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Proper Claim Management Procedures (Part 1)

Posted by Richard Spiers on May 19, 2020 at 12:42 PM

If you are a public entity or school district that initially handles all your claims in-house because you are totally self-insured or have a self-insured retention of over $100,000, this blog is going to discuss procedures that should be put together and the areas of a claim that you need to analyze before determining the level of exposure you may be facing.  There are many aspects of a case that you need to investigate, even if they initially appear to be somewhat insignificant. 

If you are managing your claim handling staff, you should put together a claim handling procedure manual, so your file handlers know what needs to be done when they are dealing with a claim.  When a plaintiff attorney gets involved in a case, he may seek a review of your handling manual.  They will look for ways to say that the claim was not handled properly and will use that to get the media’s attention that handling procedures were not adequate and not properly followed. If you do have an excess policy with an insurance carrier, it would be good to contact their claim staff to see if they would be willing to share some details of their handling policy. There are several important handling procedures that need to be addressed. 

When a claim gets reported, the file handler should begin an investigation quickly and not be hesitant in reaching out to the involved people within 24 hours. There are many times that the media learns of an incident soon after it occurs. Uninvolved people may have witnessed some of the incident and many will use their phones to video and record what they have observed. Even though they may not have witnessed all of the incident, they will share their videos and their opinions with the local news media or decide to post things on social media within minutes, which can start generating negative publicity that may have an effect on the case. These eyewitnesses may not have seen the whole event, and their opinions are not always 100% positive and correct. Your file handlers need to quickly learn all details about what happened and have good conversation with the employees involved with the incident. It is always good to have your file handlers build a good relationship with your employees before any incidents occur, so the involved parties will not be hesitant to share anything with them when something happens. 

It is also important to make sure this incident will be covered under your insurance policy. If you are not totally self-insured, you need to make sure your coverage will apply and will help you know when it is a good time to report this incident to your carrier.  Another area to make sure is improved is your internal communication. When something occurs that does not originally appear to be significant, some departments will not consider reporting it to the risk management department because they feel they did nothing wrong. It could be weeks later that a plaintiff attorney gets involved. An investigation that starts several weeks later can have a restriction on whom to contact regarding the incident and some witnesses’ identity may disappear.


Cheryl Tinsley

May 20, 2020 at 11:05 AM

As usual, Rick, good, sound advice. Thanks for sharing!