Ethics for Claims and

Legal Professionals

Anderson Crawley & Burke, pllcAttorneys and Counselors

Jim Anderson

janderson@acblaw.com

601 500 7477

216 Draperton Court

Ridgeland, MS 39157

Daniel Culpepper

dculpepper@acblaw.com

601 707 8796

www.acblaw.com

Ethics in General

Integrity

Honesty

Fidelity

Charity

Responsibility

Self-Discipline

But is it Legal?

If it is unethical, is it

illegal?

If it is illegal, is it

unethical?

What Should I Do?

What guides your decision making?

Is a Code of Ethics required?

What Should I Do?

Why Should I Do It?

Claims Professionals’

Canons of Ethics

1. A Claims

Professional shall

strive to maintain the

integrity of the

workers’

compensation system

consistent with the

social purposes of the

legislation with the

goal of promoting

public confidence

and trust in the

system.

Claims Professionals’

Canons of Ethics

2. A Claims

Professional shall not

knowingly violate any

law, regulation, or

applicable ethical

obligation in the

performance of his or

her professional

responsibilities nor shall

claims be handled with

an intent to mislead or

misinform.

Claims Professionals’

Canons of Ethics

3. A Claims Professional shall exercise a sense of urgency in the completion of a prompt and thorough investigation and in the making of and communication of such decisions as are necessary for the appropriate delivery of benefits.

Claims Professionals’

Canons of Ethics

4. A Claims Professional shall seek only information which he or she reasonably believes to be relevant, timely and accurate while simultaneously maintaining the integrity of confidential information and remaining sensitive to the rights of privacy of those about whom such information is obtained during the course of an investigation.

Claims Professionals’

Canons of Ethics

5. A Claims Professional shall maintain a courteous and sensitive attitude in his or her interactions with claimants, employers, regulators and others with whom contact is established in the pursuit of appropriate claims handling.

Claims Professionals’

Canons of Ethics

6. A Claims Professional shall support efforts to prevent fraud within the system and resist fraudulent, unmeritorious or exaggerated claims, and shall not unreasonably withhold information from appropriate authorities who are investigating and prosecuting allegedly fraudulent claims.

Claims Professionals’

Canons of Ethics

7. A Claims Professional shall be committed to maintaining his or her professionalism through continuing education and through dignified and honorable relationships with other professionals.

Claims Professionals’

Canons of Ethics

8. A Claims Professional shall not use litigation or unnecessary delays to thwart the goals of a viable system and shall seek alternatives to litigation as is appropriate under the circumstances.

Claims Professionals’

Canons of Ethics

9. A Claims

Professional shall

avoid a conflict of

interest in the

performance of his or

her duties and shall

strive to make

decisions free from

personal prejudices or

any form of illegal

discrimination.

THE MISSISSIPPI BAR

A LAWYER’S CREEDWhat are we, as lawyers, supposed to be about?

The Mississippi Bar

A Lawyer’s Creed

To My Clients

I offer faithfulness, competence, diligence, and good

judgment. I will strive to represent you as I would want to

be represented and to be worthy of your trust.

The Mississippi Bar

A Lawyer’s Creed

To the opposing parties and their counsel

I offer fairness, integrity, and civility. I will seek to fairly

resolve differences and, if we fail to reconcile

disagreements, I will strive to make our dispute a

dignified one.

The Mississippi Bar

A Lawyer’s Creed

To the courts,

and other tribunals, and to those who assist them, I offer

respect, candor, and courtesy. I will strive to do honor

to the search for justice.

The Mississippi Bar

A Lawyer’s Creed

To my colleagues in the practice of law,

I offer concern for your reputation and well being. I will

extend to you the same courtesy, respect, candor and

dignity that I expect to be extended to me. I will strive

to make our association a professional friendship.

The Mississippi Bar

A Lawyer’s Creed

To the profession,

I will strive to keep our business a profession and our

profession a calling in the spirit of public service.

The Mississippi Bar

A Lawyer’s Creed

To the public and our systems of justice,

I offer service. I will strive to improve the law and our

legal system, to make the law and our legal system

available to all, and to seek the common good through

effective and ethical representation of my clients.

Professionalism

Appearance

Demeanor

Reliability

Competence

Ethics

Maintaining your Poise

Phone Etiquette

Written Correspondence

Organizational Skills

Accountability

Examples of Professionalism

Following Policy

Being responsible

Cooperating

Addressing Conflict

The Three “C’s”

Confidence

The Three “C’s”

Commitment

The Three “C’s”

Compassion

The Goals of a Good Workers’

Compensation System

Focus on the welfare of human beings

Make sure it is affordable to permit successful business operations

It must not be an excessive cost

passed to consumers

Workers' compensation is a very important

field of the law, if not the most important. It

touches more lives than any other field of the

law. It involves the payments of huge sums of

money. The welfare of human beings, the

success of business, and the pocketbooks of

consumers are affected daily by it.

Judge E.R. Mills, Singletary v. Mangham Construction, 418 So.2d 1138 (Fla. 1st DCA, 1982)

Recent Challenges to WC on National

Level

Explosion of Opt-Out Movement

NPR/ProPublica stories

Letter to Labor Secretary Oct. 20, 2015

Constitutional Challenges in last 15 months

Pennsylvania

Alabama

Kentucky

Louisiana

Utah

Florida

Workers’ Compensation Summit in

2016—29 Issues

First Priority

• Benefit Adequacy

• Regulatory Complexity

• Treatment delays

• System failures

• WC vs Health Ins differences

• Adversarial differences

• Staffing and training of WC professionals

• Permanent partial

• Opt-out

• Uninformed workers

• Treatment protocols

Second Priority

• Perceptions/ education

• Vocational rehabilitation

• Ability vs disability

• Claims handling

• Medical ignorance

• Critical point in a claim

• Inappropriate behavior

• Misclassification

• Unrealistic expectations

• Federalization

Third Priority

• New National Commission

• Employee participation in conversation

• Occupational disease

• Lawyers in the system

• Competition between states

• Roles and delineation

• Single payer

• Outliers

So What Would We Change?

Benefit

Adequacy

1. Weekly benefit

level

2. Redesigning TTD,

PPD, PTD

3. Focus on Return to

Work

Regulatory

Complexity

1. Simplification

of Statute of

Limitations

2. Use of “Major

Contributing Cause

Treatment Delays

in Compensable

Claims

1. Treatment

Guidelines

2. Drug Formularies

3. MWCC needs a

Medical Director

Benefit AdequacyState Effective date Weekly Maximum TTD Payment

Mississippi 1-1-17 $477.82 (Minimum $25)

Georgia 7-1-16 $575.00

Arkansas 1-1-17 $661.00

South Carolina 1-1-17 $806.92

Alabama 7-1-17 $843.00

Kentucky 1-1-17 $835.04

Louisiana 9-1-16 $876.00

Florida 1-1-17 $886.00

Texas 10-1-16 $912.69

North Carolina 1-1-17 $978.00

Tennessee 7-1-17 $992.20 (minimum $136.30

Iowa 7-1-16 $1688.00 (Nation’s highest) (PPD Max is $1553.00)

$716.73If Mississippi were to use 100% of State’s AWW

Let’s Re-Imagine How Benefits are

Paid

TTDNo reason is should be payable for 450 weeks

Establish a presumption of Maximum Medical Recovery after 104 weeks

Increase minimum TTD rate to something more reasonable (i.e. TN law is 15% state AWW--$133.20)

PPDA major shift in thinking

about how to calculate

those benefits

A FORMULAIC SYSTEM

WITHOUT SUBJECTIVE

ANALYSIS

PTDLifetime benefits for a

limited category of

specified injuries such as

Paraplegic, Quadriplegic,

and other specific and

carefully defined injuries

Return to Work is the Goal

Paradigm shift is required

The system becomes about

“recovery” rather than

“compensation”

Replace the word “Claimant”

with “Injured Worker”

Commission staff focused on

those goals will be required

“You do not get injured workers well to get

them back to work. You get them back to

work to get them well.”Dr. Richard Pimentel, Disability Rights Activist

New York Workers’ Compensation

Board Statistics:

50% chance that an injured

worker will return to work after a 6-

month absence

25% chance following a 1-year

absence

1 % after a 2-year absence

The Bottom Line for an Ethical WC

System

Adequate lost time benefits to allow injured workers to maintain financial integrity while off work due to injury

Eliminate the subjective determination of PPD benefits

Pay true PTD cases an adequate benefit

Focus on the primary goal of returning an Injured worker to work