Insurance Claims and Litigation Management 101 – Top Tips for Success

Published on 9/18/2020 by Bar List Publishing

In the wide world of insurance claims and litigation management, details will vary wildly from one case to the next. Novel situations will arise and sometimes the facts can be tricky. But no matter the complexity, there are some basic operating procedures for insurance claims professionals to hold to. When an insurance claim manager sticks to these best practices they can set the entire process off on the best possible footing. And when a claim goes smoothly, everyone involved can enjoy that proverbial sigh of relief. 

Be Thorough

When documenting the details of a case, it can be easy to rely on memory more than thorough note-taking. You could assume that when it comes time to take the next steps in the process, you’ll clearly remember that obscure policy requirement or a random line of client testimony. And while you might, if you plan on assuming anything, go into this with the knowledge that you probably will not be the only person to interact with the case. 

We all have a way of taking notes that makes sense to us. Certain symbols, personal shorthand, or hard-to-decipher acronyms and abbreviations that we use freely might puzzle someone else. But we can even confuse ourselves sometimes – have you ever looked back at your own notes and struggled to make them out? This disconnect ends up being more common than not.

The point is, as insurance claims professionals you know how important it is to cross every T in complying with legal and policy-related requirements – the same holds true in your note-taking. This is especially true when insurance litigation is involved. If a law firm or trial expert who had no familiarity with a claim were to read your notes, could they make sense of things? Could they effectively communicate the basic facts of the matter to someone else, based on your notes alone? It’s key that the answer is yes, because you won’t always be available to clarify. So when taking notes, be sure that they meet these basic criteria:

  • Paint a picture. Be sure that your notes answer the all-important five “Ws” (who, what, when, where, and why) and explain how the situation came about. Further enhance the scene with additional details.
  • Think audibly. If you aren’t available and someone unfamiliar with the case consults your notes, could they make sense of them when read aloud? If a third party is referencing your notes while a stenographer types away, will the facts shine through clearly in the final transcript?

Prevent Uncomfortable Surprises

Even happy surprises can cause controversy. So you can be sure that the sort of surprise that blindsides with unexpected, negative news will never go over well. The person on the receiving end could feel frustrated and overwhelmed and might very well take it out on you. This is especially true when the result is far different than expected or originally discussed. 

The recipient of this unwelcome surprise could feel that the case wasn’t handled properly. They might assume that no one was watching the situation unfold, or that at least there was a serious breakdown in communication. Once these negative assumptions have been planted, their mind could then be racing, wondering what else they don’t know. To protect against any more nasty surprises they could then bombard you with questions, wanting to know every detail of the claim. Worst of all, once the shock wears off they might feel justified in doubting and calling into question your decisions and methods. While this could feel terrible on the receiving end, it’s ultimately just a defense mechanism. It could now seem likely that there’s another unwanted surprise lurking in the details, just waiting to pounce. Staying hyper involved and skeptical is one way for someone on the other end to be ready. None of this fosters good relations or positive outcomes, so go into claims work or litigation determined to do all you can to eliminate surprises.

Set and Control Expectations

The best way to avoid an unwelcome surprise is to set reasonable expectations from the beginning. Once you have considered all the aspects of a given case or claim, communicate your findings with the necessary party. Of course you can’t speak in definite terms but if there is a clear trajectory in sight, or if you find details that often lead to a predictable outcome, share that information. It would be nice to be able to deliver on promises of an ideal outcome, but it’s best to stay realistic. So rely on your experience and expert intuition and be honest and upfront when offering your thoughts on how the case may go. If you encounter a situation or variable in the data that changes your thoughts, take the time and effort needed to communicate the revised expectations. Whether we’re talking about insurance claims management or insurance litigation, a smooth claim or case will ultimately boil down to accurate, effective, and consistent communication.

Be Realistic

As a hard-working and dedicated insurance claims adjuster, you are invested in your clients. So when a claim requires you to go all in, we know that you will. This level of commitment could lead you to persevere despite difficulties and dead ends, sure that the desired outcome is within reach. 

But this generally positive trait can also hide a potential issue, and your personal investment can have unintended consequences. At times, your determination to make things right for your client could blind you to weak points in a claim. You could dedicate extra time and energy, creativity and problem-solving skills when details point to a less-than-favorable outcome. And an oversight like this could throw you far off track. 

Don’t get us wrong – passion has a place, and it’s admirable that you’re willing to fight for your clients. That said, this is a dangerous phenomenon because it robs you of your objectivity, a necessary tool for every insurance claims professional. Clear, analytical thinking is vital, but after so much time and work it can be hard to admit that the outcome can’t be what you hoped for. Keeping a realistic mindset from the outset will help you to remain practical and can only enhance your already strong reasoning abilities.

Stay Objective

Each of us can easily allow our own bent on a situation – informed by personal experience, viewpoints, and interpretations – to block out all other perspectives. This myopic approach can lead insurance claims adjusters and managers to miss key details or downplay facts that could be vital to an ultimate decision. While it is certainly possible for you to remain objective in your assessments, it can be a tall ask. Working with a team is one way to avoid this pitfall, especially if everyone is free and open with their viewpoints. Diversity in experience and knowledge can combine to form a more comprehensive understanding of an overall situation and of the specific facts at hand. Everyone has their niche expertise and even within the same professional arena, viewpoints will vary. Pulling from each individual’s strengths is the best and surest way to set the process up for success. 

Set the Groundwork

The above “rules” are solid but basic guidelines. And here’s our last piece of advice: develop your own set of procedures before they’re ever needed. These will vary, and every managerial team will have to develop their best way to work through the claims or litigation process. But this bank of insurance adjuster resources will be invaluable. So use these suggestions to get your creative and analytical juices flowing. We know that collectively, you can use your varied talents and skill sets to nail down the just-right practices for your team. Together you will be able to effectively and efficiently serve clients and each other, keeping communication at your core. Here’s to your continued success! 

Trust the Experts

The Bar List insurance network has taken the time to fully vet every professional that we proudly include in our listings, and we stand by their expertise. If you’re in need of a skilled insurance or legal professional to better assist your clients, look no further. The Bar List insurance network is your reference source for insurance claims adjusters and also a key source for insurance news. We have the resources your company needs to be more effective in today’s chaotic business world. Reach out today to learn how our community of experts can help you.