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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 Expectations II. Valuing Claims 5. How Insurance Companies Value Claims 6. Determining and Proving Economic Damages 7. [Reserved] 8. How Reserves Are Established 8A. Questions to Ask Insurance Experts 9. Proving Pain and Suffering 10. Handling Preexisting and Subsequent Injuries 11. Proving Hedonic Damages 12. Using Experts in Valuing and Settling Claims 12A. Harnessing the Internet as a Claim Evaluation and Settlement Tool 12B. Using Focus Groups and Mock Trials as Tools for Personal Injury Claim Evaluation III. Evaluating Coverage 13. Determining Coverage and Obtaining Policy Limits 13A. Questions to Assess Coverage Problems 14. What to Do When Liability Is Denied 14A. Homeowner's Insurance Coverage for Mold Claims IV. Documenting Claims 15. Drafting Effective Demand Letters and Settlement Brochures 16. What Adjusters Need to Settle Claims 17. Chiropractic Treatment in Soft Tissue Injury Cases 18. Attorneys’ Guide to Medical Records 18A. Countering Defense Independent Medical Examinations 19. Common Mistakes Made by Plaintiffs’ Attorneys in Documenting Claims 20. Analyzing Opinion Letters: A Physician’s Insights on the Quality of Medical Reports V. Effective Negotiation 21. Negotiating With the Insurance Adjuster 22. Establishing Bad Faith 23. How to Negotiate With Insurance Companies and Avoid Settlement Delays 24. Maximizing Damages in Small Personal Injury Cases 25. Twenty-Six Tips From Seasoned Claims Adjusters 25A. Mediation Tips for Personal Injury Counsel VI. Efficient Settlement 26. Evaluating Settlement Offers 26A. Settlement Ethics 27. Structured Settlements: Opportunities, Problems and Benefits 28. Appraisal of Insurance Claims 29. Solving Common Settlement Problems 29A. Handling Inflated and Other Liens VII. Specific Types of Cases 30. Evaluation of Soft Tissue Injury Claims 31. Evaluating and Settling Medical Malpractice Claims 31A. Investigating Cell Phone Use in Vehicle Liability Claim Recoveries 32. Settling Auto Accident Cases 33. Avoiding and Resolving the Classically Weak Case 34. Trauma & Post Traumatic Stress Disorder (PTSD): A Brief Primer for Civil Litigation 35. Stacking Un/Underinsured Motorist Coverages 35A. Investigating Slip and Fall Claims 36. Investigating and Litigating Nursing Home Abuse 37. Investigating and Evaluating the Product Liability Claim 38. Investigating False Arrest Claims 39. Investigating Negligent Security Claims in Pursuing Damages for Crime Victims 40. Investigating Workplace Violence Claims 41. Sexual Molestation Claims: Liability and Coverage Issues 42. How to Combat Smaller and Smaller Settlement Offers in Minor Impact Soft Tissue Injury Cases
I. CLAIMS HANDLING Chapter 1: How Insurance Companies Process Claims §100 Creation of a Claim §101 The Reporting Process §101.1 Reporting to the Agency Which Sold the Business Sample: Automobile Loss Notice Sample: General Liability Loss Notice Sample: Property Loss Notice §101.2 Reporting to the Carrier Sample: Telephone Claims Report §102 Policy and Coverage Verification §103 Assignment for Handling §103.1 Resolution by “Fastrack” §103.2 Additional Information Requested by Correspondence Sample: Statement of Claim §103.3 Additional Investigation by Telephone or Correspondence Sample: Schedule of Lost Contents Sample: 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 Documents Sample: 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 Reserves Sample: Claimant Summary §134.3 Suggesting an Action Plan §134.4 Requesting Settlement Authority Sample: 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 Issues Chapter 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 Adjusters Chapter 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 Conclusion Chapter 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 Commissioner Chapter 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 §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 §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 CLAIMS Chapter 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 Myths Chapter 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 Computation Sample: Present Value Computation §677 Economic Impact of Vocational Rehabilitation Sample: Table Showing Economic Impact With Vocational Rehabilitation §678 Economic Impact of No Vocational Rehabilitation Sample: 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 Damages Chapter 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 Conclusion Chapter 8A: Questions to Ask Insurance Experts §800A Introduction §810A Checklist — Questions for Insurance Experts §820A Resources for Finding Insurance Experts Chapter 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 Suffering Chapter 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 Report Sample: 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 Evidence Chapter 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 Estimates Sample: Direct Examination of Economist Sample: Cross-Examination of Economist §1161 Using Lay Witnesses to Supplement Economist’s Testimony Table: Hedonic Damages in Personal Injury Cases Chapter 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. §1243 The Lesson of Ofstedahl v. City of Phoenix §1250 Ethical Considerations §1260 Expert Fees Chapter 12A: Harnessing the Internet as a Claim Evaluation and Settlement Tool §1200A Introduction §1210A On-Line Requirements §1220A Internet Resources §1221A Search Engines §1222A Legal Research Databases §1223A Forums and Listserves §1224A Web Sites and Home Pages §1225A Court Forms on the Internet §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 §1240A Speed Bumps on the Information Superhighway §1241A Security Issues §1242A Timeliness Concerns §1243A Computer Viruses §1244A The “Spam” Factor §1245A Defamation Risks Chapter 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 Counsel Chapter 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 Contract Checklist: Elements of Breach of Contract §1422 Bad Faith Checklist: 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 Argument Chapter 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 |
