Claims/Litigation Management - SESSION 1 - Claims Resolution Strategies in Workers' Compensation - The Partnership Between the Employer, Broker, Adjuster, and Legal Counsel
Derek Aiken, ESIS
Ferdinand Castillo, Alliant Insurance Services, Inc
Norm Licanto, Georgia-Pacific
Erwin Nepomuceno, Manning & Kass, Ellrod, Ramirez, Trester LLP
This seminar will identify and emphasize the team approach between all of the key participants in the defense of a workers' compensation claim and provide advice on each team members' role and tasks.
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Claims/Litigation Management - Break
Claims/Litigation Management - SESSION 2 - The Demographic Challenge - Does Your Organization Mirror Your Client and Customer Base?
Alan Freisleben, Freisleben Law Group
Cynthia Tobisman, Greines Martin Stein & Richland LLP
Patricia Walker, Tower Hill Insurance Group, LLC
We are undergoing a tremendous demographic shift due to the impending retirement of the “boomers”, the arrival of the “millennials”, the effects of waves of migration, and the arrival/emergence in the workforce as well the customer base of a growing number of ethnically and gender diverse populace. When you look around the table at your office, and look at your client demographic, do you see a gap? How do you plan to recruit, promote, and retain colleagues that mirror your customers, both now and in the future? Our panelists have some thoughts.Back to top
Claims/Litigation Management - Break
Claims/Litigation Management - SESSION 3 - Great Customer Service or How Not to Catch a Case of Bad Faith
Edward Carlton, Quilling, Selander, Lownds, Winslett, & Moser, P.C.
Ted Colquett, Colquett Law, LLC
Sarannah McMurtry, Acceptance Auto Insurance
Deborah Molitz, Self Employed
Why is good customer service important? The company’s extra-contractual exposure may depend on it. Insureds and claimants are first and foremost customers, because they have the ability – as all product customers do – to choose between alternatives. From the point of view of an overall claims department effort, customer service plays an important role in a department’s ability to control payments, retain goodwill, and prevent extra-contractual liability. From that perspective, customer service should be included as part of an overall approach to systemic improvement.Back to top
Claims/Litigation Management - Cocktail Networking
Claims/Litigation Management - Breakfast
Claims/Litigation Management - Keynote Speaker - Keynote
Claims/Litigation Management - SESSION 4 - Articulating Value and Distinguishing Yourself from the Competition: Top 5 Conversations that Capture the Attention of Prospective Clients
Donna L. Burden, Burden, Hafner & Hansen, LLC
Mike Ethridge, Ethridge Law Group
Randall Norris, Encova Insurance
This program will revolve around the age old problem of how attorneys do a poor job of articulating their value to insurance carrier clients. Through information contained in recent surveys (including the CLM Litigation Management Study General Report) and through conversations between the members of this panel and insurance executives, this program will explore what carriers and claims directors are most interested in hearing from defense firms. We will cover topics like how to use and present metrics that measure performance and some of the things attorneys can say to senior claims personnel and litigation executives to get their attention. The presentation will fall squarely in the litigation/claims management arena.Back to top
Claims/Litigation Management - Break
Claims/Litigation Management - SESSION 5 - Know When to Hold 'Em, Know When to Fold 'Em
Mark James, Columbia Lloyds Insurance Company
Rhonda Thompson, Thompson, Coe, Cousins & Irons LLP
Holly Wolf, Geovera Advantage Insurance Services, Inc.
This panel will focus on the components of a litigated insurance claim and considerations in resolving the litigation. The primary, although not exclusive, context of the discussion will be on catastrophe or large volume commercial and residential property claims and the ensuing litigation, although the issues also translate to third party liability claims. The panel will identify the key and typical parts of a litigated claim (i.e., pre-suit activity, discovery, pleadings, venue, experts, trial) and will discuss the practical, financial and legal issues and aspects specific to each part of the litigated claim. Integral to the presentation is providing each participant with pre-prepared cards that constitute his or her "hand". The cards will provide hypothetical facts related to some of the issues typical to litigated claims. Based upon the "hand" the participant has been dealt, the group – as facilitated by the panel members – will discuss the strategies and considerations in defending and resolving each participant’s hypothetical litigated claim, ultimately reaching group consensus about whether the participant should “hold ‘em or fold ‘em”.Back to top
Insurance Fraud - SESSION 1 - Identity Theft and Identity Fraud - Does It Affect Insurance Claims?
Maria Elena Abate, Colodny Fass, P.A.
Stephen Jones, Admiral Insurance Company
Mariela Perez-Pennock, Assurant
This panel discussion will provide real life examples of both identity theft and identity fraud and discuss how they impact insurance. The panelists will discuss the latest schemes and scams and emphasize the checks and balances need to be in place to combat a growing epidemic. Participants will be asked to join in the discussion and examine their own “risk” score. After the presentation, participants will be able to define Identity (ID) Theft and ID Fraud as well as recognize ID Theft/Fraud in several different lines of insurance. They will also be able to identify action steps to counter ID Theft/Fraud and how it applies to applications, claims and coverage.Back to top
Insurance Fraud - SESSION 1 - Where's Waldo? Using Technology Tracking in Claims Investigations
Brett Kelley, Liberty Mutual
Matthew J. Smith, Coalition Against Insurance Fraud
Gene A. Weisberg, GladstoneWeisberg ALC
The technology explosion is dramatically changing how insurance claims involving potential fraud are being investigated and litigated. Insurance carriers who are “ahead of the curve” are using everything from smart phone and GPS tracking to consideration of drone technology as tools in the claim investigation process. As with any form of new technology new risks and concerns also arise. These range from government regulations to the need to update policy language and claims authorizations. This course will address all aspects of these and other new ways to successfully investigate and litigate insurance claims involving fraud.Back to top
Insurance Fraud - Break
Insurance Fraud - SESSION 2 - On the Record: The Value of Cell Phone Records in Suspicious Claims Investigations
Gianina Dimitriou, McDowell Shaw Garcia & Patton
Nancieanne Hopkins, GEICO
Princess Spencer-Kuc, Renue Systems of Indiana
The course objective is to educate those working in Special Investigations in obtaining and using cell phone records in claims investigations. Participants will walk away with a better understanding as to why cell phone records are a powerful investigative tool, and how to better overcome the legal and practical obstacles faced in acquiring these records.Back to top
Insurance Fraud - Break
Insurance Fraud - SESSION 3 - The Black Car Blues: Investigating and Adjusting Potentially Fraudulent Claims Involving Suspected Rideshare Drivers
Stephanie Glickauf, Goodman McGuffey LLP
Todd Keller, American Family Insurance Company
Valerie Moore, Self Employed
Constance Woods, American Southern Insurance Company
Uber, Lyft, and Sidecar, etc. are “ridesharing services.” Through the each company’s own smartphone app, passengers request a ride from a driver who is driving their own car, not a taxi or limousine. The drivers receive passenger requests through the app, decide whether to take the fare, and pick up and drop off the passenger at the passenger’s desired location. Drivers turn on the app when they want to take fares and turn off the app when they’re done working for the day. At the end of the ride, the passenger’s credit card is automatically billed to a credit card on file with the company.
Although we’ll use the term “ridesharing companies” throughout our presentation and paper, most ridesharing companies describe themselves as “technology companies.” There are two significant implications of ridesharing companies’ self-description. First, if ridesharing companies self-identify as “technology companies” that connect passengers with drivers, not “transportation service providers”, liability coverage under the ridesharing company’s policy versus the driver’s personal auto policy becomes a complicated question. Second, the lack of available liability coverage due to commercial exclusions in personal auto policies can lead to fraud. We will discuss how and why and how to detect and prevent fraud.Back to top
Insurance Fraud - Cocktail Networking
Insurance Fraud - Breakfast
Insurance Fraud - Keynote Speaker - Keynote
Insurance Fraud - SESSION 4 - Investigating and Litigating Large Scale Fraud Claims
The panel will discuss the unique challenges associated with investigating and litigating large scale fraud claims. Topics will include multi-claimant/suspect fraud actions such as RICO, plant wide Workers’ Compensation actions, medical billing, class actions and construction defect. While many of the tools applicable to single claimant fraud actions are applicable in the large scale situation, there are additional procedural, practical and strategic differences in investigating and litigating these large scale and multi-party fraud claims. Experienced SIU investigators will discuss on the ground investigative techniques while claims and outside counsel personnel will discuss the practicalities of pursuing an affirmative claim of fraud or asserting an affirmative defense of fraud. This is intended to be an interactive panel discussion with practical examples.Back to top
Insurance Fraud - Break
Insurance Fraud - SESSION 5 - Mock Trial Seminar
Richard Duffy, The Hartford
Vincent Gerbino, Bruno Gerbino Soriano & Aitken
Cathy Gicker, Allstate Insurance Company
Monica O'Neill, Thomas, Thomas & Hafer, LLP
Through a mock trial presentation, we will discuss the claim investigation process and what factors lead to the SIU referral. We will focus in on what frontline claims representatives should look for with respect to claims that are or should be referred to SIU.Back to top
Product Liability - SESSION 1 - To Mock or Not to Mock: Can You Really Improve The Odds with Mock Trials and Focus Groups?
Mock trials, focus groups, and other jury research provide litigants with powerful tools to maximize their chances of success in any given litigation. This presentation will provide insight into how to effectively use these techniques to increase your chances of winning. The beginning of this presentation will focus on one of the primary ways in which jurors make decisions – through the use of mental shortcuts known as “decision making biases.” By understanding these “decision making biases,” the parties to a lawsuit can tailor their messages in persuasive ways that will increase the chances of winning. The middle of this presentation will address some of the specific jury research tools available to litigants, including cost-effective methods such as on-line jury research. The panelists will also provide some specific examples of “success stories” demonstrating how jury research has been effective in particular cases. The end of this presentation will address some of the legal issues surrounding the use of mock trials and focus groups, including confidentiality issues and the potential for recovering costs and fees associated with conducting a mock trial exercise.
Product Liability - Break
Product Liability - SESSION 2 - Asbestos Litigation - The Bad Penny That Will Not Go Away
James Abbott, Litchfield Cavo LLP
Victor Hertz, Legal Language Services
Charles Stoll, Sedgwick
The Panel will provide an update or “state of the union” regarding asbestos claims across the country, including an in depth discussion of recent developments in the hotbed venues and “judicial hellholes.” The Panel will address why asbestos filings have continued to be prevalent despite the fact that less people are developing asbestos related diseases such as mesothelioma. The Panel will also discuss issues involving the plaintiff’s bar’s continual efforts to forum shop and how the courts are dealing with removal/ forum non conveniens issues. Additionally, the Panel will update the audience regarding recent verdicts, case law and trends throughout the country, highlighting which defense arguments have been successful and which have not. Lastly, the Panel will address litigation and defense strategies, such as the chrysotile defense, low dose exposure and causation arguments, and state of the art defenses. The audience should find this information useful in getting caught up on the latest developments and defense strategies in combatting asbestos claims.
Product Liability - Break
Product Liability - SESSION 3 - Products Liability and The Workers' Compensation Bar. Can I Really Sue My Employer?
Dawn Dezii, Margolis Edelstein
M. Kathryn Rogers, PruittHealth, Inc.
Patrick White, Kershaw White
This is an interactive panel discussion focusing upon direct action litigation against employers, by employees. There are instances wherein an employee can proceed with a third party tort claim against his/her employer which may involve products liability or other conduct. For example, there are pieces of equipment, which if not operated, maintained, up graded, inspected, after they leave the manufacturer’s hands, become the responsibility of the employer. How that employer operates its business, and the practices its puts into place may arise to such a level as to allow that conduct to be deemed willful, wanton, or grossly negligent, when someone is injured. What type of conduct is necessary to allow an employee to bring suit against his/her employer. There are also well established exceptions to the Workman’s Compensation bar, such as Jones Act claims, and other evolving claims which may state courts are facing. This session will look at not only these defense of these claims, but also the insurance coverage aspect of these claims.
Product Liability - Cocktail Networking
Product Liability - Breakfast
Product Liability - Keynote Speaker - Keynote
Product Liability - SESSION 4 - The Use of 3D Scanning In the Defense Of Product Liability Cases: Practical Issues, Discovery and Admissibility At Trial
Timothy Gross, Sompo America
Charles Smart, Triumph Motorcycles Ltd
Robert D. Sullivan, Wilson Elser Moskowitz Edelman & Dicker LLP
This lecture will explain how 3D scanning is used to measure accident scenes, accident products and other evidence in product liability lawsuits. Our goal is to explain how state-of-the-art 3D scanning is use to present evidence at trial. In addition, we will discuss pitfalls to be avoided during data collection and the discovery process.
3D scanning is becoming an indispensable tool in the investigation of product liability claims and in the defense of product liability lawsuits. 3D scanning is the most accurate way to measure accident products and accident scenes. 3D scanning is a convenient method for preservation of evidence. Anyone who handles product liability claims should be familiar with 3D scanning including how 3D Scanning works; its costs and its advantages. This presentation will explain 3D scanning technology operates. We will explain the costs and benefits of 3D scanning. We will address the preconceptions that some claims handlers have about the costs of 3D scanning. We will explain the benefits that 3D scanning his in the preparation of demonstrative aids and trial evidence.
In addition, for those attorneys involved in the defense of product liability cases, we will suggest best practices for discovery compliance with respect to 3D measurements. We will also suggest practices that facilitate the introduction of trial evidence created based on 3D scan measurements.
Product Liability - Break
Product Liability - SESSION 5 - Simplifying through Storytelling: Use of Animations and Graphics In Complex Product Liability Claims
Carly Celmer, Clyde & Co
Chris Egner, Continental Tire the Americas, LLC
Jeffrey Wheeler, Vector Scientific, Inc.
“If you can’t explain it simply, you don’t understand it well enough.” – Albert Einstein
One of the challenges in product liability claims is how to explain the complex design and/or manufacturing process of a product to a judge or jury (or even a plaintiff) in a way that can be understood simply, quickly and unambiguously. Graphics and animations that effectively “tell the story” of a product can greatly impact case outcomes both in pre-trial negotiations and in trial. But how are they created and when are they appropriate? This panel will discuss the use, cost and transformation of complex scientific testimony regarding manufacturing processes, design, safety features, and product use through graphics and animation. Attendees will experience the process of developing an effective demonstrative aide from the perspective of designer, counsel, and client, and then will engage in an activity to “try their hand” at telling a product’s story to enhance a client’s defense.
Workers' Compensation - SESSION 1 - Opioids in the MSA - How to Mitigate MSA Exposure and Maybe Even Save Lives
Amy E. Bilton, Nyhan, Bambrick, Kinzie & Lowry, P.C.
Jennifer L. Miller, United Fire Group
Randy Rizor, The Physicians Spine and Rehabilitation Specialists of Georgia, P.C.
Opioid use and abuse has been a hot topic in the news recently, and for good reason. From 2001 to 2013, US overdose deaths from prescription drugs increased 250%, with opioid deaths alone increasing 300% in that time. The panelists will discuss the opioid epidemic; its impact on claims and Medicare Set-Asides; and how good claim handling early on can mitigate overall exposure. The panelists will use specific examples and give real-life tips on how to effectively handle these tough cases.
Workers' Compensation - Break
Workers' Compensation - SESSION 2 - Aging Gracefully? The Senior Workforce and Impacts on Workers' Compensation
K. Martine Cumbermack, Swift, Currie, McGhee & Hiers, LLP
Marcos Iglesias, Travelers
LaRonda Razor, Utica National Insurance Group
Francis X. Wickersham, Marshall Dennehey Warner Coleman & Goggin
The collective age of the workforce is rising and having a significant impact on workers’ compensation claims and their associated costs. Approximately 20% of today’s workforce is aged 65 or older, which is double the rate it was in the 1990’s. In 2016, the number of workers over the age of 55 is expected to be almost 40 million. While this group has fewer work injuries, they can also be more expensive. This session will address the challenges the aging workforce presents to the workers’ compensation industry from a medical, legal, and claims perspective, and will provide practical, cost-effective strategies for managing such claims.Back to top
Workers' Compensation - SESSION 2 - Playing Against a Stacked Deck: Using Poker Theory to Better Manage Workers' Compensation
Lucy Jenkins, American BOA, Inc.
James Moran, Nyhan, Bambrick, Kinzie & Lowry, P.C.
Martin Pickett, Amerisure Mutual Insurance Company
The theory, practice and skills required to play high level hold ‘em poker are often identical to the skills needed to effectively handle workers' compensation defense claims. Poker players must make decisions - - whether to raise, call or fold - - based upon imperfect information. Whether to settle or proceed to trial, accept or deny, which depositions to take and investigations to pursue, and the like, are all “bets” we are making on a claim. The best strategies for both often involve probability, psychology, luck and budgetary acumen. A great claims handler, like a great poker player, is part mathematician, part psychologist and part private detective.
Workers' Compensation - Break
Workers' Compensation - SESSION 3 - Medicare Secondary Payer Compliance: The Critical Transition to the Commercial Repayment Center (CRC)
Mike Carney, Self Employed
Maggie James, Gallagher Bassett Services, Inc.
Bennett Pugh, Fidelity Fiduciary Company LLC
As part of the continuing efforts to improve the Coordination of Benefits & Recovery (COB&R) program the Centers for Medicare & Medicaid Services (CMS) has transitioned a portion of the Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) recovery workload from the Benefits Coordination & Recovery Center (BCRC) to its Commercial Repayment Center (CRC). The CRC has assumed responsibility for the recovery of conditional payments where CMS is pursuing recovery directly from a liability insurer (including a self-insured entity), no-fault insurer or workers’ compensation (WC) entity (referred to as “applicable plans”) as the identified debtor. This informative session will detail the important role of the CRC, as it works to identify and recover conditional payments, issues Conditional Payment Notices and Demand Letters and resolve disputes and appeals. Ben Pugh, a partner at Franco Signor LLC, will lead a diverse panel that includes Donna C. Shenesky from American Mining Insurance Group and John Costanzo from Coca-Cola, as they discuss the implications of this monumental shift in the way the government works to protect the vast Medicare trust fund. The audience will gain valuable insights into the best practices for navigating this very complex new system.
Workers' Compensation - SESSION 3 - Workers' Compensation Alternatives - The Option and Non-Subscription Improving Outcomes and Results
Elizabeth Bailey, Waffle House, Inc.
Chris Mandel, Sedgwick
William Pipkin, Austill, Lewis, Pipkin & Maddox, P.C.
This presentation will address alternatives to traditional workers' compensation and the exclusivity doctrine. A number of cases across the country have questioned these alternatives. The roundtable will address whether these options provide the competition needed to improve benefits to injured workers while balancing costs to employers. This session will explore how appropriate alternatives to workers’ compensation can foster innovation and competition benefiting both injured workers and employers. The panelists will promote discussion on whether these options promote free market alternatives to statutory workers compensation insurance which adequately ensure injured employees are treated respectfully and compensated fairly in the aftermath of an on-the-job injury. The discussion will address differences between what Oklahoma has done and what has been in place in Texas for years, as well as efforts to pursue similar alternatives in other states. The discussion will address the controversy over whether these alternatives encourage improved claims management and financing processes and whether they radically change the fundamentals or best practices of claims handling.
Workers' Compensation - Cocktail Networking
Workers' Compensation - Breakfast
Workers' Compensation - Keynote Speaker - Keynote
Workers' Compensation - SESSION 4 - Developing a Robust Return to Work Program
Todd DeStefano, ESIS
Michelle Leighton, Conner Strong & Buckelew
Michele Punturi, Marshall Dennehey Warner Coleman & Goggin
Richard Sumner, Ulta Beauty
This presentation will provide practical tips and actionable information to expedite the return of injured employees to gainful employment, while avoiding litigation under the Workers' Compensation Act. Attendees will gain insight from the perspectives of insurance professionals, a risk manager, and a defense attorney, who will discuss the benefits of a light duty program, including alternative work assignments and the importance of job descriptions; the best use of panel providers; and how and when to use outside experts, including case nurse managers and independent physicians. Need-to-know information about job offer letters and the specific language and contents they must include, will also be explained. The presentation will conclude with a discussion of best practices in closing a workers' compensation file.Back to top
Workers' Compensation - SESSION 4 - Effective Use of Social Media in Workers' Compensation Claims
Loreitha Lacewell, Risk Free Consulting
Esther Omoloyin, Goldberg Segalla LLP
Dorothy Stolle, Boeing
Social media is becoming one of the major methods of communication and expression in today’s society. Businesses and individuals both use various social media applications to connect with others. Many users feel a sense of community, intimacy and security when sharing online. These are some of the reasons why social media is now one of the top avenues to investigate the legitimacy of a workers’ compensation claim. With a few clicks, an investigator may be able to uncover information that disproves the occurrence of an alleged work accident or challenges the severity of an injury. Social media investigation is a necessity in workers’ compensation claims.
Workers' Compensation - Break
Workers' Compensation - SESSION 5 - Why is Pain Management Such an "Epic Fail" in Workers' Compensation Claims?
Victor Chin, The Physicians Spine and Rehabilitation Specialists of Georgia, P.C.
Ryan Klee, Drew Eckl & Farnham
Amy Urban, AIG
This lively discussion will focus on pain management difficulties in the context of workers’ compensation claims with recommendations from a panel of medical and legal experts for more effective pain management practices including the importance of taking a functional/rehabilitative approach in pain management. Issues to be addressed will include medical and legal efforts to combat chronic and overuse of opioids, the role of co-morbidities in treatment, as well as best practices from a pain management perspective to return Claimants to work, lower claim costs, and bring claims to an effective resolution in complicated and contentious pain management situations such as those involving Reflex Sympathetic Dystrophy/ Complex Regional Pain Syndrome (RSD/CRPS) and spinal cord stimulators.Back to top