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MAY / JUNE 2025 FURTHERING THE HIGHEST STANDARDS OF CLAIMS AND LITIGATION MANAGEMENT The Roundabout Get Curious, Not Furious Time to Comply THE EMERGING IMPACT OF THIRD-PARTY LITIGATION FUNDING ON CYBER INSURANCE MONEY BEHIND THE THE CURTAIN MAY / JUNE 2025 DIGITAL EDITION SPONSORED BY:Slip, trip, and fall injury accidents are often complicated matters. Using a scientific approach and reliable methodologies, Rimkus specialists in injury biomechanics and human factors work side by side with engineering and building experts to isolate the facts and determine what happened. We have evaluated thousands of such incidents across a broad spectrum of public and private environments. If you're facing a complex forensic challenge of any kind, count on us to uncover the facts. YOU HAVE QUESTIONS. WE PROVIDE ANSWERS. +1 800 580 3228Consultants. Experts. Innovators.™rimkus.com WHAT HAPPENED? WITH SO MUCH AT STAKE, YOU NEED TO KNOWMAY / JUNE 2025 FURTHERING THE HIGHEST STANDARDS OF CLAIMS AND LITIGATION MANAGEMENT The Roundabout Get Curious, Not Furious Time to Comply THE EMERGING IMPACT OF THIRD-PARTY LITIGATION FUNDING ON CYBER INSURANCE MONEY BEHIND THE THE CURTAINSlip, trip, and fall injury accidents are often complicated matters. Using a scientific approach and reliable methodologies, Rimkus specialists in injury biomechanics and human factors work side by side with engineering and building experts to isolate the facts and determine what happened. We have evaluated thousands of such incidents across a broad spectrum of public and private environments. If you're facing a complex forensic challenge of any kind, count on us to uncover the facts. YOU HAVE QUESTIONS. WE PROVIDE ANSWERS. +1 800 580 3228Consultants. Experts. Innovators.™rimkus.com WHAT HAPPENED? WITH SO MUCH AT STAKE, YOU NEED TO KNOWTHECLM.ORG/MAGAZINE CLM MAGAZINE 3 CLM MAGAZINE MAY / JUNE 2025 >>>CONTENTS 20 THE MONEY BEHIND THE CURTAIN The Emerging Impact of Third-Party Litigation Funding on Cyber Insurance 26 THE ROUNDABOUT Transportation Experts Discuss Litigation Trends 34 GET CURIOUS, NOT FURIOUS Problem-Solving the Doom Loop AROUND THE CLM 40 Keeping Our Eye on the Ball 41 ASK THE EXPERT Storms Approaching 42 VOICES Getting to know Frances O’Meara, Partner, Wood Smith Henning & Berman LLP FEATURES 4 FRONT DESK Hurricanes and Lessons Learned 6 DANGER: HIGH RISK AHEAD Managing Workers’ Comp Exposure in Risky Industries 8 FIVE CHALLENGES FACING CLAIMS ADJUSTERS TODAY Pain Points and Solutions in an Increasingly Complex Landscape 10 HOW TO R.A.I.S.E. YOUR MEDIATION GAME Top Tips for Success 12 TIME TO COMPLY Medicare Set-Asides Now Required to Be Reported to CMS COLUMNS 20 34 26 6 41 42 8 12 AROUND THE CLM 40 MAY / JUNE 2025 DIGITAL EDITION SPONSORED BY:4 CLM MAGAZINE MAY / JUNE 2025 DIRECTOR OF CONTENT Phil Gusman ASSOCIATE EDITOR Angela Sabarese ASSISTANT EDITOR Fran Clark ART DIRECTOR/ PUBLISHING OPERATIONS MANAGER Jason T. Williams EDITORIAL QUESTIONS Phil Gusman phil.gusman@TheCLM.org PRESIDENT Susan Wisbey-Smith VP PARTNERSHIPS Jeremy Campbell SENIOR ACCOUNT EXECUTIVE Laurel Metz ACCOUNT EXECUTIVE Megan Josd ADVERTISING QUESTIONS Jeremy Campbell jeremy.campbell@TheCLM.org 513-377-7228 MAY / JUNE • ISSUE 3 • VOL. 9 REPRINTS For reprints and licensing please contact Jeremy Campbell at jeremy.campbell@TheCLM.org or 513-377-7228. CLM Magazine is published bi-monthly and covers news and topics of interest to insurance claims, risk, and litigation management professionals. Copyright © 2025 by the CLM. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the CLM. The views expressed in the articles are solely those of the authors or those interviewed and do not necessarily reflect the views or opinions of CLM or the companies in which the authors are employed. A publication of Last year’s hurricane season saw five hurricanes make U.S. landfall, including two destructive storms that hit Florida’s west coast within weeks of each other. Helene struck the Big Bend region of Florida on Sept. 26 as a Category 4, causing damage across multiple states and bringing catastrophic flooding to parts of North Carolina. As the communities and insurance industry were still picking up the pieces from Helene, Hurricane Milton struck Sarasota County, Florida just two weeks later as a Category 3 storm, causing wind and flood damage and spawning tornado outbreaks across parts of Florida. In addition, communities in Florida, Louisiana, and along the Gulf Coast contended with damage brought by Hurricanes Beryl, Debby, and Francine in 2024. All told, private insured loss estimates from catastrophe modelers were as high as $50 billion for the season, with Hurricane Milton set to become among the costliest storms in U.S. history, according to Insurance Journal. As we enter the 2025 hurricane season, forecasters once again expect elevated activity, with the Colorado State University (CSU) forecast team predicting 17 named storms, nine hurricanes, and four major hurricanes, compared to a 1991-2020 average of 14.4 named storms, 7.2 hurricanes, and 3.2 major hurricanes. Is the industry prepared for the possibility of another active season? Were lessons learned from 2024, particularly when it comes to dealing with the unprecedented flooding in North Carolina caused by Hurricane Helene and the back-to-back impacts of Helene and Milton? In this issue, CLM Magazine talks to Crawford & Company’s Eva Mayberry about lessons learned from last year and how they will be applied in 2025, and about the nature of risk in general: how insurance is viewed by the public when other economic pressures rise, and how the industry can convince people to take perils such as flood more seriously. Check out the Q&A on page 41. SHARPEN YOUR FOCUS For those who are reading this issue at CLM’s June Focus Conference in Nashville, Tennessee, be sure to check out our transportation and cyber content, including the cover feature, “The Money Behind the Curtain,” (pg. 20), which dives into why cyber claims are particularly vulnerable to third-party litigation funding; and “The Roundabout,” (pg. 26), CLM Magazine’s long- running panel-discussion feature that covers transportation claims and litigation trends. Phil Gusman Director of Content phil.gusman@theclm.org Hurricanes and Lessons Learned FRONT DESK >>>THE ANSWER IS One Company For All Your Consulting Needs GENERAL LIABILITY & CONSTRUCTION FORENSICS WHO HAS EXTENSIVE FORENSIC EXPERIENCE IN CAUSE & ORIGIN AND PRE-SUIT CLAIMS? mcconsultants.com 800.729.0355 356 CLM MAGAZINE MAY / JUNE 2025 T he landscape of workers’ compensation is continuously evolving, especially within high-risk industries such as construction, health care, transportation, retail, and hospitality. These sectors face unique challenges that require proactive risk management strategies focused on injury prevention, cost control, and employee well-being. In this environment, employers, claims professionals, and defense counsel must collaborate closely to mitigate risk, reduce claim frequency and severity, and improve outcomes for both organizations and their workforces. Effective risk management begins with a deep understanding of the workforce and a comprehensive evaluation of existing safety protocols. A successful injury prevention program is not merely a checklist of safety rules; it should be an integral part of the company’s culture. This cultural integration requires a top-down commitment to safety, where leadership sets clear expectations and leads by example. Written safety policies should clearly articulate the organization’s safety objectives, define employee responsibilities, and establish accountability at every level. These policies must be well communicated and consistently reinforced through day-to-day operations and managerial oversight. When safety becomes ingrained in a company’s values, it naturally influences behavior and promotes a proactive approach to risk. TRAINING AND COMMUNICATION: FOUNDATIONS OF INJURY PREVENTION Education and training are critical to embedding safety into the workplace culture. Supervisors, managers, and frontline employees must receive ongoing training on safe work practices, hazard recognition, and emergency response procedures. Routine safety meetings, toolbox talks, and performance evaluations should include discussions on safety performance and continuous improvement. Equally important is employee involvement in safety planning. Encouraging staff to participate in hazard identification, safety committees, and job hazard analyses fosters a sense of ownership and accountability. When employees are engaged and informed, they are more likely to adhere to protocols and identify potential risks before an incident occurs. EARLY HAZARD DETECTION AND INCIDENT INVESTIGATION One of the most effective methods of injury prevention is the early identification of workplace hazards. Employers must implement systems that allow for real-time reporting and Danger: High Risk Ahead Managing Workers’ Comp Exposure in Risky Industries By Michele Punturi, David Shoaff, Michelle Leighton, and Casey Flynn WORKERS’ COMPENSATION >>> Michelle Leighton is a partner and national claim advocacy & consulting leader at Conner Strong & Buckelew. mleighton@connerstrong.com Michele R. Punturi is director of the Workers’ Compensation Department at Marshall Dennehey. mrpunturi@mdwcg.com Casey Flynn is a risk management senior insurance specialist at Clune Construction Company. cflynn@clunegc.com David Shoaff is director, risk management at Red Lobster. dshoaff@redlobster.comTHECLM.ORG/MAGAZINE CLM MAGAZINE 7 correction of unsafe conditions. When incidents do occur, prompt and thorough investigations are critical. Incident investigations should be conducted within 24 hours, whenever possible, and should focus on root cause analysis rather than assigning blame. Reports should outline corrective actions, identify contributing factors, and suggest changes to training, procedures, or equipment to prevent recurrence. Documentation should include photos or videos of the scene, witness statements, a review of the injured employee’s training history, and an evaluation of whether third-party liability exists for subrogation purposes. WORKFORCE HEALTH AND WELLNESS PROGRAMS According to the Centers for Disease Control and Prevention (CDC), workplace health programs promote and protect employee health by combining policies with benefits and environmental supports. These programs can reduce absenteeism, improve morale, boost productivity, and lower health care and workers’ compensation costs. In high-risk industries where physical demands and occupational stress are often heightened, health and wellness initiatives play a vital role in both injury prevention and recovery. Access to wellness programs, physical therapy, and mental health services help employees build resilience and maintain their well-being, which in turn supports a safer and more engaged workforce. RECRUITING AND RETAINING THE RIGHT TALENT Hiring the right employees is another essential risk management strategy, particularly in physically demanding or hazardous work environments. The hiring process should include behavioral interview techniques that assess a candidate’s comfort and experience with safety protocols. Interviewers should ask targeted questions about previous safety training, responses to high-risk situations, and contributions to jobsite safety culture. A well-written job description is equally important. Clearly defined roles and responsibilities set appropriate expectations and help prevent misunderstandings that can lead to injury or dissatisfaction. Moreover, job descriptions serve as valuable documentation in the event of a dispute or litigation, and can support claims management by defining the physical and mental requirements of a role. EFFECTIVE ONBOARDING AND TRAINING PROGRAMS Once hired, new employees must be set up for success. Onboarding and training programs should cover not only operational procedures, but also safety expectations, emergency protocols, and proper use of tools and equipment. Objectives should be clearly defined, and employees should be assessed on their understanding of workplace hazards and appropriate countermeasures. Integrating safety into onboarding ensures that employees begin their tenure with a full awareness of their responsibilities and the organization’s commitment to risk reduction. Refresher training and mentoring programs can reinforce safe practices and reduce the likelihood of early-stage injuries, which are often more frequent in the first six months of employment. INJURY MANAGEMENT AND RETURN-TO-WORK STRATEGIES An effective injury management plan is essential for controlling claim costs and supporting injured workers through recovery. High-performing organizations implement structured return-to-work (RTW) programs, which provide modified duty options and ensure clear communication between the employer, medical providers, and claims professionals. RTW programs help reduce indemnity exposure and facilitate a faster, safer reintegration of injured employees into the workforce. Additionally, employers should adopt medical management protocols that emphasize early intervention, active treatment plans, and coordinated care strategies. Strategic claim reviews and proactive file management are also crucial to minimizing claim duration and identifying opportunities for resolution. Regular collaboration between internal stakeholders and insurance partners ensures that claims remain on track and that any red flags—such as delayed recovery, comorbidities, or potential fraud—are addressed promptly. ADDRESSING MENTAL HEALTH IN HIGH-RISK INDUSTRIES Mental health is an increasingly important component of workers’ compensation risk management, particularly in industries where employees face high levels of stress, trauma, or emotional strain. Construction workers, health care professionals, restaurant staff, and transportation workers are all exposed to circumstances that can exacerbate mental health issues and complicate the recovery process. By incorporating mental health awareness into safety programs and medical management protocols, employers can improve claim outcomes and reduce the likelihood of long- duration claims. Providing access to Employee Assistance Programs (EAPs), mental health counselors, and stress reduction resources demonstrates an organization’s holistic commitment to employee wellness. Workers’ compensation risk management in high-risk industries requires a comprehensive, coordinated, and proactive approach. From fostering a culture of safety and wellness to improving hiring practices, training, and injury response protocols, employers must take a holistic view of workplace safety and workers’ compensation management. When implemented effectively, these programs not only reduce injuries and claim costs but also improve employee morale, retention, and productivity— resulting in a healthier and more resilient organization. K The authors presented on this topic at the CLM February 2025 Focus Conference. Next >