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Testifying expert

Claims handling review.

Mr. Bingham often serves as a claims handling expert witness on whether a claims professional met the standard of care. That professional may be a carrier’s claims department, a third-party administrator, an independent adjuster, an insurance agency, or the counsel who defended the claim.

Defense of TPAs, Agencies, and Counsel Carrier claims-practice reviews & audits

About this practice area

The standard of care for claims professionals.

Claims handling is the work of investigating, evaluating, reserving, negotiating, and paying insurance claims. Carriers do it through their own claims departments, and many delegate part of it to third-party administrators (TPAs), independent adjusters, and managing general agents. Agents and brokers, and the defense counsel an insurer appoints, also shape how a claim unfolds.

Claims-handling disputes ask whether one of these professionals met the standard of care. Where the conduct in question is an adjuster’s, whether on the carrier’s staff or independent, Mr. Bingham serves as an insurance adjuster expert witness. A TPA may be sued by its insurer or self-insured client under the claim service agreement; an agency may face errors-and-omissions claims over the coverage it placed or the advice it gave; defense counsel may be sued by an excess carrier over the handling of a defense. The standards come from the contract, from state insurance codes & regulations, from the professional’s own guidelines, and from what is customary in the industry.

Claims operations are also reviewed outside litigation: by regulators, by the receivers of failed insurers, and by companies assessing their own staffing, controls, reserving, and settlement practices.

Where the allegation is the insurer’s conduct toward its own policyholder, see Bad-Faith Analysis; many matters involve both.

Five claim-handling steps stacked top to bottom, notice, inspection, estimate, decision, and payment, linked in a chain with one link broken and marked amber as the gap, and the expert's solid measure bracketing it

Sub-categories

Two kinds of claims-handling review.

Defense of TPAs, Agencies, and Counsel

The defense of claims professionals when their own handling is the allegation: third-party administrators, insurance agencies, and defense counsel.

View Defense of TPAs, Agencies, and Counsel →

Carrier claims-practice reviews & audits

Reviews of a claims operation as a whole: staffing, policies & procedures, reserving, controls, and settlement practices, across a book of files rather than a single claim.

View Carrier claims-practice reviews & audits →

Engagements

Matters handled.

GIC works file by file, scores the handling against the applicable standard, and ties every opinion to the record.

Testifying expert · Report, Deposition, Trial

Three-month trial over a failed insurer’s directors and outside auditor

$2Bplea in the case

265claim files scored

800+page report

Receiver’s expert

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Engaged by the Florida Department of Financial Services as an expert to review the claims practices of an insurance entity in Receivership, in a case for damages against the Directors and Officers of the insurer as well as their outside auditor. This required analysis of issues such as corporate governance, claim reserving, communication with claimants, and adherence to fair claims practice rules & file documentation standards for claims. The plea in the case was for $2 billion. Mr. Bingham testified during the three-month trial. Mr. Bingham and his team scored 265 files and completed a report of over 800 pages.

Circuit Court of the Second Judicial Circuit, Leon County, Florida

Also listed under: Testimony for Receivers and Regulators · Claim audits and file scoring · Receiver’s expert in suits against officers and professionals · Testimony record

Testifying expert · Report

Claims handling and coverage in a major class action

80,000page record

68-pagereport, 327 citations

Fair claims practices

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Retained by a multi-national insurance conglomerate to review the 80,000-page record and issue a report on the claims handling and coverage issues presented by a major class action lawsuit against the policyholder. Allegations included bad faith, breach of contract, and failure to defend. Using case management software GIC was able to draft a 68-page report containing 327 citations to the record.

Also listed under: Fair claims practices and standards of care · Coverage and policy interpretation

Testifying expert · Report, Deposition

Errors-and-omissions suit against a failed risk retention group’s directors, auditors, and actuaries

2-daydeposition

Finalreport issued

Settledafter the deposition

Receiver’s expert

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Retained by the Special Deputy Liquidator for a South Carolina domiciled medical malpractice risk retention group in Liquidation. The Special Deputy Liquidator is suing the company’s former directors and officers, accountants, auditors, and actuaries for errors and omissions. Mr. Bingham has completed an extensive review of the company’s claim files and information management systems and has issued a final report. Upon completion of Mr. Bingham’s two day deposition the cases settled on terms favorable to the Receiver and the South Carolina Department of Insurance.

Court of Common Pleas, Fifth Judicial Circuit, Richland County, South Carolina

Also listed under: Testimony for Receivers and Regulators · Receiver’s expert in suits against officers and professionals · Estate claim adjudication and audits · Reserve studies for carriers · Testimony record

Testifying expert · Report

TPA suit over a workers compensation deductible recovery: random 52-file audit

100files reviewed, 52 selected at random

100+page rebuttal report

379citations, 23 exhibits

Defense of TPAs, agencies, and counsel

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Retained by counsel representing a third-party administrator being sued for negligence and breach of contract. Allegations against the third-party administrator included erroneous coverage interpretation and application as well as conducting an untimely investigation and inadequate reserving. The dispute arose from a workers compensation carrier’s recovery action against a policyholder for paid benefits subject to the policy’s deductible. GIC selected at random 52 files for review and utilized a proprietary score sheet to aggregate the results. In all, 100 files were reviewed. GIC authored a rebuttal report of over 100 pages containing 379 citations and 23 exhibits.

Also listed under: Claim audits and file scoring · Expert Testimony · Testimony record

Consulting

Two-year run-off plan for all claims activity

2-yearoperational plan

10,000sof claims evaluated and paid

Reinsurance and run-off

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Developed a two-year operational plan which directed all claims activities including the evaluation, adjudication, and payment of tens of thousands of claims and the collection of the commensurate reinsurance.

Also listed under: Reinsurance collections and run-off operations · Claims & Reserve Auditing

Testifying expert · Report

Workers compensation bad-faith allegations against a TPA (South Dakota)

42-pagereport, 118 citations

16 daysfrom retention to report

Defense of TPAs, agencies, and counsel

Read moreShow less

Engaged by a major claim third party administrator to address allegations of bad faith for their handling of a South Dakota workers compensation claim. Mr. Bingham’s 42-page report contained 118 citations. This report was completed 16 days from the date of retention.

Also listed under: Fair claims practices and standards of care

Similar matters, grouped

Open a group to see each matter in it.

3 matters

Defense of third-party administrators

Third-party administrators defended against breach-of-contract and claim-handling allegations, with audits of the claim files behind the opinions.

52claim files audited at random

Score sheetsfor the files reviewed

Show the 3 mattersHide the matters

Homeowner claim-file audit in a TPA service-agreement disputeTestifyingDefense of TPAs, agencies, and counselRead moreShow less

Retained by counsel representing a third-party administrator being sued for alleged breaches of a claim service agreement. This assignment included completing an audit of homeowner’s claim files. GIC repeated the TPA’s internal quality control audit and verified their file scoring and conclusory report. This portion of the audit reviewed 112 files. Deliverables included an expert’s report, rebuttal report, and accompanying claim file score sheets. Case was dismissed after opposing expert was stricken.

Also listed under: Claim audits and file scoring

Federal breach-of-contract action against a TPATestifyingDefense of TPAs, agencies, and counselRead moreShow less

Third-party claims administrator: defense of a federal action alleging breach of contract and incompetent claim handling. Relying on GIC’s analysis, the client disposed of the case by dispositive motion.

Claim service agreement dispute involving a TPATestifyingDefense of TPAs, agencies, and counselRead moreShow less

GIC was retained by a prominent New York-based law firm which represents a third-party administrator being sued for alleged breaches of their claim service agreement. Glynloen Insurance Consulting aided in the defense of a third party administrator, with Rick Bingham of GIC serving as an expert witness. Rick and his team conducted a thorough analysis of the record and subsequently reviewed the third-party administrator’s management information system. Upon completion of the team’s investigation, Rick provided a 176-page report of his findings and opinions.

Other matters

Reserve studiesTestifyingReserve studiesRead moreShow less

Performed multiple reserve adequacy studies for property & casualty, life & accident, auto warranty, workers compensation carriers, professional liability, asbestos & environmental, and more. Reports and trial testimony was provided in contested receivership proceedings.

Also listed under: Reserve adequacy studies · Reserve studies for carriers · Testimony record

Centralizing environmental, asbestos, and toxic tort claims nationallyConsultingCarrier claims-practice reviewsRead moreShow less

Designed and operationalized a national claims operation to remove CNA’s environmental, asbestos, and toxic tort claims from the 37 field offices and centralize them. This project involved the relocating of tens of thousands of claim files, their proper and adequate reserving, and drafting claim policy & procedure manuals.

Also listed under: Claims & Reserve Auditing

Multi-state market conduct examination defenseConsultingMarket conductRead moreShow less

Retained by a Property and Casualty carrier to assist in defending a multi-state Market Conduct Examination in which the client was accused of having violated rules and regulations in all 50 states. The engagement has lasted over 5 years and has required numerous appearances before the NAIC’s Market Actions Working Group (MAWG), hearings at State Departments of Insurance and on-site dealings with state Market Conduct Examiners. Other duties included writing a Corrective Action Plan (CAP) and a Regulatory Settlement Agreement (RSA). Mr. Bingham also designed and directed a mock examination based upon the tests prescribed in the NAIC’s Market Regulation Handbook.

Also listed under: Market conduct examinations and defense

Claim audit of an insolvent carrier’s property lossesTestifyingEstate claims and auditsRead moreShow less

Retained by the Receiver of an insolvent carrier to perform a claim audit and examination of property losses. A random selection of the claim population was examined to form opinions about claim handling and payment to determine accuracy of payments and adequacy of claim file documentation.

Also listed under: Reserve adequacy studies · Claim audits and file scoring · Estate claim adjudication and audits · Receiver’s expert in suits against officers and professionals · Testimony for Receivers and Regulators · Testimony record

Reserve review of a taxicab risk retention groupTestifyingReserve studiesRead moreShow less

Retained as an expert to review the held reserves of a taxicab risk retention group. Upon Mr. Bingham’s final report of audited claim files, the group was ordered into liquidation.

Also listed under: Reserve adequacy studies · Reserve studies for carriers

Unauthorized business of insurance by an agent, broker, and carrierTestifyingClaims handling reviewRead moreShow less

Retained by policyholder to testify about an agent/broker/carrier engaging in the unauthorized business of insurance in Illinois; Expert opinion report; sworn deposition; sworn trial testimony.

Circuit Court of Cook County, Illinois, Chancery Division

Also listed under: Testimony record

Notice and reporting under a claims-made policyTestifyingCoverage and policy interpretationRead moreShow less

Engaged by a major carrier to offer expert opinions in support of claim denial asserting breach of contract, specifically notice and reporting issues on a claim made policy. Mr. Bingham’s report cited in detail the breaches, offered a timeline, and described the usual, customary, and ordinary practice for insurance carriers.

Also listed under: Fair claims practices and standards of care · Coverage and policy interpretation

Review of a claims department’s staffing, procedures, and settlement practicesTestifyingCarrier claims-practice reviewsRead moreShow less

Completed reviews and expert reports assessing propriety of Subject Company’s claim department’s staffing, claims handling policies & procedures, and overall fairness of Company’s claim settlement practices.

Also listed under: Fair claims practices and standards of care · Reserve adequacy studies · Claim audits and file scoring

Negligence claims against defense counsel in a maritime caseTestifyingDefense of TPAs, agencies, and counselRead moreShow less

Retained by a law firm being sued by an excess carrier for negligence in defense of an insurance action. The excess carrier alleges that the defense of a maritime claim was flawed and that the lawyer inadequately prepared the case for trial and that counsel was responsible for providing late notice to the excess carrier. Mr. Bingham authored a report disputing the allegations and has provided testimony via deposition.

Also listed under: Testimony record

Failure to settle multi-fatality death claimsTestifyingFair claims practicesRead moreShow less

Retained by decedent’s estate in a bad-faith/breach-of-contract action against a self-insured for failure to settle death claims resulting from a driving while intoxicated accident involving multiple fatalities; Expert opinion report; sworn deposition.

U.S. District Court, District of South Carolina

Also listed under: Fair claims practices and standards of care · Testimony record

Illinois Fair Claim Practices Act and standards of care in a hospitality bad-faith caseTestifyingFair claims practicesRead moreShow less

Retained by a Chicago based hospitality and entertainment operator to offer opinions in an insurance bad-faith litigation. Mr. Bingham opined on breaches of the Illinois Fair Claim Practices Act as well as industry standards of care and best practices.

Also listed under: Fair claims practices and standards of care · Business Interruption Analysis

Agent misrepresentation of policy termsTestifyingCoverage and policy interpretationRead moreShow less

Retained as an expert for policyholder suing agent for misrepresentation of policy terms and other errors and omissions allegations.

Also listed under: Coverage and policy interpretation

Day-to-day representative of a court-appointed supervisorConsultingSupervisionRead moreShow less

Retained by the Oklahoma Insurance Department’s Receivership Office to be the day-to-day representative of the court-appointed supervisor of an insurance company: conducting a reserve audit, analysis of the claim operation, and approval of claim payments, with responsibility for a number of other tasks including compliance, reinsurance recoveries, and financial statements, reporting to the supervisor the results of the examination of the company’s operations.

Also listed under: Claims & Reserve Auditing · Regulatory Consulting · Receivership & Insolvency Issues

Environmental claim book: reserves, coverage triggers, and allocationTestifyingCarrier claims-practice reviewsRead moreShow less

Retained by a Property and Casualty carrier to review a book of environmental claims and determine reserve adequacy, coverage triggers, and allocation, propriety of investigations and file documentation as well as apportionment of defense and remediation costs. The final report included expert opinions on claim handling and file documentation.

Also listed under: Reserve adequacy studies

Insurance agency accused of negligence and bad-faith claims conductTestifyingClaims handling reviewRead moreShow less

Retained as expert for an Insurance Agency by their E&O carrier to defend against allegations of negligence, violations of the State Insurance Code, and “bad faith” claims conduct.

Also listed under: Fair claims practices and standards of care

Claims handling review.

The standard of care for claims professionals.

Two kinds of claims-handling review.

Defense of TPAs, Agencies, and Counsel

Carrier claims-practice reviews & audits

Matters handled.

Three-month trial over a failed insurer’s directors and outside auditor

Claims handling and coverage in a major class action

Errors-and-omissions suit against a failed risk retention group’s directors, auditors, and actuaries

TPA suit over a workers compensation deductible recovery: random 52-file audit

Two-year run-off plan for all claims activity

Workers compensation bad-faith allegations against a TPA (South Dakota)

Similar matters, grouped

Defense of third-party administrators

Other matters

Have a matter that involves claims handling?