Insurance Settlements 

Table of Contents

I.  Claims Handling 1.     How Insurance Companies Process Claims 2.     The Claims Review Process: How to Win Claims and Influence Claims Adjusters 3.     Aspects of Claims Frequently Questioned by Adjusters 3A.  Spotting and Countering Adjuster “Dirty Tricks” 4.     Managing the Client’s ExpectationsII.  Valuing Claims 5.     How Insurance Companies Value Claims 6.     Determining and Proving Economic Damages 7.     [Reserved] 8.     How Reserves Are Established8A.   Questions to Ask Insurance Experts 9.     Proving Pain and Suffering10.    Handling Preexisting and Subsequent Injuries11.    Proving Hedonic Damages12.    Using Experts in Valuing and Settling Claims12A. Harnessing the Internet as a Claim Evaluation and Settlement Tool12B. Using Focus Groups and Mock Trials as Tools for Personal Injury Claim EvaluationIII.  Evaluating Coverage13.    Determining Coverage and Obtaining Policy Limits13A. Questions to Assess Coverage Problems14.    What to Do When Liability Is Denied14A. Homeowner's Insurance Coverage for Mold ClaimsIV.  Documenting Claims15.    Drafting Effective Demand Letters and Settlement Brochures16.    What Adjusters Need to Settle Claims17.    Chiropractic Treatment in Soft Tissue Injury Cases18.    Attorneys’ Guide to Medical Records18A. Countering Defense Independent Medical Examinations19.    Common Mistakes Made by Plaintiffs’ Attorneys in Documenting Claims

20.    Analyzing Opinion Letters: A Physician’s Insights on the Quality of Medical ReportsV.  Effective Negotiation21.    Negotiating Insurance Claims22.    Establishing Bad Faith23.    How to Negotiate With Insurance Companies and Avoid Settlement Delays24.    Maximizing Damages in Small Personal Injury Cases25.    Twenty-Six Tips From Seasoned Claims Adjusters25A. Mediation Tips for Personal Injury CounselVI.  Efficient Settlement26.    Evaluating Settlement Offers26A. Settlement Ethics27.    Structured Settlements: Opportunities, Problems and Benefits28.    Appraisal of Insurance Claims29.    Solving Common Settlement Problems29A. Handling Inflated and Other LiensVII.  Specific Types of Cases30.    Evaluation of Soft Tissue Injury Claims31.    Evaluating and Settling Medical Malpractice Claims31A. Investigating Cell Phone Use in Vehicle Liability Claim Recoveries32.    Settling Auto Accident Cases33.    Avoiding and Resolving the Classically Weak Case34.    Trauma & Post Traumatic Stress Disorder (PTSD): A Brief Primer for Civil Litigation35.    Stacking Un/Underinsured Motorist Coverages35A. Investigating Slip and Fall Claims36.    Investigating and Litigating Nursing Home Abuse37.    Investigating and Evaluating the Product Liability Claim38.    Investigating False Arrest Claims39.    Investigating Negligent Security Claims in Pursuing Damages for Crime Victims40.    Investigating Workplace Violence Claims41.    Sexual Molestation Claims: Liability and Coverage Issues42.    How to Combat Smaller and Smaller Settlement Offers in Minor Impact Soft Tissue Injury Cases

      

I.  CLAIMS HANDLINGChapter 1: How Insurance Companies Process Claims

§100        Creation of a Claim§101        The Reporting Process§101.1       Reporting to the Agency Which Sold the BusinessSample: Automobile Loss NoticeSample: General Liability Loss NoticeSample: Property Loss Notice§101.2       Reporting to the CarrierSample: Telephone Claims Report§102        Policy and Coverage Verification§103        Assignment for Handling§103.1       Resolution by “Fastrack”§103.2       Additional Information Requested by CorrespondenceSample: Statement of Claim§103.3       Additional Investigation by Telephone or CorrespondenceSample: Schedule of Lost ContentsSample: Claimant’s Report of Automobile Accident§103.4       Field Investigation — Staff Adjuster or Independent Adjuster§110        Checklist: Primary and Secondary Duties of the Adjuster§120        Accomplishing Primary Duties§121        Interviewing Parties Directly Involved§121.1       Proper Identification of Interviewee§121.2       Establishing Relationships of Parties Directly Involved§121.3       Developing Facts From the Perspective of the Interviewee§121.4       Determining the Specific Nature of the Injury or Property Damage§121.5       Determining the Specific Loss Associated With the Injury or Property Damage§121.6       Developing Any Ancillary Problems§121.7       Conducting an Assessment of the Interviewee§121.8       Developing Leads§122        Confirming and Preserving Facts§122.1       Official Records§122.2       Inspection of Accident Site§122.3       Inspection of Damaged Property§122.4       Documenting Property Loss§122.5       Assembling Medical DocumentsSample: Medical Report (Simple)§122.6       Interviewing Witnesses

Sample: Witness Statement§122.7       Following Up on Developed Leads§130        Performing Secondary Duties§131        Factors Affecting Claim Investigation§131.1       Training§131.2       Caseload§131.3       Adjuster Compensation§132        Evaluating Exposure§133        Reserving§133.1       Specific Methods of Reserving§133.2       Reserve Runs§133.3       Opening Reserve From Loss Notice§133.4       Primary Reserves§133.5       Reserve Review§134        Reporting§134.1       Informing Superiors of Details§134.2       Recommending ReservesSample: Claimant Summary§134.3       Suggesting an Action Plan§134.4       Requesting Settlement AuthoritySample: Individual Settlement Worksheet§135        Preparing Draft Request to Disbursal Center§136        Salvage§137        Subrogation and Contribution§140        The Negotiation Process§140.1       Settlement Conferences§140.2       Disputed Coverage§150        Risk and Insurance Management§151        Risk Managers§152        Risk Identification and Evaluation§153        Risk Treatment§154        Claim Handling§160        Litigation§170        Catastrophic Injury Claims§171        Inside Claims Management§171.1       Defining “Catastrophic Injury”

§171.2       Stages of Catastrophic Cases§172        Preparing for and Responding to Catastrophic Case IssuesChapter 2: The Claims Review Process: How to Win Claims                   and Influence Claims Adjusters§200        Introduction§201        Two Prerequisites to Closing the Claims File§210        Providing the Necessary Documentation§211        Documenting and Proving Liability§212        Documenting and Proving Damages§213        Medical References§220        Evaluating the Claim§221        Settlement vs. Verdict Value§222        Kinds of Damages — Factors§223        Is the Claim Within Normal Limits?§230        The Adjuster’s Settlement Authority§240        Working With Independent Claims AdjustersChapter 3: Aspects of Claims Frequently Questioned by Adjusters§300        Introduction§310        General Questions Adjusters Ask§311        First Party Claims§311.1       Fire Loss§311.2       Burglary Loss§311.3       Liability Coverage§311.4       Uninsured Motorist Claim§312        What Adjusters Look for in Evaluating Claims§312.1       Causal Relationship Between the Accident, Injury, and Medical Records§312.2       Proportionality§312.3       Correlation Between the Medical Records and Treatment Received§312.4       Complete Records and Supporting Documentation§312.5       Lost Wage Documentation§320        Red Flag Areas on Basic Claims§320.1       First Party Casualty Losses§320.2       First Party Property Losses§320.3       Third Party Liability Claims§320.4       Workers’ Compensation§321        How Claims Adjusters Use Surveillance

§321.1       Surveillance Evidence§321.2       Surveillance Considerations§321.3       Flagging Cases for Surveillance§321.4       Surveillance Options§321.4.1    Outside Adjusters§321.4.2    Professional Surveillance Firms§321.4.3    Surveillance Firm Qualifications§321.5       Preventing and Thwarting Surveillance Problems§330        The Ramifications of Insurer Involvement in Claims§331        Duty to Defend§332        Reservation of Rights Letters§321.1       Reasons for Issuing§321.2       Two Common Concerns§321.3       Impact on Recipient§321.4       Responding to Reservation of Rights Letters§333        Conflict of Interest§334        Index Bureau§335        Fraud§336        Permissive Use Cases§337        Other Insurance§340        Contracts Affecting Liability or Responsibility§350        Specific Categories Adjusters Watch Out for§351        Problems Raised by Product Liability Cases§352        Fraud§353        Permissive Use§354        Other Insurance§360        Insurer Special Investigative Units (SIUs)§361        Factors Suggesting Fraud§361.1       Personal Factors§361.2       Case Factors§370        ConclusionChapter 3A: Spotting and Countering Adjuster “Dirty Tricks”§300A     Introduction§310A     State Unfair Claim Practice Laws§320A     Insurer Motivation§330A     Common Adjuster Ploys

§331A     “I’d like to take your statement.”§332A     “Please sign this Medical Authorization Form.”§333A     “Why do you need an attorney? I’ll work with you on the claim.”§334A     “I’m here to canvass the neighborhood.”§335A     “If you don’t accept this amount now, we will withdraw all offers.”§336A     Colossus§340A     Ten Tips for Complaining About Adjuster “Dirty Tricks”§341A     Letter to Adjuster§342A     Letter to Supervisor§343A     Letter to Home Office§344A     Letter to State Insurance CommissionerChapter 4: Managing the Client’s Expectations§400        Types of Clients — Decision Makers and Others§401        Paying Clients§401.1       Hourly§401.2       Contingency§401.3       Flat Fee§402        Nonpaying Decisionmakers§402.1       Third Party Beneficiary (Insureds)§402.2       Indigent/Pro Bono§402.3       Institutional/Corporate§402.4       In-House Counsel§402.5       Insurance Companies§402.6       Defense Counsel Duties to Insured and Insurer§410        Entering the Battle — Clients’ Initial Expectations§411        “The Injured” and “The Accused”§412        Truth§413        Justice§414        Reality: The American Rule§414.1       Money Damages Only (Usually)§414.2       Pay Your Own Attorney Fees§414.3       Protracted Battle and Delay§420        Educating You and Your Client§421        The Initial Contact§422        Do I Take the Case?§422.1       Red Flags of Danger

§422.2       Contingent Fee Agreement§423        Writing to the New Client§424        Gathering Information§425        Evaluating the Case — Your Professional Opinion§425.1       Talking About Liability§425.2       Talking About Damages§425.3       Further Handling§430        Talking About Settlement§431        The First Demand and Offer: Valuation§432        The Realistic But Hopeful Settlement Offer§433        The Offer the Opponent Cannot Accept§434        Continued Negotiations§435        Talking About Negotiation Strategies§440        Sources of Client Misinformation§441        Popular Culture§442        Client Relations and Communications§442.1       Communication Techniques§443        Failure to Respond to Inquiries§444        Interference by Others§445        The Multi-Million Dollar Settlement§450        Controlling Unrealistic Expectations§451        Can You Control Your Client?§452        How to Get Your Client to Trust You§453        Sources of Assistance§454        Should You Withdraw?§460        Responding to Complaints§461        Your Fee in the Balance§462        Collecting Unpaid Fees§470    Managing the “Difficult” Client§471    Introduction§472    Factors Making Clients Difficult§472.1     Naiveté About the Court and Tort System§472.2     Grandiose Expectations of Financial Recovery§472.3     They Feel Bad§472.4     They Face Financial Pressures§472.5     Misplaced Expectations for Retribution or Vindication

§472.6     You Have Many Cases — They Have One§472.7     Distrust of Lawyers§472.8     “Peanut Gallery” Advice§473    Practical Hints for Spotting and Avoiding the Difficult Client§473.1     Telltale Danger Signs§473.2     Trust Your Gut§473.3     Index Your Client§474    Whether to Disengage§475    Disengagement Techniques§476    Client Control Issues in Managing Difficult Clients§477    Adversaries Have Client Control Issues§478    Conclusion

      

II.  VALUING CLAIMSChapter 5: How Insurance Companies Value Claims§500        Overview§501        Introduction§510        Claim Organizations — Insurance Carriers and Others§510.1       Anatomy of a Claim Department§510.2       Claim Department Organization §510.3       Role of Caseloads in Adjuster Evaluations§510.4       Role of Claim Valuation Software§511        Insurance Company Classifications§511.1       Commercial Carriers§511.2       Personal Lines Carriers§512        Organizations Retaining Claims Exposure§512.1       Self Insureds§512.2       Self-Insured, Self-Administered Entities§512.3       Uninsured Defendants§513        Noncarrier Claim Organizations§513.1       Third Party Administrators (TPAs)§513.2       Independent Insurance Adjusters§514        Summary§520        Flexibility in Settlement Evaluations§521        Settlement Ranges

§522        Effect of Plaintiff’s Demand§522.1       Effect of Policy Limits Demand§530        Economic Factors Affecting Case Evaluation§531        Medical and Related Expenses§532        Loss of Earnings and Earning Capacity§533        Defense Costs§540        Noneconomic Factors Affecting Case Evaluation§541        Estimates of Liability§541.1       Probability of Liability§541.2       Comparative Negligence§541.3       Contributions and Other Factors§541.4       Claim Committees§542        Insurance Matters§542.1       Insured’s Attitude and Control§542.2       Amount of Insurance§542.3       Excess Carrier Involvement§542.4       Coverage Disputes§542.5       Insurance Policy Provisions Regarding Valuation of Claims§543        Effect of Elaborate Settlement Proposals§544        Jurisdiction§545        Codefendant Factors§545.1       Opportunity for Indemnity§545.2       Self-Insured or Uninsured Codefendant§546        Threats of Bad Faith§547        Horror Factor§548        Plaintiff Attorney Experience and Reputation§549        Reference to Jury Verdict Reports§550        Common Evaluation Techniques§551        The X Times Specials Formula§552        [Reserved]§553        Earnings as Index to Special Damages§554        Judgment/Experience Method§555        Scheduled Evaluation Methods§555.1       Unit of Disability Method§555.2       Hourly Unit of Time§556        Computer/Statistical Methods

§560        Case Evaluation Examples Based Upon Case Severity§560.1       Assigning Unit Values§560.2       Evaluation of Permanent Disability§561        Minor Injury Cases§562        Significant Injury Cases§563        Catastrophic Injury Cases§563.1       Loss of Earnings and Earning Capacity§563.2       Future Medical Care§563.3       Wrongful Death Claims§570        Alternate Resolution Methods§571        Pretrial Settlement Conferences§572        Arbitration, Mock Trial, etc.§573        Mary Carter Agreements§574        Separate Settlements§575        Structured Settlements§580        Adjuster Evaluation Ploys & Other Insider Info§581        Evaluation Ploys§582        Ten Methods to “Unfreeze Adjuster” Case Evaluations§583        Confessions of a Claims Adjuster§584        Common Insurance Claim Evaluation MythsChapter 6: Determining and Proving Economic Damages§600        Elements of Economic Damages§601        Loss of Income Production§602        Loss of Economic Opportunity§602.1       Labor Shortages in the 21st Century§603        Loss of Labor and Skills to Family§604        Loss of Postinjury Worklife Income and Estate Value§604.1       Changes in Social Security Retirement Age§605        Loss of Personal/Family/Social Relationships§605.1       Hedonic Damages§606        Losses and Expenses Related to Vocational Rehabilitation§606.1       Order of Selection§610        Documenting Economic Damages§611        Defining Postinjury Capability§612        Defining Residual Functional Capacity§612.1       AMA Permanent Impairment Rating

§612.2       Evaluating Work Tolerance§612.3       Job Search and ADA§613        Defining Transferable Skills and Capacities§613.1       Standard Vocational Assessment Techniques§620        Proving Loss of Past Wages and Future Economic Opportunity§621        Defining Preinjury Income Stream and Career Development Potential§622        Defining Individual Postinjury Career Development and Income Potential§623        Defining Postinjury Career Development and Income Potential With Generic Data§624        Estimating Length of Worklife§630        Death or Disablement of Unemployed Persons§631        Employers and the Disabled§632        Documenting Good Faith Job Search§632.1       Faulty Application Forms§640        Defining Contribution of Labor and Skills to Family§641        Fair Market Value of Household and Personal Services§650        Loss of Post-Worklife Income and Estate Value§651        Reduced Pension and Social Security Income§652        Reduced Savings and Property Holdings§660        Adjustment to Changes in Lifestyle Caused by Economic Damages and Restriction of Opportunities§661        Independence and Avocational Pursuits§661.1       ADA and Public Access§662        Self-Concept and Self-Esteem§662.1       Worst-Case Scenario§663        Career Development and Stagnation§670        Vocational Rehabilitation Intervention§671        Establishing Plaintiff Feasibility for Rehabilitation Intervention§672        Vocational Rehabilitation Services§673        Rehabilitant Profile§674        The Rehabilitation Counselor as a Vocational and Present Value Expert Witness§674.1       Rehabilitation Economists§675        Assessments for Evaluating Economic Damages§676        Present Value ComputationSample: Present Value Computation§677        Economic Impact of Vocational RehabilitationSample: Table Showing Economic Impact With Vocational Rehabilitation

§678        Economic Impact of No Vocational RehabilitationSample: Table Showing Economic Impact Without Vocational Rehabilitation§680        Intangible Variables Which Affect Evaluation of Damages§681        Defining Individual Differences§682        The Agony of Litigation§690        Defining Objective Measures of DamagesChapter 7 [Reserved]Chapter 8: How Reserves Are Established§800        In General§801        What Are Reserves?§802        Financial Implications of Reserving§803        Reserves and Settlement§810        How Reserves Are Established§811        Elements of Consideration When Setting Reserves§812        Sample Case Evaluation§813        Reserve Guidelines§820        Specific Methods of Reserving§821        Average Value Method§822        Loss Ratio Method§823        Tabular Value Method§824        “Reserved to Exposure”§825        Reserve Review§830        How Reserves Are Used§831        Importance of Reserves to Adjusters§832        Adjusting Reserves§833        Summary of Factors Contributing to a Claim Evaluation§840        Example of Case Reserving§850        ConclusionChapter 8A: Questions to Ask Insurance Experts§800A     Introduction§810A     Checklist — Questions for Insurance Experts§820A     Resources for Finding Insurance ExpertsChapter 9: Proving Pain and Suffering§900        Introduction/Sources of Proof§910        Investigating and Preparing Your Case§920        Negotiating (Trying) Your Case to the Insurance Company

§930        Settlement Practice Tips and Tactics§940        Litigation — Trying the Case to a Jury§950        Checklist: The Ten Commandments of Proving Pain and SufferingChapter 10: Handling Preexisting and Subsequent Injuries§1000      Overview§1010      Preliminary Investigation§1011      Query the Client§1011.1     Importance of Honesty§1012      Preexisting Injury or Preexisting Condition§1012.1     Medical Records§1013      Investigate Prior Injuries§1013.1     Medical Textbooks§1014      Investigate Prior Diseases§1015      Investigate Subsequent Injuries§1020      Effective Use of the Treating Physician§1021      The Role of the Treating Physician§1022      Query the Physician§1023      Physician’s Medical ReportSample: Physician’s Report§1024      Physician’s Deposition§1030      Proximate Cause§1031      Differentiate Old Injuries From New Injuries§1031.1     Subsequent Injuries§1031.2     Subsequent Medical Negligence§1032      Actions of the Defendant§1033      Types of Causation§1034      Prepare the Doctor for Proximate Cause§1035      Potential Cross-Examination of Plaintiff§1040      Damages§1041      Medical Expenses§1041.1     Future Medical Expenses§1042      Disability and Disfigurement§1043      Pain and Suffering§1044      Loss of Earnings§1045      Aggravation of Preexisting Conditions§1046      Loss of Consortium

§1047      Loss of Enjoyment of Life§1048      Mitigation of Damages§1049      Apportionment of Damages§1050      Negotiation Strategies§1051      Analyze the EvidenceChapter 11: Proving Hedonic Damages§1100      Hedonic Damages§1101      Development of the Concept§1102      Variation Among State Statutes§1110      Categories of Personal Injury Damages§1120      The Landmark Case of Sherrod v. Berry

§1121      District Court Opinion§1122      Seventh Circuit Court of Appeals Affirmation§1123      Seventh Circuit Court En Banc Rehearing§1130      Loss of Enjoyment of Life§1131      Supporting Case Law§1140      Cost-Benefit Analysis§1141      Establishing the Value of Human Life§1150      Loss of Enjoyment of Life vs. Pain and Suffering§1151      Proving Loss of Enjoyment of Life§1160      Using an Economist to Determine Value of Life EstimatesSample: Direct Examination of EconomistSample: Cross-Examination of Economist§1161      Using Lay Witnesses to Supplement Economist’s TestimonyTable: Hedonic Damages in Personal Injury CasesChapter 12: Using Experts In Valuing and Settling Claims§1200      Introduction§1201      Overview§1202      Deciding Whether to Use an Expert§1203      Facts and Information Upon Which Experts Rely§1204      Determining Whether an Expert Should Testify§1205      Styles of Expert Testimony§1210      Experts as Consultants§1220      Selecting Experts§1221      Introduction§1222      Referrals From Counsel

§1223      The Professional Witness§1224      Contacting and Communicating With Expert Witnesses§1225      Checklist — Finding, Screening, and Using Experts§1226      Expert Retention Letter§1227      Selecting the Right Life Care Planner for Your Personal Injury Case                §1227.1   What Is a Life Care Planner                §1227.2   When a Life Care Planner Is Needed                §1227.3   Case Selection Checklist                §1227.4   Role of Life Care Planner                §1227.5   Cost                §1227.6   References                §1227.7   Current Case Load                §1227.8   Professional Credentials, Background and Training                §1227.9   Life Care Planner Selection Checklist                §1227.10 Red Flags                §1227.11 Conclusion                §1227.12 Resources§1230      Discovery of Expert Opinions§1231      Statutory Disclosure Requirements§1232      Expert Testimony§1233      Federal Rules of Evidence, Rules 702, 703, and 705§1234      Cross-Examining an Opponent’s Expert§1240      Limitations on the Use of Experts§1241      Frye v. United States

§1242      Daubert v. Merrell-Dow Pharmaceuticals, Inc.

§1242.1   Deposition of Outline for Opposing Expert§1243      The Lesson of Ofstedahl v. City of Phoenix

§1250      Ethical Considerations§1260      Expert Fees§1270      Expert Strategies

§1271      Should You Bring Your Expert Witness Live to Trial?

§1272      When to Name Experts

§1273      Connect With Experts

§1274      Videotaping a Defense Medical Exam

Chapter 12A: Harnessing the Internet as a Claim Evaluation and Settlement Tool

§1200A   Introduction§1210A   [Reserved]§1220A   Internet Resources§1221A   Search Engines§1222A   Electronic Legal Research§1223A   Listserves§1224A   Web Sites§1225A   Court Web Sites§1226A   PACER and Electronic Court Filing

§1227A   Blogs

§1230A   Specific Uses for the Internet as a Claim Evaluation and Settlement Tool§1231A   Litigation Management and Support§1232A   Networking§1233A   Information Gathering§1234A   Researching Expert Witnesses§1234A.1  Identifying and Retaining Expert Witnesses§1234A.2  Neutralizing Hostile Experts§1235A   Evaluating and Mediating Claims Online§1236A   Using E-Mail for Claim Negotiating

§1236A.1  Is E-Mail for Liars?

§1236A.2  Use Subject Headings

§1236A.3  Receipt and Read Verification on Claim-Related E-Mails

                  to Adjusters§1236A.4  Verifying Receipt of E-Mails

§1240A   Speed Bumps on the Information Superhighway§1241A   Security Issues§1242A   Timeliness Concerns§1243A   Computer Viruses§1244A   The “Spam” Factor§1245A   Defamation RisksChapter 12B: Using Focus Groups and Mock Trials as Tools in Personal Injury Claim Evaluation§1200B           Introduction§1210B           The Difference Between Focus Groups and Mock Trials§1211B   In General§1212B   Focus Groups

§1213B   Mock Trials§1214B   Sequential Use§1220B           Advantages of Focus Groups and Mock Trials        §1221B   Force Advance Preparation§1222B   Give Each Side Advance Peek at Other’s Arguments§1223B   Preview Juror Reactions§1224B   Provide Opportunity to Test and Fine-Tune Arguments and Themes§1225B   Provide Opportunity to Test Efficacy of Evidence§1226B   Provide Objective Valuation§1227B   Calibrate Client Expectations§1228B   Let Client See You Work§1230B           Disadvantages of Focus Groups and Mock Trials§1231B   Cost§1232B   Feedback May Be Unreliable§1233B   Inability to Strike Mock Jurors§1234B   Inability to Duplicate Sympathy Factor§1235B   Time Constraints§1236B   Other Difficulties With Mock Trials§1240B           Respective Roles of Vendor and Counsel in Mock Trials and Focus Groups§1241B   Counsel’s Role§1242B   Vendor’s Role§1250B           Tips for Doing it Right§1251B   Whether to Recommend a Mock Trial or Focus Group§1252B   Use Demonstrative Evidence§1253B   Other Tips for Mock Trials§1260B           Caveats§1261B   Small Venues§1262B   Use of Results in Mediation§1263B   Confidentiality§1270B           Selecting the Vendor§1271B   Finding the Right Vendor§1272B   Selected Vendors for Mock Trials and Focus Groups

    

III.  EVALUATING COVERAGE

Chapter 13: Determining Coverage and Obtaining Policy Limits§1300      Establishing Coverage§1301      Discover Existing Policies§1301.1     Lost Policies§1302      Intentional Torts§1302.1     Is Defendant Covered?§1302.2     Avoiding the “Intentional” Exclusion§1302.3     “Intentional” or “Wrongful” Conduct?§1302.4     Intended Conduct that Is “Negligent”§1303      Continuing Occurrences and Progressive Injuries§1303.1     Multiple Insurance Policies§1303.2     Trigger Issue — Identifying Implicated Policies§1303.3     Manifestation Theory’s Impact on Coverage§1303.4     Emerging Trend Toward Adoption of Multiple Trigger Theories§1303.5     Allocation of Costs Among Insurers§1303.6     Number of Occurrences in Multiple Injury Cases§1304      Excess Insurance§1305      Know When Not to Demand Policy Limits§1306      Don’t Demand Policy Limits Unconditionally if Damages Exceed Minimal Limits§1307      Documenting the Assets of the Defendant§1308      Communicate With Your Client and Obtain Consent to Settle§1309      Review Underinsured Motorist Coverage§1310      Obtaining the Tortfeasor’s Policy Limits§1311      Checklist for Settlement Demand§1312      Meeting With Adjuster§1313      Using Client’s Uninsured Motorist Policy When Coverage Is Excluded Under the Tortfeasor’s Liability Policy as an “Intentional Act”§1320      Persuading the Insurance Carrier to Reveal Policy Limits§1321      Reasons Why Insurance Carriers Don’t Usually Reveal Policy Limits§1322      Devices for Persuading Adjusters to Reveal Policy Limits§1330      Coercing Stubborn Insurance Companies to Pay Policy Limits§1331      Law Regarding “Bad Faith” Actions§1331.1     Insurer’s Duty of Good Faith§1331.2     Essential Prerequisites for Recovery of Bad Faith Damages§1331.3     Insurer’s Liability Above Coverage Limit§1331.4     Examples of Bad Faith

§1331.5     “Bad Faith” in Denying that the Tortfeasor Is Uninsured§1332      Defense Counsel’s Perspective in Preventing Bad Faith Exposure§1333      Coercive Devices for Obtaining Policy Limits§1334      Breaking the Stalemate With an Insurance Adjuster§1335      Combining Approaches§1336      Breaking the Stalemate With a Defense Attorney§1340      Coercing the Stubborn Underinsured Motorist Carrier to Approve a Policy Limits Settlement§1350      Policy Limits and Structured Settlements§1360      Checklist — Avoiding Malpractice Relating to Acceptance of Policy Limits§1370      The Carrier’s Duty to Provide Independent Counsel§1371      Conflicts of Interest Requiring Independent Counsel§1372      Types of Conflicts Requiring Independent Counsel§1373      When Independent Counsel Not Required§1374      Duties of Independent Counsel§1375      Selection of Independent Counsel§1376      Payment of Independent Counsel§1377      Privileged Communications in Conflict of Interest Cases§1378      Duties of Counsel Selected by Insurer Where There Is a Conflict of Interest§1379      Duties of Counsel Selected by Insurer Where There Is no Conflict of Interest§1380      Duties of Coverage Counsel§1381      Control of Litigation§1382      Insurer’s Reservation of Rights as to Reimbursement and Independent Counsel Issues§1383      Obtaining Recovery of Pretender Fees§1384      Duty to Defend Only Suits§1390      Duties Between Independent Counsel and Insurer-Selected CounselChapter 13A: Questions to Assess Coverage Problems§1300A   Introduction§1310A   Common Coverage Defenses§1320A   Insurer Ploys§1330A   Dynamic Nature of Coverage Issues§1340A   Avoid Malpractice Claims§1350A   Checklist — Questions to Assess Coverage Problems§1360A   Sample Reservation of Rights Letter§1370A   Sample Non-Waiver Agreement

Chapter 14: What to Do When Liability Is Denied§1400      Introduction§1410      Determining Why the Claim Was Denied§1411      Information Required From the Client§1412      Contacting the Agent§1413      Writing the Insurance Company To Obtain Information§1420      Assessing the Potential Claim§1421      Breach of ContractChecklist: Elements of Breach of Contract§1422      Bad FaithChecklist: Elements of Bad Faith§1423      Fraud§1424      Negligence§1425      Unfair Business Practices§1430      Pre-Suit Investigation§1431      Insurance Department Records§1432      Government and Court Records§1440      Discovery§1441      Interrogatories§1441.1     Contentions§1442      Request for Production and Subpoena of Insurance Files and Documents§1442.1     The Internal Claims File§1442.2     Agent’s File§1442.3     Underwriting File§1442.4     Training and Marketing Materials§1442.5     Bonus Programs§1442.6     Complaint Records§1443      Depositions§1443.1     Agent§1443.2     Claims Personnel§1443.3     “No-Lose” Questions§1443.4     Deposition Outline — Defense Medical Expert§1443.5     Examination Techniques — Defense Medical Expert§1450      Trial Strategy§1451      Voir Dire§1451.1 Checklist — Voir Dire

§1451.2 Examination Techniques§1452      Opening Statement§1453      Order of Witnesses§1454      Closing ArgumentChapter 14A: Homeowner's Insurance Coverage for Mold Claims§1400A   Introduction§1410A   How Mold Problems Arise§1420A   Why Are Mold Claims So Prevalent Now?§1430A   The Ballard Case§1440A   Extent of Problem§1450A   Possible Causes of Action and Defendants§1451A   First Party Claims§1452A   Third Party Claims§1460A   Proving Causation§1470A   Typical Damages§1480A   Jackpot Recoveries§1490A   Determining What Policies Are Triggered by Mold Claim§14100A Policy Exclusions14101A   Coverage Avenues in Spite of Exclusions§14110A Coverage Caps§14120A Indemnity§14130A Attorney Fees§14140A Notice Issues§14141A Form: Notice Letter to Insurer§14150A Time Limitations on Actions§14160A Insurance Agent's Role in Mold Claims Process§14170A Sample Verdicts§14180A Resources

    

IV.  DOCUMENTING CLAIMSChapter 15: Drafting Effective Demand Letters and Settlement Brochures§1500      Introduction§1501      Is This a Case You Really Want?§1502      Determining Liability and Causation§1503      The “P.I. Five”

§1503.1     Liability§1503.2     Damages§1503.3     Defendant With Ability to Pay§1503.4     The Good Plaintiff§1503.5     The Bad Defendant§1510      Working With Adjusters§1511      Initial Contact With the Adjuster§1512      What the Carrier Has That You Don’t§1520      What About Your Fee?§1530      What You Need to Have in Your File§1531      Client Diary§1532      Independent Medical Examination§1533      Checklist: What You Need to Have in Your File§1534      Demonstrative Evidence§1540      When Do You Address Settlement?§1541      Should You Settle Before Pleading?§1542      Organizing Your Records and Your Thoughts§1543      Preparing a Settlement Brochure§1544      Video Settlement Brochure§1550      Where to Start and What to Say§1551      Family Background§1552      Prior Medical History§1553      Facts of the Accident§1553.1     Facts Outline — Slip and Fall Case§1553.2     Facts Outline — Products Liability Case§1553.3     Facts Outline — Premises Liability Case§1554      Injuries§1555      Special Damages and Disability§1556      Pain and Suffering§1557      Exhibits§1558      Legal Evaluation§1559      Consideration of an Excess Verdict§1560      How Much Is Enough?§1561      Plaintiff’s Credibility§1562      Using a Mock Jury§1570      The Demand Closing

§1580      Tips for Improving Settlement Brochures and Demands

§1581      Personalize Your Client

§1582      Organize Medical Records

§1583      Make the Written Product User-Friendly

§1584      Acknowledge Soft Spots

§1585      Sweat the Details

§1586      Allow Adjuster Reasonable Lead Time

§1590      What If It Doesn’t Settle?

§1591      Alternate Dispute Resolution in the 21st Century

§1591.1     Examples of Successful Alternate Dispute Resolutions

§1592      Forms of Alternate Dispute Resolution

§1592.1     Mediation

§1592.2     Checklist for Mediation Preparation

§1592.3     Arbitration

§1592.4     Checklist for Arbitration Proceedings

§1592.5     High/Low Arbitration

§1592.6     Mini Trials

§1592.7     Third Party Neutral Evaluation

Chapter 16: What Adjusters Need to Settle Claims§1600      In General§1610      How a Claims Index Works§1611      Technology in the Nineties§1612      How the Adjuster Uses the Index Information§1620      Narrative Summary About Your Client§1621      Using the Narrative Summary to Favorably Influence the Adjuster§1630      Public Agency Reports§1640      Dealing With the Client’s Medical Bills§1641      The Right Way to Provide the Client’s Bills to the Adjuster§1642      The Best Way to Explain the Client’s Bills to the Insurance Adjuster§1650      Obtaining Your Client’s Complete Wage Records§1651      Ways to Handle Negative Information from Your Client’s Employer§1660      Dealing With Medical Records§1661      Narrative Report Comparing Medical Records§1662      How to Avoid Unpleasant Surprises§1670      Narrative Summary of Expected Future Expenses§1671      Narrative Summary of Expected Future Medical Treatments

§1680      Statement of Exact Amount of ClaimChapter 17: Chiropractic Treatment in Soft Tissue Injury Cases§1700      Introduction§1710      The Effectiveness of Chiropractic Treatment§1711      Practice Pointer§1720      The Law Governing the Scope of Chiropractic Treatment§1721      Practice Pointer§1730      The Chiropractor’s Education§1731      Practice Pointer§1740      The Chiropractor’s Professional Study§1741      Practice Pointer§1750      Levels of Chiropractic Care§1760      Chiropractic Problem Areas and How to Deal With Them§1761      Request That Chiropractor Reduce Bill§1770      Sample Direct Examination of a Treating Chiropractor in a Soft Tissue Injury CaseChapter 18: Attorneys’ Guide to Medical Records§1800      Introduction§1801      Obtaining Medical Records§1802      Determining if the Record Is Complete§1802.1     Components of Hospital Records§1802.2     Components of Doctor’s Office Records§1810      Hospital Admission Records§1811      Hospital Admission Sheet§1812      General Consent to Treatment§1813      Assignment of Insurance Benefits§1813.1     Checklist: Questions for Defense-Appointed Physician§1820      Doctors’ and Nurses’ Admission Histories and Examinations§1821      Components of Medical, Family, and Social Histories§1822      Physical Examination§1823      Dealing With Defense-Oriented Doctors§1824      Nurse’s Assessment§1830      Doctors’ Progress Notes and Nurses’ Daily Notes§1831      The S.O.A.P. Method§1832      What Progress Notes Should Include§1833      What Daily Notes Should Include§1840      Surgery and Special Procedure Records

§1841      Special Procedure Consent Forms§1842      Surgery or Special Procedure Reports§1843      Anesthesia Records§1844      Operating Room Nursing Notes§1845      Recovery Room Records§1846      Intensive Care Unit Records§1850      Other Components of Hospital Records§1851      Emergency Room Records§1852      Graph of Vital Signs§1853      Medication and Intake and Output Records§1854      Doctor’s Orders and Consultation Reports§1855      Electronic Fetal Monitor Record§1856      Therapy Records§1857      Department Studies§1857.1     Radiology Department Studies§1857.2     Laboratory Studies§1858      Autopsy Report§1859      Incident Report§1860      Doctors’ and Nurses’ Discharge Summaries§1870      Medical Records Status Report and Activity Log§1880      Analysis of Medical Records§1881      Perform Chronological Analysis§1882      Case Scenarios Demonstrating the Importance of Medical Records§1890      The Essential Medical Bookshelf for Personal Injury Practitioners§1891      Introduction§1892      The Essential Texts and SoftwareChapter 18A: Countering Defense Independent Medical Examinations§1800A   Introduction§1810A   Exam Process§1811A   Scheduling Exam§1812A   Warning Signs§1813A   Candor Pays Off§1814A   Client Preparation§1815A   Client Tips on Meeting Doctor§1816A   Physical Exam§1817A   Client Should Track Exam Time

§1820A   After Exam§1830A   How to Exploit Common Mistakes in IME’s§1840A   Doctor “Irrationally Biased” Against Claimant§1850A   Bad Faith ClaimsChapter 19: Common Mistakes Made by Plaintiffs’ Attorneys in                    Documenting Claims§1900      Introduction§1901      The Players§1901.1     The Plaintiffs’ Attorney§1901.2     The Defense Interest§1901.3     The Client§1901.4     The Trier of Fact§1902      The Hypothetical Incident§1910      Mistake Number 1: Failing to Know Specifically What You Need to Document§1910.1     Overview§1910.2     Checklists of Needed Documents§1911      The Client Questionnaire§1912      Initial Client Conference§1912.1     Use the Client Questionnaire§1912.2     The Importance of Honesty§1912.3     Discussing the Litigation Process§1912.4     Note Taking§1912.5     Attorney Fees§1912.6     Closing the Initial Conference§1913      Initial Case Evaluation and Investigation§1914      Accepting or Rejecting the Case§1914.1     Accepting the Case§1914.2     Rejecting the Case§1914.3     Inform Others of Your Representation§1915      Written Correspondence§1916      Telephone Conversations§1917      Pleadings§1918      Discovery§1919      Litigation Costs§1920      Mistake Number 2: Failing to Prove Liability and Damages§1920.1     Legal Research

§1921      Documents Evidencing Liability§1921.1     Photographs§1921.2     Accident Report§1921.3     Witness Statements§1921.4     Repair Estimates§1921.5     Miscellaneous Public Records§1921.6     Medical Records§1921.7     Expert Witness Reports§1921.8     Physical Evidence§1921.9     Demonstrative Evidence§1922      Documents Evidencing Damages§1922.1     Noneconomic Damages§1922.2     Pain and Suffering§1922.3     Hedonic Damages: Loss of Enjoyment of Life§1922.4     Emotional Distress§1922.5     Loss of Self Worth§1922.6     Disfigurement§1922.7     Plaintiff’s Diary§1922.8     Photographs§1922.9     Day-in-the-Life Videos§1922.10   Recorded Statements§1923      Economic Damages§1923.1     Medical Expenses§1923.2     Future Medical Expenses§1923.3     Loss of Earnings and Future Earnings Capacity§1923.4     Disability§1923.5     Rehabilitation§1923.6     Property Damage§1923.7     Loss of Use of Property§1924      Dealing With Preexisting Conditions§1925      Punitive or Exemplary Damages§1926      Loss of Consortium§1927      Wrongful Death§1928      Documents Pertaining to Recovery§1929      Documents Confirming Settlement Authority§1930      Mistake Number 3: Failing to Obtain the Documents You Need

§1931      Informal Discovery§1931.1     Preliminary Investigation§1931.2     Books and Journals§1931.3     Investigation by Plaintiff§1931.4     Medical Record Releases§1931.5     Employment Record Releases§1931.6     Public Records§1931.7     Expert Consultants and Witnesses§1931.8     Informal Request to the Defense§1932      Formal Discovery§1932.1     Interrogatories§1932.2     Demands for Production§1932.3     Subpoenas§1932.4     Requests for Admissions§1932.5     Depositions§1932.6     Your Client’s Deposition

§1940      Mistake Number 4: Failing to Analyze the Documents§1941      Critical Review of Documentation: Case Weaknesses§1941.1     First Review Documents From a Worst Case Perspective§1941.2     Dealing With Case Weaknesses§1941.3     Preexisting Injuries§1942      Dealing With Case Strengths§1943      Understanding the Documents§1943.1     Plaintiff’s Assistance§1943.2     Assistance of Other Attorneys§1943.3     Expert Consultants§1943.4     Professional Literature§1943.5     Health Care Providers§1944      Summarizing the DocumentsSample: Medical History Summary§1950      Mistake Number 5: Failing to Organize the Documents§1951      Organizing the Documents§1951.1     Pleading File§1951.2     Discovery File§1951.3     Evidence File§1951.4     Correspondence File

§1951.5     Legal Research File§1951.6     Summaries File§1952      Indexing the Files§1953      Summarizing the Documents§1954      Trial Notebook§1960      Mistake Number 6: Failing to Effectively Utilize the Documents§1961      Consider the Interests of All Parties§1962      Evaluating Your Case Realistically§1962.1     Evaluation Checklists§1962.2     Liability Analysis§1962.3     Damage Analysis§1962.4     Total Evaluation§1963      Using Documentation to Settle the Claim§1963.1     Demand Checklist§1963.2     The Demand Letter§1963.3     The Settlement Brochure§1963.4     Periodically Reevaluate the Case§1964      Using Documents at Settlement Conferences and Arbitration or Mediation Hearings§1965      Using Documents at Trial§1970      Mistake Number 7: Failing to Maintain Documents After the Case Is ResolvedChapter 20: Analyzing Opinion Letters: A Physician’s Insights on the                    Quality of Medical Reports§2000      Medical Evaluations in Litigation§2001      Introduction§2002      The Problem of the Reluctant Physician§2003      Do I Need an Expert Report?§2004      Types of Reports§2005      Records Review§2006      Litigation v. Treatment Reports§2007      Biased Medical Reports§2008      Use of Medical Reports in Litigation§2009      The Report Itself§2010      The Doctor and Patient Relationship§2011      Limiting the Relationship§2012      Confidentiality§2020      Creating Medical Reports

§2021      Duties of Medical Reporter§2022      Medical Records§2023      Documents Not Part of the Medical Records§2024      Preparation of Medical Reports§2025      Reference Sources in Medical Reports§2030      Evaluating Patients§2031      Patient Interview§2032      Objective Observations§2033      Malingering, Hysteria and Accident Neurosis§2034      Findings Suggesting Exaggeration§2035      American Medical Association Guidelines§2036      Permanent Disability Rating§2037      Apportionment of Injury to Incident§2040      Descriptive Words for Subjective Factors§2041      Pain and Suffering Reports§2042      Levels of Pain§2043      Frequency of Pain§2050      Specific Diagnostic Testing§2050.1     History and Physical Examination§2050.2     Diagnostic Tests In General§2050.3     Tests Performed on Patient§2050.4     Pulmonary Function Tests§2050.5     Compartment Pressure (Wick)§2050.6     Electromyography§2050.7     Other Electrophysiological Diagnostic Studies§2050.8     Anatomical Pathology§2050.9     Genetic Testing§2050.10   Diagnostic Instruments§2050.11   Arthroscope§2050.12   Arteriography, Venography, and Lyphangiography§2050.13   Magnetic Resonant Arteriograph§2050.14   Clinical Laboratory Testing§2050.14.1  Chemical Laboratories§2050.14.2  Hematological Studies§2050.14.3  Microbiology§2050.14.4  Immunohematology

§2050.15   Pregnancy Testing§2050.16   HIV-AIDS§2050.17   Radiological Testing§2050.17.1  X-Ray Imaging§2050.17.2  Mammography§2050.17.3  Fluoroscopy§2050.17.4  Myleography§2050.18   Computerized Tomography (CT Scans)§2050.19   Ultrasound§2050.20   Magnetic Resonance Imaging (MRI)§2050.21   Other Imaging Techniques§2050.21.1  Nuclear Medicine§2050.21.2  Single Positron Emission (PET)§2050.21.3    Single Photon Emission Computed Tomography (SPECT)§2050.21.4  Interventional Radiology§2050.21.5  Discograms§2050.21.6  Scintography§2050.22   Performance Testing§2050.23   Thermography§2051      Elements of Orthopedic Evaluations§2051.1     History§2051.2     Physical Examination§2052      Psychiatric Consultation Reports§2053      Forensic Psychiatric Reports§2054      Psychiatric Evaluation Reporting Styles§2055      Workers’ Compensation Reports§2056      Disability Reports§2057      Head Injury Reports§2058      Child and Elder Abuse Reports

    

V.  EFFECTIVE NEGOTIATIONChapter 21: Negotiating Insurance Claims§2100      Preparing for Insurance Claim Negotiations: Do Your Homework

§2101      Know With Whom You Will Be Negotiating

§2101.1     The Case for Adjusters Handling Claim Negotiations

§2101.2     Arguments for Having Defense Counsel Handle Settlement Negotiations

§2101.3     Why Policyholders and Insurers Want Pre-Suit Counsel

§2101.4     Adjuster Reservations

§2101.5     Smelling a Boondoggle?

§2102      Get the Background on Opposing Counsel

§2103      Get the Background on the Insurance Company

§2104      Get the Background on the Client

§2110      The Four “8’s” — Investigate, Orchestrate, Evaluate, and Negotiate§2111      Investigate§2111.1     One Picture Is Worth a Thousand Words§2111.2     Importance of Personal Attention§2112      Orchestrate§2112.1     Timing§2112.2     Credibility§2112.3     Required Medical Personnel§2112.4     Expert Witnesses Needed§2112.5     Build Your File§2112.5.1  Medical Reports§2112.5.2  “Day in the Life” Videotape§2112.5.3  Client Tape Recording§2112.5.4  Client Bodily Injury (B/I) Packet§2113      Evaluate§2113.1     Set Parameters§2113.2     Be Optimistic, But Realistic§2113.3     Consider All Damages§2113.4     Use Tools§2113.4.1  Pain Chart§2113.4.2  Evaluation Sheet§2113.4.3  Reserve/Demand Letter§2114      Negotiate§2114.1     Timing Factors in Negotiating Personal Injury Claims§2114.2     Goodbye Wheel-Spinning: Rx for Effective Negotiating§2114.3     Be a Person First, Then an Attorney§2114.3.1  Know Your Strengths§2114.3.2  Know the Adjuster§2114.3.3  Know the Company

§2114.3.4  Communicate Regularly§2114.3.5  Address Weak Areas in the Case§2114.4     Starting the Negotiating Process§2114.4.1  Read About Negotiating§2114.4.2  Develop Writing Skills§2114.4.3  Learn to Listen§2114.4.4  Determine Realistic Goals§2114.4.5  Negotiate for Money, Information, and More§2120      Avoiding the Fifth “8”: Litigate§2121      Fairness of the Adjuster vs. a Jury§2122      Reputation as a Trial Lawyer Enhances Success as a Litigator§2130      “Hot Buttons”: How to Squeeze that Extra Buck§2131      Use the Adjuster’s Name Frequently§2132      Personalize§2133      Key Words§2133.1     Words and Phrases to Avoid When Negotiating With Insurance Claim Adjusters

§2134      Kickers§2140      Bibliography on NegotiationChapter 22: Establishing Bad Faith§2200      Introduction§2210      Substantive Law Regarding First and Third Party Bad Faith§2211      Basics of First Party Bad Faith Actions§2212      Relevant Statutes§2213      Basics of Third Party Bad Faith Actions§2214      ERISA Considerations§2215      Comparative Bad Faith§2220      Spotting Bad Faith Conduct§2221      General Points                §2221.1   The Basic Tests                §2221.2   Insurer’s Past Practices§2222      Theories of Recovery and Remedies                §2222.1   Checklists of Possible Theories and Remedies                §2222.2   Intentional Infliction of Emotional Distress§2223      Specific Bad Faith Practices                §2223.1   Failure to Settle Within Policy Limits                §2223.2   Refusal to Defend or Indemnify

                §2223.3   Improper Investigation and Evaluation of Claims                §2223.4   Setting Inadequate Reserves                §2223.5   Designing, Advertising, & Selling Insurance Policies                §2223.6   Conflict of Interest                §2223.7   Inadequate Defense§2224      Bad Faith Implications of Adjuster Pay Plans                §2224.1   The Myth of Adjuster Bonus Plans                §2224.2   The Reality of Incentive Compensation                §2224.3   Rationale for Pay Schemes                §2224.4   Incentive Pay Plans May Invite Bad Faith                §2224.5   Incentive Pay Plans as Risk Management Liabilities                §2224.6   Recipe for Bad Faith                §2224.7   Alternative Approaches                §2224.8   Case Study                §2224.9   Deposition Outline for the Claims Adjuster§2230      Presuit Negotiation and Informal Discovery Considerations§2240      Discovery§2241      Plaintiff§2241.1     Areas of Inquiry§2241.2     Documents§2241.3     Depositions§2242      Defendant§2242.1     Venue§2242.2     Plaintiff’s Complaint§2242.3     Areas of Inquiry§2242.4     [Reserved]§2242.5     [Reserved]§2242.6     Discovery of Company Wealth§2242.7     Information Available on the Internet§2250      Trial§2251      Motions in Limine§2252      Voir Dire§2253      Opening Statement§2254      Plaintiff’s Case in Chief§2255      Defendant’s Case§2256      Expert Witnesses

§2257      Closing ArgumentChapter 23: How to Negotiate With Insurance Companies and Avoid                    Settlement Delays§2300      Successful Negotiations: Five Places to BeginChecklist: How to Make a Successful Initial Contact With Adjusters§2310      Be Careful of Terms When Beginning Negotiations§2310.1     The Preferred Risk Policyholders§2310.2     The Nonstandard Policyholders§2310.3     The “Surplus Lines” Insurance Coverage§2310.4     The Attitude of the Self-Insured Policyholder§2310.5     The Effects of Being an Admitted or Nonadmitted Carrier§2311      Comparing Adjuster Attitudes§2320      Attitude Adjustments§2321      Determining Fault FactorsChecklist: “Sizing up” Adjusters§2322      Dealing With Multiple Adjusters§2330      Complaints of AdjustersChecklist: Documentation to Support Your Claim§2340      How to Avoid Settlement DelaysChecklist: Avoiding Settlement Delays§2350      When to Make a Recommendation for Settlement§2351      Four Fatal Settlement Errors to Avoid§2360      Settlement Demand§2361      How to Handle the Insurance Company’s Counteroffer§2370      Compromise Demand§2371      Reducing Your Own Demand§2380      What to Do When Negotiations Break Down§2380.1     Four Possible Solutions§2381      List Offers and Compromises in Writing§2382      Game Playing and Other Trivial Pursuits§2383      Face-to-Face Settlement ConferenceChapter 24: Maximizing Damages in Small Personal Injury Cases§2400     Small Claims Challenges

§2401     The Request for a Recorded Statement in Third Party Claims

§2402     The Request for a Recorded Statement in First Party (Uninsured or Underinsured) Party Claims

§2410     Typical Injuries and Elements of Damages

§2411      Headache Pain

§2412      Sleeping Problems

§2413      Mental and Emotional Damages

§2414      Cosmetic Compensation

§2415      Loss of Consortium

§2416      Overall Quality of Life

§2417      Hired Help

§2418      Nursing Services

§2419      Travel Expenses

§2420      Past, Current, and Future Complaints

§2421      Disability and Impairment

§2421.1     Minor Clients’ Disabilities

§2421.2     Elderly Clients’ Disabilities

§2422      Prior Injuries

§2423      Subsequent Injuries

§2424      Future Medical Costs

§2430      Wage Loss

§2431      Loss of Earnings

§2432      Proving the Self-Employed Client’s Wage Loss

§2433      Secondary Sources of Income and Lost Opportunities

§2434      Unemployed Client’s Wage Loss

§2440      Property Damage

§2441      Vehicle Damage

§2442      Vehicle Loss of Use

§2443      Other Property Damages

§2450      Habitual Dilemmas in Routine Negotiations

§2451      General Recommendations for Effective Negotiations

§2451.1   Distinguishing Significant Injuries

§2451.2   Portraying Your Client Favorably

§2451.3   Soothing the Adjuster’s Concerns

§2451.4   Dealing with Colossus or Other Computer Programs Insurance Companies Use to Determine

Value

§2452      Delays in Seeking Treatment

§2453      Living With the Facts of Life (Your Client’s, That Is)

§2454      Claimant’s Admissions

§2455      Multiple Clients, Same Adjuster

§2456      Settling the Unsettleable Claim

§2457      Comparative Negligence Set-Offs

§2458      Formula Settlements

§2459      Structured Settlements

§2460      Negotiation 101

§2461      Prepare for Negotiations

§2462      Break Down Harms

§2463      Appear Reasonable

§2464      Build a Relationship With the Adjuster

§2470      Resorting to Litigation

Chapter 25: Twenty-Six Tips From Seasoned Claims Adjusters§2500      Introduction§2501      How We Got Here§2502      Adjusters Are People Too§2510      The Twenty-Six Tips§2511      Twelve DOs§2511.1     Be a True Professional§2511.2     Be Courteous§2511.3     Be Prepared§2511.4     Be Objective§2511.5     Be Realistic§2511.6     Listen§2511.7     Be Assertive§2511.8     Use Interim Agreements to Move Toward Settlement§2511.9     Separate Methods From Substance§2511.10   Be Principled§2511.11   Get Settlement Authority in Writing§2511.12   Get Settlement in Writing§2512      Fourteen DON’Ts§2512.1     Don’t Depend Upon Sham Values or Issues§2512.2     Don’t Lose Your Temper§2512.3     Don’t Belittle Your Strengths§2512.4     Don’t Lose Professional Distance§2512.5     Don’t Ignore Newly Learned Information§2512.6     Don’t Attack a Person Instead of an Idea§2512.7     Don’t Spill Your Bottom Line

§2512.8     Don’t Undo a Done Deal§2512.9     Don’t Ignore the Other Person§2512.10   Don’t Cheat§2512.11   Don’t Draw Arbitrary Lines in the Sand§2512.12   Don’t Bid Against Yourself§2512.13   Don’t Go “Off the Record”§2512.14   Don’t Allow Yourself to Be Exploited§2520      ConclusionChapter 25A: Mediation Tips for Personal Injury Counsel§2500A           Introduction§2510A           Mediation Success Tips§2511A   Expect More of a Marathon Than a Sprint§2512A   “Anchor” the Opposing Side’s Expectations§2513A   [Reserved]§2514A   Select the Mediator Wisely§2515A   Weigh Timing Factors§2516A   Be Creative§2517A   Plan and Train§2518A   Prep Yourself Physically§2519A   Prep the Client§2520A           Mediation Mistakes§2521A   Throwing in the Towel Too Soon§2522A   Assuming You Know What the Other Side Wants§2523A   “Tit for Tat” Negotiating Ploys§2524A   Tactless or Inflammatory Opening Statements§2525A   Coming to the Mediation After Trying Too Hard to Settle the Case§2530A           Adjuster Perspective on Court-Ordered Mediation

    

VI.  EFFICIENT SETTLEMENTChapter 26: Evaluating Settlement Offers§2600      Introduction§2601      The Art of Settlement§2602      Hypothetical Fact Situation§2610      The “Big Three” Factors Affecting Case Value§2611      Liability

§2612      Damages§2612.1     Medical Expenses§2612.2     Lost Wages§2612.3     General Damages§2612.4     Checklist for Evaluating Damages

§2613      Proceeds§2613.1     Policy Limits and Reserves§2613.2     Assets of Defendant§2613.3     Other Sources§2620      Other Factors Affecting Value§2621      Evaluating Bodily Injuries§2621.1     Medical Reports§2621.2     Preexisting Conditions§2621.3     PrognosisSample: Checklist to Evaluate Pain and Suffering§2622      Type of AccidentChart: Probability of Million Dollar Verdicts§2623      [Reserved]§2624      [Reserved]§2625      [Reserved]§2626      Timing of Settlement§2627      Expenses of Litigation§2628      Bad Faith§2629      lntangibles§2630      [Reserved]§2640      Using Mathematical Formulas to Evaluate Claims§2641      Range of Values§2641.1     Settlement Strategy Using Range of Values§2642      [Reserved]§2643      Point Allocation SystemSample: Case Evaluation§2644      Jury Verdict Research Evaluations§2645      Computerized Applications§2646      Small Claims CourtChapter 26A: Settlement Ethics§2600A           Introduction

§2610A           Typical Ethical Dilemmas and Risks Associated With Settlements§2620A           Failure to Disclose and Misleading Client§2621A   Failure to Convey a Settlement Offer to Client§2622A   Failure to Disclose an Adverse Interest in a Settlement or Potential Settlement§2623A   Promises of Quick Settlement in Attorney Advertising§2630A           Problem Settlements§2631A   The “Package Deal” Settlement Offer§2632A   Minor vs. Adult Variation of the Package Deal§2633A   “Backlash” Settlements§2634A   Ethical Propriety of Attorney Signing Settlement Documents§2640A           Attorney Fee Dilemmas§2641A   Legitimacy of Attorney Fee§2642A   Attorney Fees and Structured Settlements§2650A           Improper Handling of Funds§2651A   Pre-Settlement Funding of Client’s Personal Expenses§2652A   Innocent Misdepositing of Settlement Funds§2653A   Not Properly Honoring a Lien From Settlement Funds§2654A   Settlement Funds Disbursed Too QuicklyChapter 27: Structured Settlements: Opportunities, Problems and Benefits§2700      Introduction§2701      Definition§2701.1     The Qualified Funding Asset§2702      The General Process§2702.1     The Cash Settlement§2702.2     The Structured Settlement§2702.3     How They Compare§2702.4     Summary§2703      Considerations in Structuring Settlements and Picking a Structured Settlement Broker§2703.1     Introduction§2703.2     Use§2703.3     Benefits§2703.4     Identifying Candidate Cases for Structures§2703.5     Barriers to Structuring Personal Injury Settlements§2703.6     Firms§2703.7     Insurer or Defense Counsel Usually Retains the Broker

§2703.8     Does Claimant’s Attorney Need to Retain a Broker When Insurer Has Already Retained One?§2703.9     Factors in Evaluating Brokers§2703.10   Conclusion§2710      Documents§2711      Settlement Agreement and Release§2712      Qualified AssignmentsSample: Two-Party Qualified Assignment FormSample: Three-Party Qualified Assignment Form§2713      Annuity PolicySample: Annuity Contract§2720      Financial Security§2721      The Life Company§2722      The Casualty Company§2723      The Assignee§2723.1     Secured Creditor Status§2724      State Guarantee Associations§2730      Tax Issues§2731      Internal Revenue Code§2732      Constructive Receipt§2732.1     The Settlement Documents§2732.2     The Payment Plan§2732.3     The Negotiation Process§2733      Estate and Inheritance Taxes§2734      Preservation of Entitlements — Special Needs Trust§2740      Payee/Contingent Payee Wording§2741      Common Incorrect Payee Designations§2742      Preferred Payee Designations§2750      Attorneys’ Fees§2751      Contingent Fee Contract§2752      How to Determine Attorneys’ Fees§2753      When the Fees Are Paid§2754      Deferring Fees§2755      Constructive Receipt by the Attorney§2760      Standard vs. Non-Standard Claimant§2761      Potential Value of a “Rate-Up”

§2762      Claim-Related vs. Preexisting Condition§2770      Use of Trusts§2780      Putting It All Together§2781      How to Identify Candidate Cases for Structured Settlement§2781.1     Motivation to Use a Structured Settlement§2781.2     Explanation for the Claimant§2782      How to Design a Settlement Payment Schedule§2782.1     Claimant’s Planning Worksheet§2782.2     Strategy for the Non-Standard Claimant§2783      How to Valuate Different Alternatives§2783.1     Evaluating a Structured Settlement Offer§2783.2     Inherent Attorney-Client Tension§2784      How to Negotiate a Structured Settlement§2784.1     The Environment§2784.2     -Using Consulting Services, Financial Planners and Tax Practitioners§2784.3     The Claimant’s Involvement§2784.4     Cash vs. Structured Format§2784.5     Initiating a Structured Settlement Offer§2785      How to Tie It Together Into a Neat Closing§2785.1     Checklist for the Attorney§2785.2     Explanation of the Final Mechanics for the Claimant§2790      Related Uses§2791      Workers’ Compensation§2792      Periodic Payment of Judgments§2793      Hazardous Waste ClaimsChapter 28: Appraisal of Insurance Claims§2800      BackgroundSample: Appraisal Clause§2810      Scope of Appraisal Proceedings§2811      Determination of Loss§2812      Appraisal and Arbitration Distinguished§2813      The Role of the Mortgagee§2820      Avoiding the Appraisal Process§2821      Bad Faith§2822      Waiver or Loss of Right§2830      Beginning the Appraisal Process

§2831      Identify Dispute§2832      Timing§2833      Proof of Loss§2840      Selection of Appraisers§2841      Choosing Your Appraiser§2842      Objecting to the Other Party’s Appraiser§2850      The Appraisers’ First Decision: Selecting the Umpire§2851      Role of the Umpire§2852      Appointment by Appraisers§2853      Appointment by Petition to the Court§2860      The Appraisal Proceedings§2861      Appraising the LossSample: List of Appraiser Items for Umpire Review§2862      The Appraisal Hearing§2863      The Deliberations§2864      Setting Aside the Appraisal Award§2865      Paying the Umpire and AppraisersChapter 29: Solving Common Settlement Problems§2900      In General§2910      The First Encounter§2911      Set the Right Tone From the Beginning§2912      The Adjuster Is Not the Enemy§2920      Attorney’s Level of Insurance Knowledge§2921      Prepare Your Case in Advance — Do Your Homework§2922      Don’t Make the Adjuster Do Your Work§2923      What You Don’t Know Can Hurt Your Case§2930      Adjuster’s Level of Legal Knowledge§2931      Don’t Underestimate the Adjuster§2932      Educate the Adjuster as a Cooperative Gesture§2940      Negotiation Roadblocks§2941      Keep Egos Out of the Equation§2942      Clearly Communicate Your Goals§2943      Follow the Chain of Command§2950      Presenting the Demand§2951      Create a Straightforward Demand§2952      The Demand Is Only a Request

§2960      Establishing the Value of the Claim§2961      Base Your Figures in Reality§2962      Examine and Understand Local Practices§2963      Consider the Economic Picture§2970      Filing the Lawsuit§2971      Preserve the Client’s Interests§2972      Consider the TimingChapter 29A: Handling Inflated and Other Liens§2900A   Negotiating With Lienholders§2910A   Make a Record of All Liens§2920A   How to Handle Disputed Funds §2930A   Hospital Liens§2940A   Medicaid Liens: What Can Lawyers Do About Them?§2950A   Medicare§2960A   Medical Indigent Programs§2970A   Workers’ Compensation Liens

    

VII.  SPECIFIC TYPES OF CASESChapter 30: Evaluation of Soft Tissue Injuries§3000      Introduction§3001      Definition of a Soft Tissue Injury§3002      How a Soft Tissue Injury Occurs§3002.1     Soft Tissue Pathology and Impairment§3010      Evaluating Soft Tissue Injuries With Medical Histories and Physical Examinations§3011      Obtaining the Medical History§3012      Assessing the Extent of the Injury§3020      Preexisting Injuries and Conditions§3030      Effects of Soft Tissue Injuries on Other Systems and Organs§3031      Muscle§3031.1     Muscle Tissue Defined§3031.2     Structure and Function§3031.3     Motor Units§3031.4     Mechanics§3031.5     Actions§3031.6     Classifications

§3031.7     Supplementary Structures§3031.7.1  Retinacula§3031.7.2  Sheaths§3031.7.3  Synovial Bursae§3031.7.4  Synovial Sheaths§3031.8     Muscle Pain Defined§3031.9     Fibromyalgia and Fibrositis§3031.10   Why Muscles Hurt — Myofascial Pain Syndrome§3031.11   Less Obvious Causes of Muscle Pain§3031.12   Myofascial Pain§3031.13   -Medico-Legal Aspects of Fibromyalgia, Myofascial and Repetitive Strain Disorders§3031.13.1  Compartment Syndromes§3031.14   Evaluating Chronic Muscle Pain§3031.15   Stress and Muscle Pain§3031.16   Pain Defined§3031.16.1  Sensory Mechanisms§3031.16.2  Chronic Pain§3031.16.3  Biochemistry of Muscle Injury§3031.16.4  Spinal Cord Pathways§3032      NervesChecklist: Occurrence, Diagnosis and Causal Effects of Nerve Injuries§3032.1     Compression Neuropathies§3032.2     Nerve Injury After Knee Arthroscopy§3032.3     Susceptibility of Nerves to Pressure Injury§3032.4     Head Injuries§3033      Vascular Injuries§3034      Ligaments§3034.1     Tendons§3035      Intervertebral Discs§3035.1     Pathophysiology of Intervertebral Discs§3035.2     Anatomy and Physiology§3035.3     Description of the Disc§3035.4     Degenerative Disc§3035.5     Bulging Discs§3035.6     Terminology§3040      Pain

§3040.1     Introduction§3040.2     Learned Pain§3040.3     Evaluation of Hysterical Pain§3040.4     Effect of Settlement on Compensation Claimant’s Impairments§3040.5     Pain Management§3040.6     Placebos§3040.7     Malingering§3040.7.1  Chronic Pain and Somatization§3040.8     Surgical Considerations in Pain Management§3040.9     Physical Impairment Ratings§3040.9.1  Evaluation of Chronic Pain§3040.9.2  Evaluation of Chronic Pain Syndromes§3040.10   The Impact of Chronic Pain§3050      Psychological Factors: Emotional Trauma§3050.1     Use of Placebos§3050.2     Justifiable Lies§3050.3     Legal Issues of Using Placebos§3050.4     Emotional Trauma§3060      Cervical Injuries (Including Whiplash)§3061      Diagnosis and Treatment of Neck Pain§3062      Whiplash-Cervical Sprain Injuries§3063      Causes of Head-Neck Pain — The Temporomandibular Joint (TMJ)§3064      Post Traumatic Cervical Dystonia§3065      The Cervical Spine — Risk of Injury§3070      Disability and Permanency of Soft Tissue Injuries§3071      Disability§3072      Components of Disability§3073      Determining When Client Is Permanent and StationarySample: Chart Showing Characteristics of Experts and Pseudoexperts§3080      Testing Methods§3081      Stress X-Rays§3082      Arthrograms§3083      Arteriograms and Venograms§3084      Bone Scans§3084.1     Myelograms§3085      Magnetic Resonance Imaging and CT Scans

§3086      Doppler§3087      Radiology and Nuclear Imaging§3088      Discograms and Pressure Measurements§3089      Less Common Tests§3090      Treatment§3091      Coverage vs. Noncoverage§3092      The TENS Unit§3093      Traction§3094      Treatment for Whiplash§3095      Treatment of Nerve Injuries§3096      Healing TimeChapter 31: Evaluating and Settling of Medical Malpractice Claims§3100      Introduction§3101      Al Capone’s Theory of Settlement§3102      A Word to the New Lawyer§3103      Screening the Medical Malpractice Case§3110      Preparing for Settlement Means Preparing Your Case for Trial§3111      When to Discuss Settlement With Your Client§3112      Pre-Suit Expert Consultation§3113      The Expert’s Preliminary Written Report§3120      Negotiation Strategy§3121      Preparing Your Client for Settlement Negotiations§3122      Explaining the Benefits and Pitfalls of Litigation§3122.1     Financial Risks§3130      Factors to Consider in Making Your Settlement Evaluation§3131      Your Opponent’s Perception of You as an Attorney§3132      Jurisdiction and Venue§3132.1     State or Federal Court§3132.2     Prior Case Experience in the Jurisdiction§3132.3     Venue§3132.4     The Judge§3133      The Plaintiff§3133.1     Physical Appearance§3133.2     Personal Background§3133.3     Jury Appeal§3133.4     Credibility

§3133.5     Conduct§3133.6     Criminal Background§3133.7     Work History§3133.8     Prior Medical Problems§3133.9     Motivation§3133.10   Prior Claims§3133.11   Handling the Plaintiff’s Deposition§3134      The Defendant Physician§3134.1     Conduct§3134.2     Criminal Background§3134.3     Past Medical Problems or Impairment§3134.4     Collectibility§3134.5     Prior Claims§3134.6     Professional Qualifications§3134.7     Performance in Deposition§3135      Opposing Counsel§3135.1     Style of Practice§3135.2     Who Is in Control of the Settlement Negotiations?§3140      Evaluating Experts§3141      Qualifications§3142      Knowledge About the Case§3143      Use of Literature§3144      Reputation§3145      Communications Skills§3146      The Plaintiff’s Expert§3147      The Defendant’s Expert§3150      Issues With Jury Appeal§3151      Aggravated Conduct of Similar Prior Occurrences§3152      Catastrophic Injuries§3153      Significant Admissions§3160      The Settlement Package§3161      The Demand Letter§3161.1     Liability Issues§3161.2     Causation§3161.3     Burden of Proof§3161.4     Damages

§3161.5     Deadlines§3162      Listen to Your Opponent’s Evaluation§3170  Final Considerations§3171      The Art of Compromise§3172      The Critical Importance of Timing§3173      Costs of Further Prosecution or Defense§3174      The Role of Prejudgment Interest§3175      At Trial: Knowing When to Settle§3176      Conclusion: Persevere!Chapter 31A: Investigating Cell Phone Use in Vehicle Liability Claim Recoveries§3100A   Introduction§3110A   Cell Phone Distraction and Causation§3120A   Vicarious Employer Liability§3130A   Case Investigation§3131A   Did Driver Use Hands-Free Technology?§3132A   Does Local Law Prohibit Cell Phone Use While Driving?§3133A   Does Driver's Company Have a Cell Phone Policy?§3134A   What Does Accident Report Say?§3135A   What Does Client Say?§3136A   What Do Witnesses Say?§3140A   Checklist — Questions for Employer§3150A   Checklist — Questions for Adverse Driver§3160A   ResourcesChapter 32: Settling Auto Accident Cases§3200      What Is a Viable Auto Accident Claim?§3201      Determine Liability§3202      Confirm the Coverage§3203      How Extensive Are the Injuries?§3204      Is Property Damage the Source of Conflict?§3205      Are Medical Payments Covered?§3210      Take Control of the Case§3211        Who’s in Charge?§3212        How Do You Maintain Control?§3213        “How Much Is My Case Worth?”§3220      What to Accomplish in the First Month of Case Work

§3221      Always Obtain the Police Report§3222      Conduct Your Investigation§3222.1     Retain an Expert§3222.2     Tips on Investigating Pedestrian Accidents

§3223      Assess Your Ability to Handle the Case§3223.1     When to Decline a Case§3230      Dealing With the Insurance Company§3231      How to Handle First Party Coverage§3232      Is There a Third Party Involved?§3233      Examine the Underinsured Motorist Coverage§3234      Does Workers’ Compensation Coverage Apply?§3240      The Treatment and Recovery Phase§3241      Monitor and Document the Client’s Progress§3242      How the Care Provider Affects the Claim§3242.1     Health Maintenance Organizations§3242.2     Chiropractors§3242.3     Independent Medical Examinations§3243      Prepare Your Documentation§3250      Working With the Adjuster§3251      Establishing Settlement Authority§3252      Litigation Specialists§3260      Preparing the Demand§3270      Discuss the Claim Value With Your Client§3280      ConclusionChapter 33: Avoiding and Resolving the Classically Weak Case§3300      Introduction§3301      Provide Escape Hatch in Contract of Representation§3310      No Insurance, Assets or Coverage§3320      Controlling Client’s Unreasonable Expectations§3330      Classically Weak Liability Cases§3331      Slip and Fall§3332      Intersection Collisions§3333      Medical Malpractice§3334      Product Liability§3335      Disappearing Witnesses§3340      Classic Damage Problems

§3341      Delayed Medical Treatment§3342      Failure to Connect Injury to Accident and Treatment§3343      Excessive Chiropractic Bills§3344      Excessive Medical Treatment§3345      Prior Accidents and Injuries§3346      Clients Who Exaggerate Symptoms§3347      Negligible Property Damage§3350      Bringing Weak Cases to Conclusion§3351      Stress Positives and Gloss Over Weaknesses§3352      Mediation§3353      Arbitration§3354      Compromising Medical Bills§3360      Convincing Unreasonable Clients to Settle§3361      Require Client to Sign Letter§3362      Use Economic Reality Approach§3370      Using Other AttorneysChecklist: Key Points to BewareChecklist: Enhance and Resolve CaseChapter 34: Trauma & Post Traumatic Stress Disorder (PTSD): A Brief                    Primer for Civil Litigation§3400      Overview: What Is PTSD?§3401      Diagnostic Criteria — History§3402      PTSD & Civil Litigation§3410      Diagnosis§3411      DSM-III-R Criteria§3412      DSM-IV Criteria§3412.1     PTSD Criteria Overview§3412.1.1  Trauma§3412.1.2  Re-Experience, Avoidance & Arousal§3412.1.3  Onset & Duration§3412.1.4  Functional Disturbance§3412.2     Clinical Interview§3413      DSM Multi-Axial System§3414      DSM & Civil Litigation§3415      PTSD Diagnosis — Essential Evidence§3420      Reserved

§3430      Litigation Considerations§3431      Use of a Consultant: A Critical Asset§3432      PTSD as a Compensable Injury§3432.1     Prognosis§3432.2     Risk Factors§3432.3     Role of Treatment§3433      Child Trauma Claimants§3434      Causation & Alternative Causal Factors§3434.1     Potential Alternative Causal Factors§3434.2     PTSD Alternative Causes§3434.2.1  Pre-Existing Trauma§3434.2.2  Pre-Existing PTSD§3434.2.3  Medical Mimics§3440      Damages§3441      Psychological Pain & Suffering§3442      Psychosocial Injury & Loss of Consortium§3443      Cognitive Damages§3444      Future Risk of Illness§3445      Direct Economic Loss§3450      Checklist for Analyzing the Trauma Based Claim§3460      Common Errors Made in Diagnosis of PTSD§3470      Theories & Strategies for Enhancing or Mitigating the Trauma Based Claim§3480      Conclusion§3490      Overview of Case Law Involving Post-Traumatic Stress Disorder (PTSD)Chapter 35: Stacking Un/Underinsured Motorist Coverages§3500      Introduction§3510      What Stacking Is and What It Does§3511      Precluded by Statute or Anti-Stacking Provisions§3512      Limited by Amount§3513      Limited by Number of Policies§3514      Reduced by Amount of Available Liability Coverage§3520      Multiple UM Policies§3521      “Other Insurance” Provisions§3522      Stacking Precluded§3523      Pro Rata Stacking§3524      Class II Stacking

§3525      Stacking Minimum UM to Create UIM Coverage§3530      Multiple Vehicles on Single Policy§3540      Fleet Policies§3550      Primary/Secondary UM/UIM Coverages§3551      Majority Rule§3552      Georgia Rule§3552.1     Receipt of Premium§3552.2     More Closely Identified§3552.3     Primary Coverage — Not Availed§3560      Coverage for Punitive Damages§3570      Subrogation Rights On Un/Underinsured Motorist Carriers§3580      SummaryChapter 35A: Investigating Slip and Fall and Dog Bite Claims§3500A   Introduction§3510A   Foundation of Claim§3520A   Injury at Home of Friend or Acquaintance§3530A   Government Liability§3540A   Sources of Insurance Coverage§3550A   Collectability of Judgment§3560A   Case Investigation§3570A   Components of Thorough Investigation§3580A   Investigating Work Related Injury§3590A   Anticipating Defenses§35100A Medical Payments Coverage§35110A Investigation Checklist

§35120A  Preparing the Premises Liability Claim Arising From Slips and Falls on Snow and Ice

§35121A  Introduction

§35122A  Range of Injuries and Damages

§35123A  Investigative Checklist

§35130A Preparing the Dog Bite Claim

§35131A  Introduction

§35132A  Assignment to Adjuster

§35133A  Adjuster Will Confirm Coverage and Establish Reserve

§35134A  Adjuster’s Investigation

§35135A  Other Steps by Adjuster in Handling Claim

§35136A  Investigative Approaches for Plaintiff’s Counsel

§35137A  Sources of RecoveryChapter 36: Investigating & Litigating Nursing Home Abuse§3600      Introduction§3610      Elder Abuse Defined§3620      Nursing Home Abuse Facts§3630      Initial Interview Checklist§3640      Liability Insurance Considerations§3641      Insurance Reforms — State Overview§3650      Preparing Your Case§3651      Typical Causes of Action§3652      Medical Malpractice or Elder Abuse?§3653      Negligence§3654      Causation§3655      Standard of Care§3656      Discovery§3657      Use of Experts§3660      Recent Cases§3670      Sample Jury Verdicts§3680      ResourcesChapter 37: Investigating and Evaluating the Product Liability Claim§3700      Introduction§3710      Investigation Nuts and Bolts§3711      The Product§3711.1     Identify the Product§3711.2     Obtain the Product§3711.3     Inspect the Product§3711.4     Photograph the Product§3711.5     Videotape the Product Inspection§3711.6     Closely Examine Product Warnings§3712      The Product Manufacturer§3712.1     Research Prior Product-Related Complaints§3712.2     Look for Key Words and Phrases in Company Documents§3712.3     Investigate Sources of Component Parts§3713      The Opposition§3713.1     Investigate Opposing Counsel’s Background and Experience§3713.2     Anticipate Failure-to-Maintain Defenses

§3720      Factors Affecting Case Evaluation and Settlement§3721      Case Considerations§3721.1     Liability Picture§3721.2     Damages§3721.3     Venue/Jurisdiction§3721.4     The Role of Precedent§3722      Party Considerations§3722.1     Appearance of the Plaintiff§3722.2     Status of the Defendant§3722.3     Collectability§3722.4     Parties’ Litigation and Settlement Philosophies§3723      Other Considerations§3723.1     Regulatory Backdrop§3723.2     Media and Public Opinion BackdropChapter 38: Investigating False Arrest Claims§3800      Introduction§3810      Investigative Strategies§3811      Five Steps the Defendant Should Have Followed§3812      Areas to Focus Investigation On§3820      Investigating the Damages§3830      Investigating the Defendant(s)§3831      Investigating the Business Establishment§3832      Investigating the Apprehending Security Guard(s)§3833      Investigating the Security Provider/Vendor§3840      Investigating the Liability Insurance Picture§3850      Investigating the Clients§3860      Investigating the Case’s Criminal/Police Aspects§3870      Investigating the Witnesses§3880      Investigating the Venue§3890      Investigating Opposing CounselChapter 39: Investigating Negligent Security Claims in Pursuing Damages                    for Crime Victims§3900      Introduction§3910      Investigative Strategies§3911      Possible Theories of Liability§3912      Key Factors

§3913      Assessing the Need for Investigation§3920      Investigating the Premises§3921      Inspection of Premises§3922      Assessing Security Systems§3930      Investigating the Criminal/Police Aspects§3931      Obtaining Police Data§3932      Investigating the Wrongdoer/Assailant§3940      Causation Investigation§3950      Investigating Defendants/Potential Defendants§3951      Investigating the Property Owner/Manager§3952      Investigating the Security Provider/Vendor§3960      Client Investigation and Background§3970      Investigating the DamagesChapter 40: Investigating Workplace Violence Claims§4000      Introduction§4001      OSHA§4010      Context, Causes, and Prevalence of Workplace Violence Claims§4020      Possible Theories of Liability§4030      Investigative Approaches§4031      Components of Successful Claim§4032      Initial Avenues of Inquiry§4040      Investigating the Warning Signs§4041      Case Study: Multiple Shooting Fatalities at Mississippi Plant§4050      Negligent Retention and Supervision§4051      Investigating Negligent Retention§4052      Investigating Negligent Supervision§4060      Anti-Violence Programs§4070      Investigating Terrorism Preparedness§4080      Investigating the Insurance CoverageChapter 41: Sexual Molestation Claims: Liability and Coverage Issues§4100      Introduction§4110      Molestation Defined§4120      Molestation by Professionals: Breach of Trust§4121      Therapist and Patient§4122      Other Health Care Providers and Patients§4123      Attorney and Client

§4130      Potential Causes of Action§4140      Liability of Perpetrator’s Employer§4141      Vicarious Liability§4142      Independent Ratification§4143      Negligent Hiring and Supervision§4144      Youth Organizations and Child Participants: Negligent Failure to Protect§4150      Insurance Coverage for Sexual Molestation Claims§4151      Coverage for Perpetrator§4152      Coverage for Employer§4160      Pre-Suit Investigation and Settlement§4161      Quick Settlement When Defendant Requires Secrecy§4162      Information to Gather From Victim§4163      Documents to Obtain and Examine§4164      Witnesses§4170      Additional ResourcesChapter 42: How to Combat Smaller and Smaller Settlement Offers in Minor Impact Soft Tissue Injury Cases§4200      Trends in Settlement Practices§4201      Introduction§4202      Common Insurer Delaying Tactics§4203      Bad Faith Practices§4210      Insurers' Approach to Low Impact Soft Tissue Injury Cases§4211      Colossus and the Low-Ball Offer§4212      Colossus Variables§4213      The Biomechanical Expert and the Orthopedist:  The One, Two Punch§4220      Solutions to the Shrinking Settlement Offer§4221      Don't Take the Case: An Inadequate Response§4222      Hold Down Overhead (the "Lean & Mean Approach") and Consider Low Settlement Offers§4223      Bite the Bullet and Try Soft Tissue Cases§4230      Tips for Maximizing the Value of Minor Impact Soft Tissue Injury Cases§4231      Research and Investigate§4231.1     Countering the Insurer's One, Two Punch§4231.2     Obtain Latest Medical and Scientific Information§4231.3     Understand the Spine§4231.4     Learn the Basics of Biomechanics and Delta V

§4231.5     Find Hidden Property Damage§4231.6     Use Insurance Institute for Highway Safety as a Resource§4232      Conduct Exhaustive Discovery§4232.1     Interrogatories§4232.2     Depositions§4232.3     Deposition/Cross-Examination Outline for Defendant's Biomechanics Expert§4232.4     Deposition/Cross-Examination Outline for Defendant's Orthopedic Surgeon§4233      Use Motions in Limine and Voir Dire§4233.1     Bring Appropriate Motions in Limine§4233.2     Typical Grounds for Motions in Limine§4233.3     Conduct Exhaustive Voir Dire§4234      Discredit Opinions of Defense Experts§4234.1     Expose Misrepresentations of Biomechanical Experts§4234.2     Hire Your Own ExpertsTable of CasesIndex