Bill will be back next month…

Are We Building Relationships From Our Desks?

Andrea Collins
Sienna Staffing

I was talking to an Adjuster friend who has worked in the business for over 20 years. We always talk about kids and house prices, but the conversation always leads to shop talk. Even though it has been sometime since I have been on a desk, I still remember the breakneck speed of the work and how the majority of my time was spent on the phone talking to injured workers, insureds, and various others who are involved in the life of a file. Many of these people I would never meet, but nevertheless, I would have an impact on them by the way I handled my cases.

My friend now does some auditing, but mostly she adjusts run-off accounts for various companies. She says she is more familiar with the postmortem of a case than any other stage of a file. She can see the arch of a case from her vantage point. The various contributions of each file handler weaving a story of victories or missed opportunities. Of course, she always laments that many of the mistakes she sees in these files are from lack of training.

My friend came from an era where companies had structured training programs to allow their employees time to learn their jobs instead of the “trial by fire” method of training favored by so many companies. Then, learning technical skills came with learning to deal with people. Not the “I’ll tell them what they need to know to get off my back” kind, but learning to build relationships with people. My friend points out that much of the style and nuances of claims handling has been lost in the more convenient yet impersonal types of communication.

“Everything is done by email” she said wistfully, “Just the other day, I received an outrageous demand letter from an Applicant’s Attorney on one of my cases and instead of emailing her, I got on the phone.” The case, she explained, was worked out with a compromise, because of an effort to make human contact; a connection that left both parties satisfied and a willing to work together again in the future.

She points out that sometimes, she will call her injured workers to ask how they are. “When I was training, were expected to talk to the injured worker periodically to keep communication open. We were told that contact created trust; something I don’t see much of these days.”

I could hear the phones ringing in the background, signaling an end to our break. She told me she had to get back to work. We promised we would get together soon. She asked me to email her when I had time to go to dinner. “Yeah,” I said with a smile. “I’ll email.”

Suggestions can be sent to Bill@adjustingworld.com

Okay, has this ever happened to you ?

Stephen L. Kline, Esq.
ARMSTRONG LAW FIRM
stephenk@arm-law.com

Maintaining Attorney-Client Privilege

Applicant is injured and then is terminated. Applicant files the work comp application and also adds a Labor Code sec 132a action. The carrier has one attorney and the employer has separate counsel for the 132a action.

Employer prepares a confidential summary for their attorney of the applicant‘s history with the company and sends it off to their attorney. That attorney then sends the confidential summary to the carrier’s counsel, who in turn sends it to the adjusting agency and the carrier … are you still with me?

A co-defendant insurance company subpoenas the adjusting agency’s claim files and the confidential summary is photocopied and given to the Applicant’s attorney (AA). At the MSC, employer’s attorney notices the confidential summary in AA’s file and demands its return.

AA says “no way”, the privilege is waived. The Workers Compensation Judge say return it and AA must pay $200 in sanctions.

The Fourth District Court of Appeal upheld the attorney-client privilege and the sanctions against AA in Lamouree v WCAB (Cal Casualty & Liberty Mutual), 70 Cal Comp Cases 640. “Because the summary was plainly privileged, AA had an obligation to return it to defense counsel, which he did not do. The imposition of sanctions is an available remedy for such conduct. (Lab. Code, § 5813).”

Moral of the story. Be careful what you let be copied from your file. If possible, have your submissions to SDT photocopy services reviewed by attorney to redact any privileged documents. Part of what you pay for is the protection of that attorney-client relationship and its waiver can happen in a snap. Here it was saved, by the skin of their teeth. You may not be so fortunate.

The Plight of Obtaining Contributions from CIGA.

Starting to be settled is the law with respect to getting contributions from insolvent carriers through the California Insurance Guarantee Association (CIGA). The news is not good. In a published decision, CIGA v WCAB (Weitzman), 70 Cal Comp Cases 556 (2 nd Dist, 2005), the Court of Appeals held that despite the general principle that “a workers' compensation insurer that pays a claim for which other insurers are partially responsible generally can seek contribution from those insurers.” , the exception to the rule is where the carrier goes insolvent and CIGA stands in their shoes.

CIGA successfully argued that Insurance Code section 1063.1, subdivisions (c)(5) and (c)(9)(i) and (ii), clearly states “that CIGA is not responsible for reimbursing solvent insurers where, the solvent insurer paid workers' compensation benefits due to injuries sustained during periods of coverage by the insolvent insurers.”

Section 1063.1, subdivision (c)(5) provides: '' 'Covered claims' does not include any obligations to insurers, insurance pools, or underwriting associations, nor their   claims for contribution, indemnity, or subrogation, equitable or otherwise, except as otherwise provided in this chapter.''

Section 1063.1, subdivision (c)(9)(ii) provides: '' 'Covered claims' does not include . . . any claim by any person other than the original claimant under the insurance policy in his or her own name . . . and does not include any claim asserted by an assignee or one claiming by right of subrogation, except as otherwise provided in this chapter.''

More critical attention is called for with dates of injuries for cumulative trauma claims. The Courts are upholding CIGA’s very strong position, that we don’t reimburse any other carrier.

Spring at last! Kind of makes you want to clean out your closets and wash your windows, doesn't it? Well, almost. It's also the time of year to clean up your career. Here are a few ideas to freshen up your career or make a clean sweep altogether.

§ Scrub up your job satisfaction. If you've been crabbing about your job, now is the time to begin the process of change. The summer months are a good time to network. Once a week, call a colleague or schedule a lunch with someone in a related industry. By the time fall rolls around, you will be able to make a clear-headed decision and may even have some job offers... More >>

NURSE CASE MANAGERS
Experienced Nurse Case Managers for all of Northern California
Send resumes to recruiter@siennastaffing.com

WORKERS' COMP ADJUSTERS, CLAIMS ASSISTANTS, & SUPERVISORS
Experience work comp personnel with at least 3 years of experience For openings in San Francisco, Oakland, Concord, Walnut Creek & San Jose, for temp and perm positions.
Benefits for temps: PTO, medical, dental, vision
Send resumes to recruiter@siennastaffing.com

Results of the May Poll

Who Should Be Responsible For Training Insurance Personnel?