As a worker’s compensation major case claims specialist there are many times when the news lands on my desk. Workplace or public shootings, major storms or fires, major vehicle or plane crashes, sexual harassment and other harassment suits, or other traumatic workplace events are the high-profile types of claims that require a balance of empathy, knowledge, a thorough investigation of the facts, and clear, precise communication.
Those who have handled claims for a long time will remember the warning about not saying anything you wouldn’t want to be the headline on the front page of the newspaper. With the power and reach of social media today, that warning is you don’t want what you say going viral on social media. Think about some of the posts you read after the health insurance CEO was shot in New York? We are usually portrayed not only on social media but in late night ads by the plaintiff bar, authors, and screenplay writers as the bad guys—a greedy corporation trying to cheat and lowball their customers and innocent parties.
So, when a high-profile claim comes across your desk a thorough investigation and clear communication is key to avoiding or reducing the negative reactions and news. Before a catastrophic claim happens, it is imperative that we’ve explained the coverages and jurisdictional laws to our insured employers to lay the groundwork.
Initial Response
So, you’ve just gotten a high-profile claim what should you do? Know that there will be multiple eyes on the claim and your handling of it, both internal and external.
Your first step is to reach out to the parties, express sincere sympathy for their loss, and obtain the facts – what happened, why did it happen, who was responsible, and if there are any unanswered questions. Explain the process and what happens next to all the parties. Set expectations and timelines.
If there is a coverage question, stop any further investigation until you’ve sent out a Reservation of Rights letter outlining the issues and get a coverage attorney involved.
Information Collection
Go out to news and social media sites and gather pictures, videos, interviews, and news articles about the event. Be wary, however, about the possibility of deepfake videos. Fact-check what you find.
Often in the early stages of official investigations, reports, photos, party and witness statements, and the party at fault or perpetrator’s identity may not be available until the investigation is done. In this day of video cameras everywhere there are often videos of the event on security cameras and neighborhood Ring doorbells. Bystanders may be taking videos of the aftermath on their phones.
How many have seen and watched the videos that were taken of the evacuation of Delta 4819 after the crash landing?
Use Google Genie or Microsoft CoPilot or other AI search filters to help you locate any mention of the event online to look for photographs or videos, people who indicate they witnessed the event, or news articles covering the event. But again, fact-check the source and information that you find.
Check for Related Claims and Arrest Records
Go to ISO/NICB sites to look for other claims that were filed related to the event to see who those parties are if you are looking for responsible parties or claims made by the claimant or the claimant’s family against other parties.
If the claim is due to a criminal activity, look for stories on arrests to find out who was arrested or accused of the crime and what police or sheriff office responded to the scene. Does the article say where they are being held and will be arraigned? Go to the inmate search for the law enforcement agency to get the case number and full name of the perpetrator.
You can then look up cases involving them on Case.Net. Prior arrests and convictions are public records that you can obtain on Case.Net as well as what court the charges are filed in and what the charges are. You may want to put the prosecutor on notice of your claim and potential subrogation lien in case restitution is ordered at sentencing.
Fatalities and Dependents
If the claim results in a fatality, look for the decedent’s obituary which will provide information as to the funeral and burial and possible dependents.
On-Site Investigation
Collect the evidence you can online, but high-profile claims require onsite investigations. Send out company or independent investigators to help complete the scene investigation by obtaining witness statements, photographs of the site of the event, and any photos or videos of the event and aftermath at the scene that aren’t posted online.
Again, the neighborhood Ring or local business security cameras. Have the investigator talk to the first responders who were at the scene to get the information they can provide prior to the report being ready.
Secure Official Documents and Records
Secure official reports, including police, fire, EMS, OSHA, and arrest records. If the claim involves a fatality obtain the autopsy report, death certificate, marriage certificate and/or divorce decrees, and birth certificates of the parties.
Obtain a complete set of medical records related to the event from EMS forward. In some events you may need to obtain prior medical records if the accident records indicate a prior medical history that could impact the nature and extent of the injury and their recovery.
Employer and Corporate Investigation
If the claim is the result of a workplace event such as a shooting or catastrophic accident, go to the company website and social media sites such as LinkedIn and Facebook. Go to the Secretary of State website to look at the articles of incorporation and if they are in good standing.
Review the parties who make up the leadership of the company, their internal and external news, their history, and business activities. Look at their annual reports for investors and potential suits or accidents that impacted their bottom line. These can sometimes indicate the motive for the shooting and why those were the parties who were singled out.
Or if the company had recently been required to address a suit or an OSHA investigation that may have led to the event or been a warning of the potential for the accident that happened. Find out what happened before and what they’d done, if anything, after the prior event.
Evaluate and Consult
Once you’ve gathered the facts, validate them and review applicable statutory and case law. If the facts are not conclusive on whether the claim should be accepted or denied, discuss the evidence with your attorney.
If a denial is indicated, what is the likelihood you will prevail if the case goes to trial? What is the exposure if you are not successful both financially and reputationally? Be sure you have documented and recorded all your investigation. Don’t overlook the work product protections by documenting it with the attorney.
If there was equipment or machine failure, be sure the company preserves the equipment involved for experts to examine the machine or equipment and document their findings in a report. Be sure to tell the insured to keep it and not throw it away even if it was damaged where it is no longer useful. It is still valuable evidence that needs to be preserved.
Be sure that the parties preserve the chain of evidence of not only the equipment, but the vehicles, videos, statements, photographs, and reports.
If you found information on social media that impacted your decision about acceptance or payment of the claim, be sure you get forensic people to secure a copy of the post, have them validate it to avoid any AI or fake posts, and have them secure the metadata that documents where it was posted and when. Without that the party can delete the post or deny making it.
Litigation Readiness and Settlement
If you are headed to a trial, always complete your discovery including medical records reviews or Independent Medical Examinations; and depositions of the parties to evaluate the type of witness they’ll make and to uncover information that may lead to other facts or evidence that need to be investigated, collected, and preserved.
It is critical when evaluating if the claim is one to settle or try that you’ve properly evaluated the damages and exposure and chance of prevailing; including looking at the judge who will be presiding and recent case law and jury verdicts for the venue.
If the claim is clearly owed and the exposure supports it, be sure you’ve offered the policy limits in an attempt to settle the claim before going to trial to reduce or avoid the potential for extra-contractual or punitive damages that could be awarded against your insured if you don’t prevail.
Final Thoughts
While you may never handle a claim that makes the nightly news, it is important that every claim that crosses your desk receives a combination of empathy, investigation, education, and clear communication to reduce the exposure for your insured and the company, and so that you make the right decisions and do the right thing for the parties.
About the Author: Brenda McDermott, CPCU, CLP, SCLA, CIIP, SCLA, ARM, AIDA, AIC is a workers’ compensation claims specialist in The Hartford’s Major Case Unit. She is a past International Rookie, Claims Professional of the Year, Risk Management Professional of the Year and International CWC Speak-Off winner. She was the 2022 Region V Insurance Professional of the Year. She has been a long-time member of IAIP and served in multiple offices at the local, state, and regional levels. A Past Region V RVP she is currently serving as the Region 5 Marketing Director and Assistant to the RVP. She is Co-Chair of the International Marketing and Today’s Insurance Professional Committee. She is an MAL in Region 5 from Missouri.