By all accounts, it has been a brutal campaign season that hastaken a toll on politicians and voters alike. Being in the“swing state” of Florida, I for one anxiously awaited thismorning's lack of political ads on local TV.

That said, we should take the time now to reflect on some of thelessons learned during the campaigning that can be used to not onlydecide the election, but to also improve our own claimsorganizations.

Much like politicians, those inside of claims organizationsoften find themselves in adversarial positions. Whether it is the attorneyinsisting that the $10,000 in medical bills from the $200 bumper ding were indeed necessary to managers trying to explaininconsistent results to executives, there is never a lack ofopportunity for a little “spin.”

Perhaps the greatest lesson we have learned is that transparencydoes matter. Whether it is internal or external customers, itis important that there is a firm understanding of workflow,processes and outcomes. Providing clear and conciseexplanations up front tends to yield increasingly positive resultsdown the line.

Valuing Honesty, Integrity

Equally important are honesty and integrity. If a person ispartially at fault for an accident, this needs to be explainedas soon as the determination is made. Sometimes this is anuncomfortable conversation, but when done honestly with all of thefactual supports being clearly explained, the outcome is going tobe far superior to springing it at the last minute like some typeof October surprise.

The dealings with customers don't have to be adversarial,either. Just as the voters are often a little leery ofpoliticians, claimants may have some reservations about theiradjusters. By presenting positively and professionally, itbecomes possible to lay out the case in a manner that makes logicalsense.

Of course, like politics, there will be times when “we simplyagree to disagree.” Arguably, this is why we have the courtsand other means for dispute resolution. Fortunately, most claimsdon't resolve in that manner, as fairer heads tend toprevail.

In a sense, handling claims are much like reaching across theaisle. While we may strongly believe our position as itrelates to the case, it is important to remember that the bodyshop, claimant or attorney has an equally strong position. Butthat gap can often be bridged through effective negotiations.

Successful Negotiations

The key to success in negotiations is to understanding not onlyyour own position, but that of the other party. Attorneys arewell aware that adjusters are very busy, often to the point ofbeing overworked. The same often holds true for attorneys, whooften use a staff of associates, or negotiators, to push through aneven greater volume of work. Fortunately, this latter bit ofinformation can be of invaluable assistance when evaluating andnegotiating injury claims.

When doing due diligence, taking the additional time to researchall possible scenarios is time well spent. This is especially truefor injury claims, where a few critical building blocks can be thedifference in millions of dollars annually. Consider thefollowing:

Police report. Was there any mention of injuryat the scene? Which parties were cited as well as listed forcontributing factors, which often don't result in acitation. These facts are critical for establishing bothliability and damages.

Vehicle photographs (auto claims). Does thedamage match? Are there paint transfers? What is thedirectional force of impact? Was there a mechanism forinjury?

Accident scene. Are there any other potentialtortfeasors? Overgrown bushes, signal outages, missing orblocked signage, absentee third parties, and so on.

Emergency Room records. What does the admissionstatement say? What type of pain was related to the treatingphysician? Was there a mention of symptoms other than what maybe related to the accident? Is there evidence of apre-existing condition or intervening cause?

Treatment patterns. How soon did treatmentstart? Were there gaps? Was there treatment on eveningsand/or weekends?

Provider type. Was the claimant seen by achiropractor or medical doctor. If the latter, then whatwas the specialty? What are their credentials? Arethe licensures current? Are there any prior or pendingdisciplinary actions with their current state, or priorstates?

Duration and frequency. When did treatmentstart? How long did it last? Was it active orpassive? Was it longer than an anticipated expected recoverydate among the general population for a similar complaint?

Objectivity. Where there objective findings,such as those from an x-ray, MRI, or CT scan? Were the recordsand films obtained and reviewed by an independent medicalexpert?

Pain Management. Did the doctor prescribemedication to ease the complaints of pain? What type(analgesics, prescriptions, injections)? Did the injury haveany impact on the claimant's lifestyle?

“SOAP” Notes. Does the treatment being chargedmatch the medical providers' subjective, objective, assessment,plan (SOAP) notes? These notes can often provide a greatindicator of not only what treatment really occurred, but also ared flag for CPT coding modifier abuse. These can be a greatsource for identifying upcoding, unbundling, or other deceptivemedical billing practices.

While these are just a few of the many considerations in claims,they are important because different parties may have differentopinions. It is all but certain that the perspective of theinsurer and the claimant or trial lawyer will begin diametricallyopposed. After all, who really admits to being at fault for anaccident?

It is only through effective negotiations that there will be aconvergence of agreement as to the acceptable liability anddamages. This is precisely why having a well plannednegotiation strategy is of critical importance.

Like an effective campaign, the most effective negotiationstrategy requires knowledge of the facts and of the other side'spotential vulnerabilities. By capitalizing on opportunities, itbecomes possible to leverage winning arguments to effectivelyposition the claim for the most accurate resolution. It isthis mastery of the art of negotiation that separates theextraordinary from the ordinary.