School of Professional Lines
Learning Objectives
Overview of Professional Lines Insurance
This class will provide a broad overview of professional lines insurance and examine of the major types of professional lines policies, how they work in "real life" and the general categories of claims they're meant to protect against. There will also be an in-depth analysis of key policy terms and conditions and their significance.
After completion, participants will be able to:- Understand typical Professional Liability policy features including coverage triggers, key definitions and terms.
- Understand Duty to Defend vs. Reimbursement policy options.
- Identify what is a claim, common exclusionary language including issues relating to applications and warranties.
- Establish a working knowledge of key provisions and claim examples under various Errors & Omissions policies including Misc. Professional, Directors and Officers, Employment Practices and Fiduciary Liability Policies.
Roles Within Professional Lines
People perform a wide variety of functions in the professional lines insurance world. This class will explain the functions of various professionals, such as brokers (retail and wholesale), underwriters, claims analysts, actuaries, risk managers, coverage counsel, defense counsel, reinsurers, third-party administrators, managing general agents and others. The significant impact that the Claims function has on the overall profitability of an insurance company will also be examined.
Investigating and Evaluating Professional Lines Claims
Professional lines insurance claims can be very complex. This class will focus on best practices in thoroughly investigating claims (using a variety of resources) and using that information to accurately evaluate a claim's ultimate cost. Participants will also explore the importance of various policy provisions in formulating an accurate coverage analysis. In addition, the reserving process will be explained in depth with a discussion of various reserving practices and philosophies.
After completion, participants will be able to:- Identify and understand key aspects of Coverage. Understand the concepts of Cost Erosion, Per Event and Aggregate limits, and identify other potential sources of coverage.
- Understand the concept of Duty to Defend and the key aspects of Liability & Causation. Understand Duty, Breach, Proximate Cause and the need for Expert review as a foundation of professional liability claim evaluation.
- Understand the elements of General, Special and Exemplary Damages. Appreciate Tort Reform and its impact on exposure.
- Understand the concept of Reserve Philosophy, and understand why timely reserving is important.
- Identify external Investigative Services and how they can impact evaluation. Appreciate CMS reporting and the need to identify liens.
- Appreciate the nuances of each case and the various factors than can impact exposure.
Crafting the Perfect Coverage Letter and Assembling the Perfect Claim File
The wording of an insurance coverage letter, whether it sets forth a reservation of rights or an outright declination, can be critical in the overall disposition of a claim. This class will review essential elements of a well-crafted coverage letter. It will also explore the various components of a well-constructed claim file, with special emphasis on steps that must be taken to minimize the possibility of allegations of bad faith claims handling.
After completion, participants will be able to:Craft a coverage letter:
- Identify when a Coverage position letter is appropriate
- Identify the parties that should receive the position letter
- Appreciate the nuances of dealing with various parties
- Establish the necessary foundation to establish a viable coverage defense
- Initial Documentation: fundamental Items
- Identifying and establishing contact with interested parties
- Proper initial correspondence
- Identifying potential pitfalls of documentation
Coordinating the Claims Process
A number of stakeholders are involved in virtually every professional lines insurance claim. This segment will focus on how a claims professional can best coordinate the claims process among the various interested parties, including the insured, the insured's counsel, coverage counsel, other insurers, reinsurers and co-defendants' counsel. Strategies for dealing with each of these constituencies in an optimal manner to reach the best possible claim result will be explored.
After completion, participants will be able to:- Identify the life cycle of a typical professional liability claim
- Recognize the roles and responsibilities of each party involved in professional liability claims
- Analyze the potential impact on various parties respecting decisions made during the claims resolution process
- Better understand and aim for an optimal result for all parties in a professional liability claim
Resolution Planning: Your Roadmap for Steering Claims to Conclusion
A very beneficial ? yet often neglected ? element of successful claims handling is to formulate a strategy for resolving a claim as early as possible in the claims process. This class will discuss various resolution strategies and techniques, such as mediation, arbitration, settlement (including insights on optimal timing of a settlement offer) and seeing a claim through to final adjudication. Participants will learn the strengths and weaknesses of each type of resolution process and the characteristics that make claims particularly suited for each.
After completion, participants will be able to:
- Suggest options for resolving claims and engage in critical thinking and a constructive dialogue to help evaluate resolution options suggested by other stakeholders.
- Lead a collaborative effort with all stakeholders, including the insured and defense counsel, to formulate a cost-effective plan to resolve a claim that has the support of all stakeholders.
- Better assess the advantages and disadvantages of various forms of alternative dispute resolution (ADR), and learn how to fit the best form of ADR to a resolution plan and how to help influence the selection of optimal third-party neutrals.
- Better assess the utility of a proposed litigation strategy, including how to critically assess proposed discovery and motion practice proposed by defense counsel.
Negotiating Effectively — An Essential Skill
This class will provide an overview of a number of effective negotiating tactics, including when to implement them and when to refrain from doing so. Practicing professionals will provide real-world examples of both successful and unsuccessful negotiation strategies. Participatory exercises will aid class members in sharpening their negotiation skills and will identify issues in the negotiation process that are often overlooked.
After completion, the participants will be able to:- Appreciate the nuances associated with the art of negotiation and how to apply the skill set learned when presented with settlement opportunities.
- Recognize the core elements, within the negotiation exercise, and how to enhance the learned skill to affect positive outcomes.
- Observe the “what-not-to do’s” when confronted with difficult negotiation sessions and the pit falls to avoid ensuring the negotiation exercise is a productive event.
- Recognize when to end a negotiation without losing a future opportunity to successfully resolve a case.
- How to utilize defense counsel, in the negotiation exercise, without eliminating the role of the claim adjuster.
- How to evaluate whether a negotiation was successful utilizing an outcome based formula.
