1. Ethics: Do the Right Thing!
Presented By:
Courtney Davis
Jeff Moffett
Jackson, MS
Ocean Springs, MS

2. Duty to the “Insured” General Workers’ Liability Compensation
Insured Employer
Claimant?
Insured Employer
Claimant?

3. Conflicts of Interest Hartford Moeller
The insurer owes a fiduciary duty to the insured and is liable for all damages which result from the breach of this fiduciary duty. Hartford Accident & Indemnity Co. v. Foster, 528 So. 2d 255 (Miss )
Moeller v. American Guarantee and Liability Ins. Co., 707 So. 2d 1062 (Miss )
Options?
Provide a defense for the covered claims (favored)
Provide a defense for all claims under reservation of rights
Provide a defense for all claims without a reservation of rights (not favored)

4. Ethical Goals Efficient, effective claims handling
Encourage prompt reporting of injuries
Complete a prompt and thorough investigation
Have a good faith basis for denying any claim or benefit
Professionalism
Authorize medical treatment or other benefit timely

5. Constructive Denial
See Travelers Indem. Co. v. Weatherbee, 368 So. 2d 829 (Miss ) - Eight month delay was not the problem, bad faith was in the lack of active investigation.
See Caldwell v. Alfa Ins. Co., 686 So. 2d 1092 (Miss ) - Six week delay not unreasonable in light of evidence in file of active investigation.

6. Do NOT rely on your own medical opinions
Severity of an injury
Pre-existing conditions/prior injuries
Tutor v. UPS

7. Ex Parte Communication
Claimant
Medical Provider
When is it ok to contact the claimant?
What if the claimant contacts
you directly?
What if the claimant files a new claim?
When is it ok to contact the medical provider directly?
What information can you give the medical provider?

8. Communication with Claimant
Initial contact
Do not mislead or misinform
Do not threaten
Explain the process
Explain any delays
Can you share your opinions on a lawyer or
doctor the claimant has chosen?

9. Do NOT give legal advice
Do I need to hire a lawyer?
Settlement negotiations
What are your duties related to the statute of limitations?

10. Social Media Should you connect with a claimant on social media?
How can you ethically use
social media in claim handling?

11. Mileage Fee Schedule Section XIII
“The payer shall notify the claimant in writing of his/her right to receive mileage reimbursement for travel…Mileage must be paid promptly to the claimant without unreasonable delay. In the absence of good cause shown, any failure to pay a claimant’s mileage within 30 days after receipt of a request for mileage reimbursement from the claimant may be considered by the Commission to be an unreasonable delay and subject the payer to attorney’s fees, expenses, and a penalty of up to $10, ”
** Reimbursement includes trips to medical appointments
and trips to pharmacy or to obtain medical supplies!

12. Mississippi Code §
“Any person who willfully makes any false or misleading statement or representation for the purpose of obtaining or wrongfully withholding any benefit or payment under this chapter is guilty of a felony…”
When should you contact the Attorney General’s office?
When and how can you use the possibility of fraud charges as leverage?

13. Directing Care & Opioids
Choice of Physician issues
How can you direct care?
Can you suggest medication generics or opioid alternatives?

14. Offices in Oxford, Jackson, and Ocean Springs
Courtney Davis
Jeff Moffett
Jackson, MS
Ocean Springs, MS
Offices in Oxford, Jackson, and Ocean Springs