Case Study:

Pre-Litigation Management

Quick Facts

Community Type: CCRC

Number of Locations: 2

Resource: Professional Liability Claims Advocacy

Valued Client Since: 2013

Challenge

The Senior Living Claims Manager immediately responded to an email received from a not-for-profit CCRC community stating, “an unfortunate incident occurred the previous evening.” During the initial investigatory phone call, the Claims Manager identified a catastrophic event occurred resulting in the loss of the resident’s life. During this call, a number of liability and regulatory concerns were identified that would hamper a successful resolution of any claim or lawsuit.

Solution

Due to the nature of the event, identified concerns, and loss of life, the Claims Manager immediately outreached to the carrier. During the course of initial conversations, the Claims Manager identified the need to escalate this throughout the claims department as the Adjuster was going to establish a notice only and not complete an investigation.

The Carrier’s Complex Claims Unit began participation in the pre-litigation management process driven by the Claims Manager. Defense Counsel and a Public Relations firm were assigned to support the community leadership that was overwhelmed at the on-set of this emotional event. Communication support was provided so leadership could communicate with staff, family members, media and the community. Staff counseling was also arranged. A collaborative relationship was formed as the Claims Manager participated with the owner, administrator, defense counsel, regulatory counsel and adjuster to ensure all parties operated in sync so as not to have any one party negatively impact the efforts of the other. For example, the Public Relations firm didn’t say anything that could be used against the community, etc.

The Claims Manager quarterbacked multiple conversations between these parties and also involved the Senior Living Nurse Risk Manager and the Producer.

Value

From the date of the initial contact to the date of claims resolution - 68 days. The timeliness was crucial due to the notoriety of the event, potential loss exposure, and issues surrounding insurance coverage due to pending staff criminal charges. Resolution was reached prior to plaintiff attorney involvement resulting in a lower than full limits loss and minimal defense costs.