Ethics: Do the Right Thing! Presented By: Courtney Davis Jeff Moffett Jackson, MS Ocean Springs, MS 601-853-1911 601-872-1923 cdavis@markowwalker.com jmoffett@markowwalker.com

Duty to the “Insured” General Workers’ Liability Compensation Insured Employer Claimant? Insured Employer Claimant? www.markowwalker.com

Conflicts of Interest Hartford Moeller The insurer owes a fiduciary duty to the insured and is liable for all damages which result from the breach of this fiduciary duty. Hartford Accident & Indemnity Co. v. Foster, 528 So. 2d 255 (Miss. 1988) Moeller v. American Guarantee and Liability Ins. Co., 707 So. 2d 1062 (Miss. 1996) Options? Provide a defense for the covered claims (favored) Provide a defense for all claims under reservation of rights Provide a defense for all claims without a reservation of rights (not favored)

Ethical Goals Efficient, effective claims handling Encourage prompt reporting of injuries Complete a prompt and thorough investigation Have a good faith basis for denying any claim or benefit Professionalism Authorize medical treatment or other benefit timely www.markowwalker.com

Constructive Denial See Travelers Indem. Co. v. Weatherbee, 368 So. 2d 829 (Miss. 1979) - Eight month delay was not the problem, bad faith was in the lack of active investigation. See Caldwell v. Alfa Ins. Co., 686 So. 2d 1092 (Miss. 1996) - Six week delay not unreasonable in light of evidence in file of active investigation.

Do NOT rely on your own medical opinions Severity of an injury Pre-existing conditions/prior injuries Tutor v. UPS www.markowwalker.com

Ex Parte Communication Claimant Medical Provider When is it ok to contact the claimant? What if the claimant contacts you directly? What if the claimant files a new claim? When is it ok to contact the medical provider directly? What information can you give the medical provider?

Communication with Claimant Initial contact Do not mislead or misinform Do not threaten Explain the process Explain any delays Can you share your opinions on a lawyer or doctor the claimant has chosen?

Do NOT give legal advice Do I need to hire a lawyer? Settlement negotiations What are your duties related to the statute of limitations? www.markowwalker.com

Social Media Should you connect with a claimant on social media? How can you ethically use social media in claim handling? www.markowwalker.com

Mileage Fee Schedule Section XIII “The payer shall notify the claimant in writing of his/her right to receive mileage reimbursement for travel…Mileage must be paid promptly to the claimant without unreasonable delay. In the absence of good cause shown, any failure to pay a claimant’s mileage within 30 days after receipt of a request for mileage reimbursement from the claimant may be considered by the Commission to be an unreasonable delay and subject the payer to attorney’s fees, expenses, and a penalty of up to $10,000.00.” ** Reimbursement includes trips to medical appointments and trips to pharmacy or to obtain medical supplies!

Mississippi Code § 71-3-69 “Any person who willfully makes any false or misleading statement or representation for the purpose of obtaining or wrongfully withholding any benefit or payment under this chapter is guilty of a felony…” When should you contact the Attorney General’s office? When and how can you use the possibility of fraud charges as leverage?

Directing Care & Opioids Choice of Physician issues How can you direct care? Can you suggest medication generics or opioid alternatives? www.markowwalker.com

Offices in Oxford, Jackson, and Ocean Springs Courtney Davis Jeff Moffett Jackson, MS Ocean Springs, MS 601-853-1911 228-872-1923 cdavis@markowwalker.com jmoffett@markowwalker.com Offices in Oxford, Jackson, and Ocean Springs www.markowwalker.com