How does a severely injured party come to the decision to settle his or her claim? This is a question we are asked frequently and there isn’t a quick, easy answer. However, being honest with injured parties and exploring ways to address their specific needs is the best way to earn their trust — which is the first and most important part of the process.
There are many moving parts to a settlement and when all parties involved are kept in the loop the result can be a true win-win for everyone, especially the injured party. Far from a simple exercise, many factors and differing points of view need to be considered, analyzed, discussed and agreed upon for it to work.
Initial Involvement of a Professional Administrator
As a professional administrator, Ametros’ role often starts when a defense carrier hosts ‘settlement days,’ a time to examine open claims to see if any have potential for closure. Or, alternatively, when a plaintiff attorney identifies that settlement may be the best option for their client. Either way, we are brought in to look at medical reports on these claims and help determine if our services would be beneficial for the injured party.
Once we’ve identified a claim we start building a relationship with the injured party and, often, their family. Understanding the components of the actual medical allocation of a settlement is just one portion of the process, though it is typically the most complex. In addition, it’s important to determine the goals and aspirations of the injured party throughout their lifetime to ensure there is enough money to cover all their future medical costs. Additionally, there can be other government benefits involved, such as Medicare, Medicaid, and Social Security programs that can also add complexities for the injured party. Who pays for what? Coordination of benefits is an important part of post-settlement life for an injured party. Finding out the answers to these questions and building a path forward for the injured individual and their family is our main goal.
Settlement Negotiations
A variety of parties are typically involved in settlement negotiations. Most of the time, though not always, there is an applicant/plaintiff attorney as well as a defense attorney involved, as well as insurance carriers, maybe third-party administrators, and structured settlement brokers. At the center is the injured party and, often members of their family. While the discussions center around the injured party, many of the parties involved bring their own perspectives and agendas as well.
Once Ametros becomes involved in a claim, we too are added into the group at the settlement table. However, our role is quite different from that of the others. Rather than representing any particular interest, our job is to be a true advocate for the injured individual post-settlement. We coordinate equally with all parties to try to find the very best solution for the injured party.
Often times, we are asked to provide visibility into what the true costs will be for the injured person’s medical after they settle through our CareQuote service. This can be important information to help all sides feel comfortable that the final amount is sufficient.
After Settling a Case
The goal of everyone involved is to facilitate the very best post-settlement outcome for the injured party. That is where the role of a professional administrator differs from that of others involved. Once the settlement is finalized, the attorneys, insurance adjusters, brokers, and other parties have completed their jobs, but it is really only the beginning of Ametros’ core involvement.
The advantage of having a professional administrator is not only in helping to contribute to the settlement process, but, more importantly, to help the injured person arrange their medical care and ensure their settlement funds last as long as possible.
Professional administrators offer a wide variety of services to help the injured parties who have settled their claim. The services are aimed at making the transition from pre-settlement to post-settlement seamless. For example:
- The injured party has had a nurse case manager help arrange medical care; the professional administrator takes over coordination responsibilities at the injured person’s direction
- No out-of-pocket payments and tracking of medical bills were required while the claim was open; the same should apply to post-settlement life with an administrator organizing all the billing
- The injured party did not need to be concerned about having the money to pay for injury-related medical expenses; the same should be true post-settlement. In fact, that aspect should be even easier, as there is no longer the chance that treatment will be denied. Working with a professional administrator exposes the injured party to substantial discounts for medical treatment — office visits, medications, and durable medical equipment.
Doing a good job during mediation means the injured party — and others involved — have a clear understanding of what post-settlement life involves. Ultimately, it is not only the injured party who benefits from having a professional administrator at the table.
Applicant/plaintiff attorneys can appreciate that their client will be well taken care of and insurers are getting the claim resolved knowing the injured party will continue receiving adequate care. And most importantly, the injured party’s family sees an end to the frustrations of dealing with the insurance system, knowing their loved one will be able to get the care and support they need to move forward with their life.
