As a claim-handling professional, you may have more than 100pending claims. You receive calls and letters every day on variousfiles. There just doesn't seem to be enough time in the day. In theperfect world, every claim would be handled with no mistakes. Everyphone call would be returned immediately. Is it possible?

The following article will discuss some of the basics ofhandling a claim investigation. While it is not possible to workevery file perfectly every time, a claim handler who follows thesteps listed below will ensure that, on most days, they areresolving their claims in the most expeditious (and economical)manner possible.

The First 48 Hours

In the hustle and bustle of handling claims, adjusters oftenoverlook important investigatory steps. Usually, good results canstill be achieved, despite such inactivity. Oftentimes, thisinactivity occurs because we forget the basics of claiminvestigations.

The first 48 hours after any accident is golden time. If you aregoing to find any witnesses or make any favorable discoveries, itgenerally occurs during this time period. Making valuablediscoveries after this period will be a combination of hard workand good luck. This first two days after an accident is also thetime when you are going to find out information that adverselyaffects exposure on a claim. Find out this information sooner thanlater, because no one likes last-minute surprises.

Looking ahead, the work accomplished during the first 48 hourscould be incredibly helpful to a hired defense lawyer should thecase go into litigation. The claim adjuster is literally the eyesand ears of the defense attorney. If the basics are not coveredearly on, the defense attorney is going to have to make thesethings happen. Guess what that does to your litigation costs?That's correct; it will send them right through the roof. Why pay adefense lawyer to do the things that you can easily accomplishyourself?

Be Systematic

All claim professionals have a system by which they handleclaims, and it should be followed every time. Even though no twoclaims are exactly alike, the same basic steps should be takenbecause this ensures that critical steps are not missed. Also, whenan adjuster has to review an on-going file, knowing thatappropriate steps have been taken will make the process easier. Anyadjuster who has inherited a file that appears to have riddenaround in the trunk for several months of another adjuster willunderstand why. It reinforces the importance of having a system bywhich you work files the same way every time.

If you have a systematic approach to investigating, the chancesof settling the claim are maximized because the more you know aboutthe claim, the claimant, and your insured, the better youunderstand the big picture. This should help claim professionalsdetermine the true value of the claim sooner than later because allof the players and facts are known. With this information, anadjuster will be in a better position to resolve the claim whileboth parties' costs remain relatively low.

We can all agree that the best claim is a closed claim. However,settling claims for its true value is a very different approachthan settling claims just to be able to close them. Settling claimsfor its true value typically will satisfy your clients morebecause, at the end of the day, less money is being paid out. Thatmeans fewer cases go into litigation and legal expenses will drop.This, in turn, could mean more business for a company because theclients are happy.

Obsessively Document

Remember, if any action in a file is taken, you must documentit. If the activity has not been documented in the file and someoneelse looks at it, the activity might as well have never occurred.This is an important step, especially in litigation, because no oneis left wondering what has been done, and no one has to reinventthe wheel.

Next, a claim handler should always have photographs taken ofthe accident scene. Remember the movie, My Cousin Vinny? If so, youshould recall the importance of taking as many pictures of thescene as possible. If you don't, chances are it will change withinhours of the accident. Don't be frugal with your pictures. Take asmany photographs as needed to capture the scene. Any camera will dothe job (especially digital). Also make sure that the photographsare dated and time stamped. Finally, if using film, it is always agood idea to keep the negatives so you can use them in thefuture.

Also, if possible, be sure to photograph the claimant; thesephotos can be used to verify targets for surveillance. Oftentimes,investigators do not know what a claimant looks like, so having aphoto reduces the chances of an investigator ending up with sixhours of great footage — of the wrong person!

Recorded statements, if done properly, can be a great asset to acase. If not done properly, however, they are a waste of time and asource of frustration. To avoid this problem, make sure to getclear answers from the speaker. Make sure to stay on top of theclaimant if they answer questions with “uh-uh” or “huh-uh.” Nailthem down to verbal responses like “yes,” and “no.” This savesheadaches down the road when folks are trying to figure out if theclaimant meant “yes,” or “no,” to an answer. Answers like this giveclaimants an incredible amount of wiggle room when confronted withtheir statements during cross-examinations.

And do not forget that under the Texas rules of civil procedure,any witness statement must be turned over during litigation.Therefore, be cautious about the statements taken. Ask yourselfthis: Do I want to have to turn this statement over to opposingcounsel? If you don't, then don't take it.

Keep in mind the important information that you need to obtain,such as a claimant's complaints and damages. Try to be specific andverify their exact injuries and damages. What doctors have theyseen? What hospital did they go to? What treatments have theyreceived? Should they file suit, you can order up their medicalrecords and get a better sense of their damages. By using yourstatement outline as a “go by,” you won't forget to cover theimportant points.

Make sure to be clear about who the claimant is talking about.If a claimant is excessively using pronouns, clarify whom are theytalking about. By making sure that everyone is clearly identified,you will reduce confusion down the road. Also, having an outline ofpoints or questions that need to be covered during the statement isa good idea because it reduces the chances that you will forget toask a certain question or cover an issue. Do not use your outlineas a script, but rather as a guide. When you think you are almostdone with your questions, look over your outline to make sure thatyou have covered everything.

Also, be sure to listen to what the claimant is telling you. Donot gloss over answers just to get to the next question. You maylearn some very valuable information by following their leads andasking them questions about what they are talking about.

Make sure that a list of witnesses and people with knowledge iskept. You or your defense counsel may need to revisit them down theroad to find out what kind of witnesses they will make with a juryand whether they have changed their stories. If a witness isfavorable to your position, ask the witness for the name and numberof someone who will always know how to contact them. It may be morethan two years until a case goes into litigation and that witnessmay be very important to your defense. Finding a way to keep tabson a witness increases the chances of being able to utilize them inthe future.

When handling claims, be responsive to information. It is easyto fall into a trap of drawing a line in the sand when confrontedwith a certain type of claimant, attorney, or treating physician.The ability to handle the claim, and ultimately the case, will beharmed if you are not careful. Instead, remember that informationequals knowledge, which equals an informed evaluation, which equalsa better settlement. This includes listening — rather than justhearing — what people have to say. Knowing the difference betweenlistening and hearing is important; increasing your listeningskills will increase your effectiveness.

Finally, keep the ball in the claimant's or attorney's court.For example, what if an attorney sends you a demand for settlement,but does not give you all the information that you need? Send theattorney a letter requesting the missing information as soon aspossible. This puts the ball back in his court to give you what youneed to move the claim. It also shows good faith in adjusting theclaim.

Mike H. Bassett is a partner and Jennifer Eldridge is anassociate at The Bassett Firm, a litigation firm that focuses ontransportation litigation and premises liability. They may bereached at 214-219-9900, www.thebassettfirm.com.