Creative Settlement Strategies for Workers’ Compensation Programs

Cindy Parker – Vice President, Operations Sedgwick

October 31, 2014

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“If you do what you've always done, you'll get what you've always gotten” - Anon

Creative Settlement Strategies for Workers’ Compensation Programs

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Creative Settlement Strategies for Workers’ Compensation Programs

When it comes to aging . . .

Claims are not like fine red wine

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Preface: Two Populations to Consider: Older & Newer No Silver Bullet No Pilots Settlements had to Remain Reasonable

“I can settle and close any claim we have, all it takes is money”

- Don Marken

Creative Settlement Strategies for Workers’ Compensation Programs

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Mission #1 Keep the new claims from becoming old claims

What did we do? Changed our settlement philosophy Employed = C&R Not Employed = C&R Value all cases for a C&R Arrange personal discussion if needed Stipulation only as a last resort Monthly scorecard to track results

Creative Settlement Strategies for Workers’ Compensation Programs

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Creative Settlement Strategies for Workers’ Compensation Programs

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Results: 5,089 claims settled by compromise and

release for existing employees over a 6 year period

241 (5%) of those employees filed a new claim for the same settled body part

Total New Reports up 13% Open indemnity inventory reduced by 47% Reduction in ultimate loss expense of

$45,870,000

Creative Settlement Strategies for Workers’ Compensation Programs

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Creative Settlement Strategies for Workers’ Compensation Programs

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Mission #2 Close those old claims

What did we do? Review all open claims

3 years old or older Look for key indicators

Medicare eligibility Treatment patterns Milestones

$ettlement offer

Creative Settlement Strategies for Workers’ Compensation Programs

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Creative Settlement Strategies for Workers’ Compensation Programs

Case Studies Nip & Tuck Mine, Mine, Mine Hearing Crashers Social Media . . . The privacy button use it or lose it! You Can’t Tell the Players Without a Scorecard

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Creative Settlement Strategies for Workers’ Compensation Programs

Case Studies Nip & Tuck

The injured employee had mentioned several times to the examiner how hard it was for her to face turning 60. She mentioned wishing she could have work done like the celebrities do but she doesn’t have that kind of money.

2 weeks before her 60th birthday the examiner worked up her future medical case for settlement and offered her a nice lump sum just in time for her milestone birthday.

Case closed

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Creative Settlement Strategies for Workers’ Compensation Programs

Case Studies Mine, Mine, Mine

The injured employee had mentioned several times to the examiner that he was going through a very contentious divorce. He made the comment that his ex-wife was taking everything.

The examiner worked up the future medical case for settlement and suggested that the injured employee may want to consider a lump sum settlement right after the divorce was final.

Case closed

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Creative Settlement Strategies for Workers’ Compensation Programs

Case Studies Hearing Crashers

The examiner could not get the applicant attorney to respond to her attempts to discuss an early settlement of a contested and potentially expensive new litigated case.

The examiner did an extensive EAMS search and found the applicant had an upcoming hearing with a different employer. She went to the hearing and cornered the applicant attorney until a very cost effective settlement was reached.

Case closed in 3 months.

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Creative Settlement Strategies for Workers’ Compensation Programs

Case Studies Social Media . . . The privacy button use it or lose it!

This case involved an claimant that alleged he was in essence bed ridden for 18 months except for his medical appointments.

A search of multiple social media sites including Facebook, Instagram, and Yelp showed a different story. The claimant had traveled extensively over the 18 months (great pics) and he was an avid Yelp reviewer posting daily reviews of restaurants and stores that he frequented with his friends.

Case settled at deposition after his testimony under oath that he was bed ridden.

Case closed.

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Creative Settlement Strategies for Workers’ Compensation Programs

Case Studies You Can’t Tell the Players Without a Scorecard

Learn the approaches of the various applicant attorneys and even the judges. Tailor your approach to those tendencies.

In this case (potential high exposure) there was an applicant attorney that truly became angry when she learned her client was untruthful. The examiner secured strong film and medical records evidence and set an early deposition.

Before the deposition the examiner asked to meet with the applicant attorney privately. She showed the attorney the evidence. The attorney immediately agreed to a settlement for less than the cost of a deposition.

Case closed.

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