Agentic Claims Management™

While working with a client, an insurance broker verbally recommended to the client’s representative that the company purchase additional coverage to protect itself against lawsuits by employees. No further discussion was had, and when the policy was renewed a few weeks later, the additional coverage was not purchased. Later that year, an employee filed a suit against the client company and was eventually resolved for an amount in excess of the client’s limits. The policyholder then sued the broker, claiming they were told their existing coverage was sufficient.

A construction company employed a laborer who had a heart condition that required them to miss a day or two of work each month for doctor’s appointments. After a few months, the laborer’s supervisor told them they needed to be on disability and terminated their employment. The laborer sued the construction company, claiming they had discriminated against them based on their disability and failed to engage in the interactive process by not exploring whether he could be moved to another role before they fired them. The laborer’s complaint requested back pay, front pay, punitive damages, attorneys’ fees, and court costs.

A family-owned metal fabrication company and its management were sued by three minority shareholders. Plaintiffs claimed that the company’s management did not inform them of the company’s finances for years. According to the complaint, the defendants had failed to publish board and committee meeting minutes, only provided sporadic and incomplete financial updates, and had misused corporate funds for their own personal benefit. Plaintiffs asserted that these actions prevented them from fully understanding the company’s financial health and economic prospects. The complaint asserted claims for breaches of fiduciary duty and unjust enrichment. Plaintiffs asked the court to award them monetary damages and to remove the individual defendants from their management positions at the company.

A group of unions sued their employers on the grounds that the employers had not properly calculated or made their contributions to the shared retirement plan for the union employees as required by the parties’ collective bargaining agreement. The unions also asserted that the employers had failed to provide them with accurate reports detailing the hours worked by each union employee and the associated amount of fringe benefit contributions owed. According to the complaint, the employers’ actions violated both the CBA and ERISA. The unions requested damages in the amount of the missing contributions, interest on those amounts, liquidated damages, attorneys’ fees, court costs, and a permanent injunction barring the employers from similar conduct in the future.

A reseller of stone and tile products fell victim to a phishing scheme when a fraudster pretending to be one of their overseas suppliers requested a change in their banking information. The insured wired more than $400,000 to the “new” bank account before the fraud was discovered. Although most of the funds were recovered directly from the bank, the insured was still left with a loss of roughly $100,000, which was covered by insurance.

While working with a client, an insurance broker verbally recommended to the client’s representative that the company purchase additional coverage to protect itself against lawsuits by employees. No further discussion was had, and when the policy was renewed a few weeks later, the additional coverage was not purchased. Later that year, an employee filed a suit against the client company and was eventually resolved for an amount in excess of the client’s limits. The policyholder then sued the broker, claiming they were told their existing coverage was sufficient.