5 Fatal Flaws in Litigation Management: Why Immediate Change is Crucial

With over 25 years of experience in the insurance industry, I’ve had the unique opportunity to see both sides of the litigation management equation—first as a defense attorney representing carriers, and later as a claims professional hiring counsel to protect insureds. Despite decades of advancements in technology and claims practices, one critical aspect has stubbornly remained unchanged: the strained dynamic between insurers and their legal counsel. The pervasive “us versus them” mentality continues to undermine collaboration, inflate costs, and prolong claim resolutions. Instead of fostering a true partnership, the focus has often shifted to controlling defense costs, leading to rigid oversight rather than meaningful teamwork. Yet, I firmly believe this doesn’t have to be the case. True collaboration—where counsel and claims professionals align around shared outcomes—isn’t just a lofty goal; it’s a necessity. The question is, are we ready to move beyond surface-level cooperation and embrace a partnership that truly delivers value?

Over the next few articles, I will delve into the persistent challenges plaguing litigation management and introduce practical solutions to bridge the gap. While these insights may seem straightforward, the fact that these issues persist underscores their complexity. This article serves as the starting point, outlining the problems.

I will be exploring solutions to this problem and present the Decision+™ approach—a framework designed to accelerate decisions and reduce payouts, which fosters genuine collaboration, leverages innovative strategies, and embraces technology to transform litigation. Together, we can break free from outdated practices and create a more efficient, collaborative future. Stay tuned for the solutions ahead.

Problem 1 – The Carrier-Counsel Divide

A key issue in litigation management is the lack of alignment between carriers and counsel. Many industry guidelines emphasize the importance of adjusters maintaining control of claims during litigation:

“Adjusters should proactively handle the claim in litigation and not abandon the claim to defense counsel just because the claim is in litigation.”

Despite these guidelines, adjusters often relinquish control once litigation begins, treating attorneys more as external agents than as integral members of the claims team. This hands-off approach results in a leadership vacuum, leaving attorneys to manage cases without the benefit of a cohesive claims perspective or strategic guidance. The outcome is a reactive process with limited opportunities for meaningful collaboration, hindering both efficiency and effective resolution.

Left to navigate cases independently, attorneys often make decisions that are technically sound but disconnected from the carrier’s broader objectives. The lack of alignment can lead to:

  • A focus on litigation tactics over settlement strategies increases filings, prolonging cases and driving up costs.
  • Overuse of depositions and document requests without clear plans inflates expenses.
  • Without guidance, attorneys may prioritize billable hours over efficient resolutions, conflicting with cost-containment goals.

The carrier-counsel divide highlights a critical need for stronger integration and alignment. Without a unified approach, inefficiencies persist, and opportunities for timely and effective case resolution are missed. Building a true partnership based on shared goals and open communication is essential to overcoming these challenges and ensuring better outcomes for all stakeholders, especially the insured.

Problem 2 – Costs and Outcomes

The disconnect between carriers and counsel has significant financial and operational consequences, driving inefficiencies that disrupt the claims process. Ineffective collaboration exacerbates three critical issues:

  • Delayed Resolutions: Without streamlined decision-making, claims linger in litigation for extended periods, escalating frustration and costs.
  • Escalating Costs: Poor coordination often results in prolonged lawsuits that inflate expenses without delivering meaningful value.
  • Erosion of Trust: Lengthy litigation leaves policyholders feeling overlooked, undermining trust and damaging the carrier’s reputation.

Efforts to address these challenges through communication mandates and litigation plans have had limited impact, largely due to the entrenched adversarial mindset between carriers and counsel. The ongoing emphasis on cost control rather than collaboration continues to perpetuate inefficiencies and dissatisfaction for both sides.

Problem 3 – Culture and Billing

At the core of the carrier-counsel division lies a systemic issue: the culture of litigation management within the insurance industry. The dominant focus on cost containment often overshadows the need for collaborative, outcome-driven relationships. Industry guidelines frequently emphasize the importance of aligning legal strategy with claims objectives:

“Attorneys must align with the overall claim strategy and obtain adjuster approval for significant decisions such as filing motions, hiring experts, or pursuing depositions.”

However, in pursuit of cost control, the industry has swung to extremes, implementing stringent billing guidelines and complex coding requirements. While these measures aim to rein in expenses, they often have unintended and counterproductive consequences:

  • Administrative Overload: Attorneys spend an increasing amount of time ensuring bills meet approval standards rather than focusing on meaningful casework. This adds layers of bureaucracy, detracting from substantive progress on cases.
  • Micro-Management of Tasks: Carriers frequently require pre-approval for even routine tasks as a cost-control measure. Instead of fostering open dialogue about case strategies, these conversations often occur indirectly through billing systems, reducing opportunities for collaboration.
  • Frustration and Distrust: Restrictive guidelines leave counsel feeling stymied and claims perceiving attorneys as billing-focused, eroding trust and hindering teamwork. Attorneys may feel undervalued or constrained, leading to a transactional relationship where both parties operate defensively. This dynamic discourages proactive problem-solving and reinforces a mindset of minimal compliance rather than genuine partnership.

The cultural divide stems from viewing attorneys as cost centers rather than strategic partners, limiting their ability to craft solutions and drive effective resolutions. This compliance-focused relationship stifles innovation and collaboration, leaving carriers with higher costs and delays, and attorneys constrained by rigid controls. Breaking this cycle requires shifting from cost-control to a value-driven approach.

Long-standing issues—misalignment, cultural divides, and inefficiencies—have persisted throughout my three decades in the industry. Change is a necessity.

Problem 4 – Misaligned Priorities and Increased Documentation Demands

A critical issue in litigation management arises from a lack of understanding between claims professionals and legal counsel regarding their distinct roles, responsibilities, and external pressures. While both aim to achieve favorable outcomes for the insured and the carrier, their differing methods, priorities, and incentives often clash, undermining collaboration and amplifying inefficiencies.

Legal counsel, incentivized by billable hours, dedicate significant time to documenting their work—efforts that may not always align with the carrier’s broader goals. Meanwhile, claims professionals focus on efficiency, striving to resolve cases swiftly and cost-effectively while also managing mounting scrutiny from internal auditors, regulators, and compliance teams. This dual burden of efficiency and oversight has increased demands for meticulous documentation at every step, creating friction between the two groups.

The disconnect manifests in several ways:

  • Documentation Overload: Attorneys feel encumbered by frequent requests for detailed reports, while adjusters grapple with the pressure to justify their decisions to superiors, auditors, and regulators, often in real time.
  • Strategic Misalignment: Attorneys, concentrating on legal nuances and litigation risks, may lose sight of broader claims strategies. Conversely, adjusters, preoccupied with timelines and audit compliance, may overlook critical legal considerations.

The lack of alignment between claims professionals and legal counsel creates a cycle of inefficiency, with each side constrained by competing demands and priorities. This misalignment not only hampers collaboration but also detracts from achieving timely, effective outcomes for all stakeholders. Bridging this gap requires a shared understanding of roles and a commitment to aligning strategies with overarching goals.

Problem 5 – The Impact of COVID-19 on Staffing and Collaboration

The COVID-19 pandemic further intensified these challenges by introducing new pressures on both claims departments and legal counsel. Remote work, staff shortages, and increased caseloads have forced both sides to “do more with less,” often under strained circumstances. The demands for enhanced documentation and compliance have only grown in this environment.

For claims professionals, staffing reductions and remote operations have disrupted workflows, resulting in delays in decision-making and reduced capacity for active oversight of litigation. Attorneys, meanwhile, have faced similar staffing challenges, coupled with court backlogs, increases in nuclear verdicts and procedural changes that demand additional effort to navigate. The combined effect has heightened existing tensions, as both parties feel overburdened and under-supported.

Key impacts of the post-COVID environment include:

  • Increased Scrutiny: Carriers face higher demands from regulators and auditors, requiring extensive documentation and justification for claims handling and litigation decisions.
  • Reduced Collaboration: Remote work and virtual communication tools have made it harder for claims professionals and attorneys to engage in the face-to-face discussions necessary for building trust and aligning strategies.
  • Burnout and Attrition: Both claims and legal teams are experiencing high turnover rates, leading to a loss of institutional knowledge and continuity, further complicating the alignment of goals and strategies.

As noted, the COVID-19 pandemic has intensified challenges in litigation management, with remote work, staffing shortages, and increased caseloads disrupting workflows and straining resources. These pressures highlight the urgent need for a more adaptable, collaborative approach. Prioritizing clear communication and shared strategies is essential to building a resilient framework for effective litigation management.

Looking Ahead

The problems outlined in this article underscore the urgent need for a fundamental transformation in litigation management. These long-standing issues—misalignment, cultural divides, and inefficiencies—have persisted throughout my three decades in the industry, now intensified by post-COVID pressures. While these challenges are significant, they are not insurmountable. Addressing them requires a deliberate shift in mindset, where carriers and counsel move beyond entrenched adversarial dynamics to foster trust, mutual respect, and alignment around shared goals.

At its core, this transformation is about reframing the carrier-counsel relationship as a partnership, one where both parties are aligned around a common purpose: achieving fair, efficient, and value-driven claim resolutions. It is only through collaboration and open communication that the full potential of this partnership can be realized, benefiting insureds, carriers, and counsel alike.

Future articles will explore actionable solutions, innovative strategies, and frameworks like my Decision+™ approach. Together, we can break free from outdated practices and transform litigation management into a strategic advantage. Stay tuned for the next steps toward meaningful change.

Improving Litigation Management: A Data-Driven Approach

Addressing the Challenges of Accurate Data

The integration of data analytics and predictive modeling into litigation management can revolutionize how insurers handle claims, especially considering some of the new technologies hitting the market.  For years the focus has been on billing data to help manage counsel and litigation. This type of information provided some insight into counsel performance and compliance with billing guidelines but did not really translate to better litigation management. I would argue that some of this taken the effectiveness of litigation in the wrong direction but that is an article for another day. 

The success of this data-driven approach relies heavily on the quality and consistency of the data itself. For many claims departments, the hurdles of poor data input, unstructured information, and inconsistent data formats remain significant challenges. In addition, busy adjusters are being asked to spend more and more time inputting data which is taking away from their primary function as claim professionals. Addressing these issues is essential to unlocking the full potential of analytics in reducing litigation costs and improving outcomes.

Challenges in Achieving Accurate Litigation Data

1. Inconsistent or Incomplete Data Input by Claims Professionals

Claims professionals often prioritize immediate claim resolution over data entry, which can lead to missing, incomplete, or inaccurate information. Key details about litigation—such as court timelines, case strategy, or witness information—may be overlooked during input, reducing the reliability of downstream analytics.

2. Unstructured Data in Litigation Reports and Court Documents

Much of the critical information for managing claims litigation resides in unstructured formats, such as adjuster notes, attorney reports, and scanned court documents. Extracting insights from this data requires significant manual effort or sophisticated technology, which can slow down processes or introduce errors.

3. Data Inconsistency Across Systems

Data from different sources—claims systems, legal databases, and external platforms—often lacks standardization. Disparate formats, conflicting terminology, and varying levels of detail make it difficult to integrate and analyze data effectively.

Strategies for Overcoming Data Challenges

1. Improving Data Input Quality

  • Simplify Data Entry Interfaces: Design claims systems with intuitive, user-friendly interfaces that guide adjusters to input essential information without overwhelming them.
  • Incentivize Accurate Data Collection: Recognize and reward claims professionals for thorough and accurate data entry as part of their performance metrics.
  • Automate Data Entry: Leverage technologies such as natural language processing (NLP) and AI to extract relevant information from adjuster notes and reports, reducing manual workload and errors.

2. Structured Data Extraction from Unstructured Sources

  • Implement Text Mining Tools: Deploy NLP and machine learning algorithms to scan unstructured data sources, such as litigation reports and court documents, for relevant information. These tools can identify key data points like settlement ranges, precedent cases, and critical deadlines.
  • Centralized Data Repositories: Consolidate unstructured and structured data into a centralized system, allowing claims teams to access and cross-reference information more effectively.
  • Invest in Document Digitization: Use optical character recognition (OCR) and AI-powered data extraction to digitize physical documents and integrate their contents into claims systems.

3. Standardizing and Validating Data Across Systems

  • Create a Unified Data Schema: Establish a standardized framework for entering and storing claims and litigation data to ensure consistency across all systems and teams.
  • Cross-System Integration: Use middleware or APIs to synchronize data from disparate systems, ensuring that all platforms are working with the same information.
  • Regular Data Audits: Conduct periodic reviews of data quality to identify and address inconsistencies, duplicate entries, or missing information.

Enhancing Litigation Management with Reliable Data

Once the challenges of data quality are addressed, the true potential of analytics in litigation management can be realized:

  • Early Identification of High-Risk Cases: With accurate data, predictive models can reliably flag cases likely to result in significant litigation costs, allowing early intervention.
  • Improved Resource Allocation: Better data consistency enables teams to allocate legal and claims resources more effectively, focusing efforts on high-priority cases.
  • Enhanced Outcome Prediction: Clean, standardized data improves the accuracy of predictive analytics, helping to forecast settlement ranges and litigation timelines.

Building a Culture of Data Excellence

To address these challenges, claims leaders must prioritize a cultural shift toward data excellence:

  • Training and Education: Provide regular training for claims professionals to emphasize the importance of accurate data entry and how it supports better litigation management.
  • Collaborative Tools: Use tools that facilitate collaboration between claims handlers, legal teams, and IT departments to ensure data flows smoothly across functions.
  • Continuous Improvement: Establish feedback loops to refine data entry processes and adjust technology solutions based on user experiences.

Conclusion: A Foundation for Data-Driven Success

Accurate and consistent data is the foundation of a successful data-driven approach to litigation management. By addressing the root challenges—poor data input, unstructured information, and inconsistency—claims departments can unlock the full potential of predictive analytics and streamline litigation processes. While technology plays a vital role, building a culture that values data accuracy and consistency will ultimately ensure sustained improvements in litigation management.

How does your organization ensure data quality in litigation management? Share your strategies in the comments below, and let’s explore solutions to elevate our industry together.

A Nice Refresher: The Critical Role of Timely and Accurate Practices in Claims Management 

I hate to state the obvious, but accurate, timely and consistent reserving is the one truth that remains constant in the ever-evolving world of insurance. As a recent industry analysis pointed out, “This gap ultimately impacts claims and reserves, as carriers with outstanding cases will have to ensure they have adequate reserves to handle payouts when the cases do eventually resolve.” This statement underscores a critical aspect of claims management that deserves our full attention. This concept is so important it deserves repeating again and again.  

While many reading this blog know the importance it’s worth a refresher especially for those new to the industry. Let’s dive into why consistent reserving and informative trend analysis are not just good practices, but essential strategies for navigating the choppy waters of modern insurance.

The Ripple Effect of Reserving

Think of reserves as the financial shock absorbers of the insurance world. When set correctly, they help cushion the impact of claim payouts, ensuring the stability and solvency of insurance companies. But when reserves are inadequate or inaccurate, the consequences can ripple through the entire organization, affecting everything from financial reporting to pricing strategies.

Consistency: The Golden Rule of Reserving

Consistent reserving practices are the cornerstone of effective claims management. By establishing and adhering to clear guidelines for setting reserves, insurers can:

  • Enhance transparency for stakeholders
  • Facilitate more effective comparison of performance over time
  • Improve accuracy in financial forecasting
  • Provide a solid foundation for identifying emerging trends

But consistency doesn’t mean rigidity. The key is to have a systematic approach that can adapt to changing circumstances while maintaining its core principles.

Trend Analysis: Your Crystal Ball

While consistent reserving provides the foundation, trend analysis is your crystal ball, offering insights into the future of claims patterns. By regularly analyzing reserve change trends, insurers can:

  • Identify potential problems with reserving practices early on
  • Distinguish between reserving issues and genuine increases in exposure
  • Anticipate and prepare for emerging risks
  • Make data-driven decisions about policy pricing and risk management strategies

The Power of Early Detection

One of the most valuable aspects of robust trend analysis is the ability to detect issues early. By monitoring reserve change trends, insurers can quickly identify whether increases are due to:

  • Inadequate initial reserves (a reserving problem)
  • Unexpected claim development (a potential new trend in exposure)
  • External factors like social inflation or legal environment changes

Early detection allows for prompt corrective action, whether that means adjusting reserving practices, re-evaluating risk assessment protocols, or developing new strategies to address emerging exposures.

Putting It into Practice

So, how can claims departments implement these principles effectively? Here are a few key strategies:

  • Establish clear, written guidelines for setting and adjusting reserves
  • Regularly review and update these guidelines to ensure they reflect current realities
  • Implement a robust data analytics program to track and analyze reserve trends
  • Conduct frequent (at least semi-annual) reviews of reserve adequacy and trends
  • Foster collaboration between claims, underwriting, and actuarial teams to ensure a holistic view of risk and reserving
  • Invest in training to ensure all relevant staff understand the importance of accurate reserving and can interpret trend data

The Road Ahead

In an industry facing challenges from social inflation, court backlogs, and evolving risk landscapes, the importance of timely and accurate reserve practices cannot be overstated. By focusing on consistency in reserving and leveraging the power of trend analysis, insurers can navigate these challenges more effectively, ensuring they’re prepared for whatever lies ahead.

Remember, in the world of insurance, forewarned is forearmed. The insights gained from robust reserving practices and trend analysis are not just numbers on a spreadsheet – they’re the compass that guides strategic decision-making and ultimately, the long-term success of the organization.

What strategies does your organization use to ensure timely and accurate reserving? How do you leverage trend analysis to stay ahead of emerging risks? Share your thoughts and experiences in the comments below – let’s learn from each other and continue to elevate our industry practices.

Leveraging AI as a Decision Support Tool in Claims Processing: A Balanced Approach

In the rapidly evolving landscape of insurance claims operations, Artificial Intelligence (AI) has emerged as a powerful ally. However, its true potential lies not in replacing human judgment, but in enhancing it. As we navigate this technological frontier, it’s crucial to develop a strategic plan for implementing AI as a decision support tool in claims processing, ensuring we maintain the critical balance between efficiency and ethical considerations.

The key to successful AI integration lies in viewing it as a sophisticated assistant rather than an autonomous decision-maker. This approach harnesses AI’s analytical power while preserving the irreplaceable human elements of empathy, complex reasoning, and ethical judgment – particularly vital when dealing with diverse claim types requiring different levels of oversight.

To effectively implement AI as a decision support tool, insurers should consider a multi-faceted plan:

  1. AI-Powered Insights: Utilize AI to analyze vast amounts of data, providing claims adjusters with comprehensive insights, historical comparisons, and potential settlement ranges. For instance, in complex liability cases, AI can quickly analyze historical claim data, legal precedents, and policy details to offer a comprehensive overview and suggest settlement ranges.
  2. Bias Mitigation: Implement AI systems designed to identify and flag potential biases, both in historical data and in real-time decision-making processes. This helps ensure fair and consistent outcomes across similar claims, addressing unconscious biases that human adjusters might have.
  3. Explainable AI: Prioritize AI models that provide clear rationales for their recommendations. This transparency allows human adjusters to understand, validate, and, when necessary, override AI suggestions, fostering trust in the system.
  4. Continuous Learning and Feedback Loops: Establish mechanisms for human decisions to refine AI models over time. This ensures the system evolves alongside changing regulations, market conditions, and industry best practices.
  5. Customizable Thresholds: Develop systems that allow claims departments to set and adjust thresholds for AI autonomy based on their risk appetite and regulatory requirements. This flexibility ensures that human oversight can be dynamically allocated where it’s most needed.
  6. Cross-functional Collaboration: Engage claims adjusters, data scientists, and ethicists in the development and ongoing refinement of AI decision support tools. This multidisciplinary approach helps balance technical capabilities with practical and ethical considerations.
  7. Regular Ethics Reviews: Conduct periodic reviews of AI-assisted decisions to ensure they align with the company’s ethical standards and values. This process should involve both internal stakeholders and external ethics experts.

By thoughtfully integrating these elements, insurers can create a synergistic environment where AI amplifies human expertise rather than attempting to replace it. This approach not only enhances operational efficiency but also maintains the trust of policyholders by demonstrating a commitment to fair, ethical, and empathetic claims resolution.

It’s important to note that the level of AI support may vary across different types of insurance claims. For straightforward cases, like minor auto damage, AI can handle most of the process autonomously. However, for complex scenarios such as liability disputes or severe injuries, human expertise becomes indispensable, with AI serving primarily as a decision support tool.

Implementing AI as a decision support tool also helps mitigate potential bad faith risks. By maintaining human oversight, especially for claim denials, and ensuring transparency in AI decision-making processes, insurers can avoid the perception that claims are being unfairly handled by automated systems.

By viewing AI as a sophisticated decision support tool rather than a replacement for human judgment, insurers can significantly enhance efficiency and consistency in claims processing while maintaining the critical human element. This balanced approach not only improves operational performance but also builds trust with policyholders by demonstrating a commitment to fair, ethical claims resolution in an increasingly AI-driven industry.