GUIDELINES AND INSTRUCTIONS FOR DEFENSE COUNSEL REGARDING SELF INSURED OR LARGE DEDUCTIBLE WORKERS'
GUIDELINES AND INSTRUCTIONS FOR DEFENSE COUNSEL REGARDING SELF INSURED OR LARGE DEDUCTIBLE WORKERS' COMPENSATION PROGRAMS
The guidelines and instructions contained herein have been established by the insured for all law firms handling Workers’ Compensation cases on their behalf.
Within 5 business days of receipt of the assignment, Outside Counsel shall provide an initial acknowledgment letter by e-mail or fax.
Within 15 business days of receipt of the assignment, Outside Counsel shall provide an Initial Report containing the following:
A. A description of the alleged injury.
B. An opinion regarding the compensability of the alleged injury.
C. A statement indicating all medical conditions accepted and or denied.
D. A description of all medical treatment and testing.
E. A statement detailing the type and amount of indemnity/impairment benefits paid.
F. A determination of the correct lost time rate (AWW/CR).
G. A list of all pending issues.
H. A specific defense to each issue and the probability of success in defending the issue.
I. An estimate of the monetary exposure of all issues and total settlement value to close the case.
J. An analysis of any possibility of apportionment, contribution or, subrogation.
K. A detailed Action Plan with suggestions regarding innovative methods to resolve the matter.
Subsequent Status and Summary Reports
After submitting the Initial Report, Outside Counsel should provide a written Status Report at least every 90 calendar days.
Subsequent Status Reports should summarize the current status of the litigation, developments since the previous report and Outside Counsel’s recommendations for further handling. The Subsequent Status Report should include a discussion of any change in Outside Counsel’s evaluation of the exposure and the settlement value of the case.
All depositions should be summarized and provided to the insured within 5 business days after they are taken. This brief report should state the pertinent facts discovered, the credibility of the witness and how each of these affects Outside Counsel’s evaluation of the case.
When Outside Counsel receives any documents, a brief Summary Report shall be provided within 5 business days. This Summary Report should highlight the significant facts in the documents and analyze their impact on the case.
Outside Counsel shall immediately notify and copy the insured regarding any Notices, Motions, Mediations, Pre-Trial Conferences and Final Hearings,
At least 21 calendar days before mediation, Outside Counsel shall submit a Mediation Evaluation. This report should include all pending issues, defenses and Outside Counsel’s opinion on the estimated win/loss probability and strengths and weaknesses of the opponent’s case. The “worst case", “best case" and “most reasonable scenario" should be addressed. In addition, the report should include a total settlement value evaluation.
Outside Counsel shall provide a list of all pending issues with a specific defense to each issue. In addition, Outside Counsel shall provide an Action Plan, which identifies each task requested to be performed and who is to perform the task requested.
Final Hearing Report
45 calendar days before the Final Hearing, Outside Counsel shall provide an exposure analysis of all issues scheduled to be heard at the Final Hearing, a list who is needed to testify at the Final Hearing, and whether Outside Counsel suggests an attempt to be made to resolve the entire case or any issues prior to the Final Hearing.
Within 7 calendar of receipt of the Final Order Outside Counsel shall provide a Post-Trial/Appeal report which includes an analysis of any reversible error, probable outcome of the appeal, anticipated costs of the appeal, whether the appeal will set precedent or any other significant factors to be considered at that time.
III.BILLING GUIDELINES, PROCEDURES AND PROCESS
Bill Review Process
The insured will review all bills and statements. All such communications are to be treated and protected as attorney-client communications. All statements and bills are to be marked on each page as “privileged and confidential."
Billing Cycle and Submission
The insured’s billing cycle, for each matter, is monthly. The monthly time period will be calculated beginning on the first day of the calendar month following receipt of the new matter or case. Invoices will be paid the first business day of the second month after the month the invoices are dated.
Due to the fact that the insured retains a significant number of Outside Counsel it necessary to use a standard format for billing.
Each billable task shall provide a precise description of the service performed showing the date of service, time spent, initials or name of individual providing the service, hourly rate of individual providing the service, calculation of rate\hours equaling the charge for the individual entry. The hours and charges shall be totaled for all services.
Each billable task must be itemized as a separate time charge. “ Grouped" or blocked" time entries, e.g., entries in which more than one task is shown for a single time entry, will not be approved for payment. Travel time, preparation time, and time spent attending meetings, multiple depositions, hearings, etc., are each separate tasks. Multiple phone calls should be separated and the time noted for each call.
Each billable task must be adequately described. The description provided must be specific enough to allow a person not familiar with the case or matter to determine what task is being performed and the necessity of the task to the progress of the case. Where telephone conversations and review of correspondence are charged, the identity of the other party and the substance of the correspondence or telephone conversation must be identified.
Immediately following the above listing of hours/fees and their totals for each matter, the related costs and expenses for that case with individual entries dated, charges shown, and any necessary itemization required to describe a particular cost and expense shall be presented. The charges shall be totaled for all costs and expenses. In addition, copies of all third party invoices must be attached to the monthly bill.
A recapitulation of the total services billed must also be included in the firm’s invoice for each matter. The recapitulation should list each individual’s name, hours billed, hourly rate and total fees billed.
A cumulative Invoice Summary showing the firm’s cumulative total of fees and expenses charged on the matter to date must be included in each bill. The Invoice Summary must include the status of each invoice (paid or unpaid) for each time period.
The insured will pay only for the actual time necessary to complete a task. Actual time in 6-minute increments to the nearest .10-hour must be charged. No higher billing minimum is acceptable. Rounding in increments greater than .10-hour will not be accepted.
The insured will not pay for unapproved legal services or for things that you are expected to know already as a matter of your readiness to assume responsibility for the insured's work.
No reimbursement will be made for any time spent in complying with these billing requirements, including any time devoted to the preparation of billing forms and invoices.
There is a limitation of (12) hours per day on billing by each timekeeper, unless previously approved by the insured or during actual trial.
Use of Personnel
Attorney billing rates will not be paid for work that is administrative, paralegal or secretarial in nature.
The firm is encouraged to maximize the use of well-qualified paralegals. The insured will not pay for individuals who are traditionally construed to be overhead personnel of the firm, including secretaries, file clerks, librarians, administrative, computer data entry, messengers and word processors, as well as other comparable level individuals.
Paralegals must concentrate upon case support functions and other value added activities, leaving administrative, secretarial and clerical duties to the firm’s clerical staff.
Firm personnel who perform functions such as routinely delivering documents and checking on court dockets are considered overhead to the firm and should not be charged to the insured, even if you choose to have this work performed by paralegal personnel, law clerks or attorneys.
If a previously drafted form document or pleading is available, the insured will pay only for the amount of time necessary to modify it for use in this matter, not the time originally incurred to draft the standard document. Many firms have “standard" motions, pleadings and settlement documents, and we expect your firm to utilize these wherever appropriate, with only modifications required to particularize to the insured's matter.
Legal research and Motion Practice
The insured must approve all legal research that is anticipated to require 5 or more hours to complete in advance. Unless unique or unusual issues are presented, there is no reason for research to establish already well-established principles or doctrines of law. Research should be limited to “updating" the law only. State the person giving approval in the billing entry.
It is expected that firms will set up and utilize a brief and memo bank to capture the institutional knowledge and experience of the firm’s representation of the insured and the firm’s other clients as well, as appropriate.