle early in the case often increases the claim cost (in most cases, exponentially). Any requests made by an attorney to a claims examiner, such as for settlement authority or evidentiary information (i.e., medical records) should be tracked and monitored. Likewise, when an examiner asks for information from an attorney, those requests should be monitored. Both the law firm and the claims administrator should have a safe means to elevate any delays in the process in a non-threatening manner. That is to say, it should be designed solely to facilitate communication of the requested information – and not for punitive purposes.

• Highlight key details in letters. It's not surprising that important information often gets lost or overlooked when it's buried in the text of a lengthy letter. Important information should be highlighted and emphasized. Ask your law firms for an executive summary or synopsis at the beginning of the correspondence, whether a letter or a report.

• Share information. Invite attorneys to participate in claim reviews, which will help ensure all relevant information is being communicated to them. Many attorneys won't charge for their time to attend the claim review, but you'll need to confirm this with any law firm you retain.

• Audit what is important. Audits provide an opportunity to identify program gaps early and offer the opportunity to rectify the situation. You might also use positive audit results to reinforce what is working. Share examples of excellent status reports and letters to help elevate performance of your entire team.

While communication breakdowns between claims examiners and attorneys result in longer durations, sub-optimal claim outcomes and greater costs, there are effective ways to prevent them. The fundamental steps to improve communication between claims executives and defense attorneys are relatively easy to implement. Although some of these steps require constant monitoring and reinforcement, the overall results of improved communication are measurable. Over time, the initial outlay for the requisite training will be recaptured many times over in the form of improved claims outcomes and associated costs.