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Understanding the insurance company
Part I - Pre suit
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Jill Snyder Introduction Experience
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New suits Approach Internal Requirements Handling policies
New assignments
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Investigation Facts And more facts Numbers And more numbers
“other” facts
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Know your audience Adjusters Managers Attorney negotiators
Associate directors Directors
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Know your audience Adjusters Experience Years in position
Number of assignments Specialty Claims specialists Attorney specialists Medical specialists
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Know your audience Internal hierarchy Authority based on position
Reserves How are reserves set How are reserves changed Purpose of reserves
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Know your audience Managers/Directors Specialists
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Case presentation Know your case Present your case Case status/updates
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Negotiations Goal for negotiations Proper reserve
Proper claims assignment Is the case ripe for settlement?
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Negotiations – demand Reasons to make a demand
Reasons not to make a demand “suggestions” of value Proofs of value
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Negotiations – timing Liability Is liability at issue? Other parties?
Coverage Policy limits
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Negotiations – Value Injuries Length of treatment Venue Plaintiff
Wage loss/OOP/ Liens
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Negotiations – homework
Understanding value to the insurance company Not their first rodeo Case presentation Value – proofs Paralegals “RGIP”
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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!
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Negotiations – documents
Case presentation Medicals/injuries Treatment Wageloss Liens be aware of requirements for liens “other” expenses
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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!!!!
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Conclusion Fine wine Is your case aging well? Or just aging?
Insurance company goals Measuring success Creative resolution
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