Why Your Company Should Take a Team Approach to Claims Investigations

By Sean Flavin July 08th, 2021

At Captive Resources (CRI), we spend a lot of time thinking about and consulting with our captive clients on risk management, workplace safety, and how to prevent incidents. But the fact is, no matter how safe a company is, incidents do happen. When serious incidents occur, insurance claims are usually close behind. In these instances, a company needs to know how to respond quickly and conduct effective claims investigations.

To help companies understand how to handle claims investigations, we invited Rachel Didier — Assistant Vice President of Claims Operations at Gallagher Bassett — to join our Risk Control Webinar series. Below is a recap of Didier’s presentation. In keeping with her teamwork analogy, we broke the overview into a lineup of the three major players who need to work together to ensure a successful claims investigation.

The Lineup

  1. Insured/Client
  2. Claims professionals
  3. Defense counsel

Lead-Off Spot: The Insureds (e.g., Your Team)

As the lead-off hitter, your company sets the tone in claims investigations. Risk managers and other members of your management team charged with safety need to make sure your team knows what to do when an incident occurs. Here’s some advice from Didier’s presentation on how to make that happen.

Practice Makes Perfect

Preparation is critical for your team to respond to an incident successfully. Didier shared some tips for getting your employees ready to step up to the plate when an incident occurs.

Be familiar with your claims team: Knowing the key players at the TPA who help your company manage claims can make all the difference during a claims investigation. This familiarity is especially useful in facilitating communication and ensuring timely responses.

Have tools necessary to jump into action: When an incident occurs, the last thing you want is your team having to improvise a response. Train your team on how to complete an incident report and how to report the claim up the ladder. Your team should also be aware of surveillance cameras at your facilities and know how to pull any valuable recordings.

Execute the Game Plan

When an accident happens, your team’s actions will set the stage for the claims investigation. Do it right, and you’ll set yourself up for a big win; do it wrong, and you’ll clinch defeat from the jaws of victory. Here are some tips from Didier’s presentation on how to respond to an incident:

  • Talk to the claimant and secure a written statement.
  • Talk to employees and have them complete written statements.
  • Fill out an incident report based on written statements and eyewitness accounts.
  • Document the scene by securing photos and preserving video.
  • Prepare a list of employee witnesses and independent witnesses.
  • Keep any physical evidence, such as defective products.
    • Gather other documentation that will be helpful (e.g., crew schedules, time punches, relevant reports, etc.)

The 2-Spot: Claims Professionals

Next up to the plate is the claims professionals. According to Didier, it’s important to partner with a claims service provider who understands your business and values your brand. Take advantage of mutual training opportunities where you educate your claims provider about your business while they instruct your team on how to handle claims investigations.

As Didier put it: “Encourage collaboration, communication, and partnership.”

Here are some things your provider should be doing to ensure all the team members are prepared for a claims investigation:

Develop Protocols

Your claims provider should work with your internal teams to develop protocols that will facilitate securing evidence or expedite resolution. Protocols enable all parties involved to know who to go to, what questions to ask, and how to obtain key evidence.

Familiarize the Team with Policies and Agreements

Your claims provider should make sure everyone understands indemnification agreements with key suppliers or contractors. Doing so will expedite your ability to tender a claim to a third party.

Promote Teamwork Throughout the Investigation

Once an incident occurs and a claims investigation is initiated, it’s vital that your team and your claims provider works together to obtain and preserve all relevant material items in a timely fashion.

Since we've already outlined how to gather relevant items above, let's focus on the preservation element. Didier covered the concept of Spoliation of Evidence, which is "the act of deliberately, negligently, or accidentally destroying evidence that is considered relevant to the case.” According to Didier, the implications associated with the Spoliation of Evidence can include negative implications at trial (e.g., the optics of losing evidence to a jury) and an increase in the claim's value.

The 3-Hole: Defense Counsel

Even if your team and your claims partner do everything right, a claims investigation may end in litigation. When a claim ends up in litigation, it's time to bring in the big bat of a defense counsel. According to Didier, the job of the first two hitters is to set up the third batter for success and work together to determine if a claim rises to the level of requiring defense counsel’s expertise.

In many cases, there are several advantages of bringing in a defense counsel early in the process.  

“Early involvement of defense counsel can offer guidance on potential exposure and offer privilege when necessary,” said Didier.

Closing it Out

Successful claims management or litigation requires a team approach with the insured, claims team, and defense counsel working together toward a common purpose. The better your team is equipped to handle incidents, the more efficient the claims process will be, ultimately resulting in quicker resolutions and more favorable litigation outcomes.

About the Webinar

This presentation was part of CRI’s Risk Control Webinar Series — regular installments of webinars to educate the group captive members we work with on topics like workplace safety, organizational leadership, and company performance. The thoughts and opinions expressed in these webinars are those of the presenters and do not necessarily reflect CRI’s positions on any of the above topics.

Contact us to learn more about joining a group captive.

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