Robert L. Alpert
President
rla@icalmgroup.com

David B. Zoffer
Executive
Vice President
dbz@icalmgroup.com
  Claims and Litigation Questionnaire


  1. What is your current organizational structure as it relates to insurance and litigation?
  2. What manuals, memos or other documents describe or are related to the responsibilities of the departments and individuals listed in the organizational structure? For example - claims manuals, procedures manuals, charts, indexes, company directories, etc.
  3. When, how, and by/to whom are accidents/incidents/losses first reported?
  4. Describe the steps taken following a loss, to include -
    • insurance coverage assessment
    • investigation and documentation
    • the timing, form and content of information captured
    • reporting (what, how, when and to whom)
    • assignments to independent adjusters
    • tasks completed by your administrative and support personnel
    • communications with claimant, division, claims personnel, adjusters, experts, attorneys, insurers, government agencies and others
    • management of the file, to include diary system
    • creation and use of forms and checklists
    • evaluation of liability and damage issues
    • settlement negotiations
    • issuance of checks (procedure and authority levels)
    • establishment of and changes to reserves (procedure and authority levels)
    • loss of use
    • travel and time accounting
    • releases and closing documents
    • salvage and subrogation
    • governmental hearings
  5. Do narrative reports include the following elements -
    • date
    • file number
    • division/insured
    • insurance
    • date assigned
    • date and time of loss
    • location
    • deaths, injuries and property damage
    • summary of accident facts
    • witnesses
    • damages
    • recommended reserves
    • subrogation
    • recommended further activity
    • remarks
  6. Do plans for the response to major and catastrophic losses include the following elements -
    • rescue efforts
    • site security
    • interaction with local government agencies
    • communication and coordination with emergency medical services and hospitals
    • communication and coordination with medical examiner and mortuaries
    • communication and coordination with government agencies
    • telephone traffic management
    • victim (public) command and information center
    • media information center and public relations
    • creation of an accurate list of potential claimants
    • identification of parties who actually sustained injuries
    • policy of timing and method of communication with injured and next-of-kin of the deceased
    • evaluation of property damage
    • mobile communications center
    • bereavement counseling
    • collection, identification and return of personal effects
    • claimant information forms and death certificates
    • insured/insurer command and control center
    • telecommunications support system
    • accident and claims management information system
    • logs, forms, status boards and worksheets
    • eye witness testimony
    • claims resolution and litigation strategy
  7. Identify any claim procedures that are unique to certain kinds of losses or certain of your departments or divisions.
  8. What happens to a file and all of its contents after it is closed?
    • If held, where and for how long?
    • Is microfilm, microfiche, or electronic scanning utilized?
    • If need be, how is a closed file re-opened?
  9. How are multiple claim files arising from the same loss cross-referenced and managed?
  10. What other forms of cross-referencing are used for -
    • related liability and workers compensation files?
    • files involving similar liability or damage issues?
    • files involving related litigation?
    • other issues?
  11. What records/reports exist that -
    • total and detail reserves and IBNR?
    • total and detail loss, legal and other expense for all claims?
    • can be sorted so as to identify (for each claim) the claim number, claimant name, division/insured, accident date, file origination date, last activity date, file closed date, nature of claim, in suit/out of suit designation and date, defense attorney code, the prior outstanding, the current outstanding, the paid to date, and the responsible supervisor ?
  12. How are those records created and maintained?
  13. How current is the information they contain?
  14. Who uses those records/reports and for what purposes?
  15. Outside of individual claim files, what books, records or other documents are kept for the use and reference of your claims and legal personnel? For example, curriculum vitae of experts, consultants and adjusters; listings of defense counsel previously utilized; government and industry publications; significant briefs, memos, reports and transcripts; etc. How, when and for what purposes are those reference materials utilized?
  16. What "tools" are available to your claims personnel to assist them in their work? Mobile telephones, pagers, personal computers, data bases, audio, video and photographic equipment, voice mail, private aircraft?
  17. What company resources are available to claims personnel, i.e. - structured settlement professionals, engineers, computer specialists, rehabilitation and medical personnel, legal staff, etc.
  18. Under what circumstances do claims and legal personnel meet with their counterparts at other companies? As additional parties to an accident? At claims reviews? Industry meetings?
  19. What procedures are currently in place to assure consistency in the manner in which similar claims are handled by different offices and individuals?
  20. Describe the flow of information -
    • among division or local offices
    • from division office to home office
    • from home office to division office
  21. "Top fives" -
    • What are your five largest claims?
    • If the "yardstick" utilized is exposure rather than reserve, how does the list change?
    • What are the five oldest claims?
    • What are the five most complicated or difficult claims?
    • Which divisions generate the most claims?
    • What are the five most frequent kinds of claims?
    • What kinds of claims take the largest part of your time?
    • In which five cities are the largest number of claims pending?
    • In which five cities are the largest number of suits pending?
    • Which five cases have resulted in the largest verdicts returned to date?
    • Identify five cases that have been appealed.
    • Which five outside adjusters, experts, consultants and attorneys, respectively, are utilized most frequently?
    • What is the average length of time between opening and closing a liability claim file?
    • How has that time changed in the last five years? Why?
  22. Litigation -
    • what is the role of specific company personnel after commencement of litigation?
    • how and by whom are witnesses prepared for testimony?
    • which personnel -
      1. establish litigation objectives
      2. plan litigation strategy
      3. review and revise pleadings, motions and briefs
    • identify the "pool" of lawyers from which you select defense counsel, and for each firm, specify their
      1. location
      2. range of hourly rates
      3. responsible partner
      4. total billings in the last full calendar year
    • identify all law firms/lawyers currently working on your claims
    • how and by whom are these lawyers selected?
    • what standard instructions, guidelines and reporting procedures are conveyed to lawyers at the time they are engaged?
    • how and by whom are these lawyers managed?
    • what cost and loss exposure controls are in place?
    • how are lawyers' statements reviewed for quality, efficiency and comparison to other available firms?
    • how, where, when and by whom are experts and consultants retained?
    • when, where and under what circumstances do your personnel attend -
      1. meetings with defense counsel
      2. meetings with experts and consultants
      3. meetings with plaintiffs' lawyers
      4. depositions
      5. argued motions
      6. settlement conferences
      7. depositions
      8. trials
      9. appellate arguments
    • is a central trial calendar maintained, wherein all cases (wherever pending) scheduled for trial have their relevant details listed in the month preceding trial?
    • do pre-trial reports contain the following elements
      1. file number
      2. date
      3. author
      4. division/insured
      5. opposing parties
      6. date and time of trial
      7. place of trial
      8. name of court
      9. name of trial judge
      10. name of attorneys who will actually try the case
      11. stipulations
      12. what facts must opposing parties prove to prevail?
      13. what admissible evidence will be used to establish such facts?
      14. what admissible evidence will be presented, by cross-examination or otherwise, to rebut such facts? (include witness names)
      15. what facts must defendant prove to prevail?
      16. what admissible evidence will be used to establish such facts?
      17. what admissible evidence will be presented by cross-examination or otherwise, to rebut such facts?
      18. name, address and area of expertise of each opposing party's expert witnesses and each of defendant's expert witnesses
      19. summary of the contested legal issues
      20. what authority will be offered pertaining to such legal issues? (statutes, cases, law reviews, etc.)
      21. status of settlement negotiations
      22. attorney's evaluation of the case
      23. attorney's recommendations
    • how and by whom are legal issues evaluated?
    • how and by whom are lawyers evaluated?
    • how is research shared among defense counsel?
    • what methods are used to coordinate multi-jurisdictional litigation?
    • what continuing education and training is utilized to assure the professional development of claims personnel?
 
   
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