Greg Gitter and Connie O’Mara provide us with a second installment of short stories that illustrate some real world techniques on how to deal with difficult claims.
In our first episode (March 18, 2020), we depicted the resolution of a workers’ comp claim that hinged on “reading the room” and adding king-sized sheets to the negotiation to sweeten the settlement proposal. Here is another story that demonstrates how listening skills are a key component of resolving a case.
“Mrs A” was in bad shape. But that was not her name. In addition to suffering from a prior lumbar injury and multiple failed back surgeries, she had hypertension, she was obese and smoked 2 packs of cigarettes per day (which was doubtless a contributing factor to her failed back fusions). In addition to all that, the claimant suffered from MRSA, Methicillin-resistant staphylococcus aureaus, an infection caused by a type of staph bacteria that’s resistant to many of the antibiotics used to treat ordinary staph infections.
In order to cope with her conditions, the claimant needed to reside in an assisted living care facility plus her annual medical usage was in excess of $69k per year. Full value of the case was approximately $2.5 Million. The key issue fueling the demand was the need to provide a roof over the claimant’s head in the type of facility that could deal with her conditions for the next 25 years.That cost was the major concern of the claimant’s lawyer.
So, how to deal with that unknown? Deal directly with the facility. By agreeing on a long-term contract directly with the facility and funded by an annuity with a cost of living increase, the case could be settled for $972k. Thus, once again, understanding what needs are most critical for a claimant and creating a solution to satisfy those needs resulted in a win-win for both the insurer and the claimant.
