Understanding the insurance company Part I - Pre suit

Jill Snyder Introduction Experience

New suits Approach Internal Requirements Handling policies New assignments

Investigation Facts And more facts Numbers And more numbers “other” facts

Know your audience Adjusters Managers Attorney negotiators Associate directors Directors

Know your audience Adjusters Experience Years in position Number of assignments Specialty Claims specialists Attorney specialists Medical specialists

Know your audience Internal hierarchy Authority based on position Reserves How are reserves set How are reserves changed Purpose of reserves

Know your audience Managers/Directors Specialists

Case presentation Know your case Present your case Case status/updates

Negotiations Goal for negotiations Proper reserve Proper claims assignment Is the case ripe for settlement?

Negotiations – demand Reasons to make a demand Reasons not to make a demand “suggestions” of value Proofs of value

Negotiations – timing Liability Is liability at issue? Other parties? Coverage Policy limits

Negotiations – Value Injuries Length of treatment Venue Plaintiff Wage loss/OOP/ Liens

Negotiations – homework Understanding value to the insurance company Not their first rodeo Case presentation Value – proofs Paralegals “RGIP”

Negotiations - Reserves Understanding reserves The “business” of insurance A claim reserve is money set aside for a claim that has been reported but not settled Money for the reserve is taken from a portion of the premiums paid. Loss reserves are an estimate of an insurer’s liability from future claims Reserves are adjusted based upon changed circumstances * Complex calculations must estimate loss dollars for future payments *but not happily!

Negotiations – documents Case presentation Medicals/injuries Treatment Wageloss Liens be aware of requirements for liens “other” expenses

Time limit demands A demand that sets forth a complete detailed analysis of liability and losses associated with the claim. The demand will set forth a demand for a specific dollar amount or “policy – limits with a reasonable deadline Timing of demand Purpose of demand Include relevant documentation TGFP!!!!

Conclusion Fine wine Is your case aging well? Or just aging? Insurance company goals Measuring success Creative resolution