I’m looking to go to claims side from ID atty. Some job posts are looking for claims counsel. I don’t think I ever dealt with claims counsel with any of the carriers I dealt with. How is the work done by claims counsel different from claims adjuster’s work?

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Typically, claims counsel handle more complex and/or high severity claims. This is an adjuster role but with a different title.

Sometimes these roles may involve some capacity as in-house coverage counsel. It can vary amongst the carriers.

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Do you need to be licensed in the state where you’re located to be claims counsel?

Coverage counsel doesn’t adjust a claim. They interpret the policy and provide coverage opinions to the adjuster and handle resulting litigation.

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Claims counsel is the same thing as a claims representative or claims adjuster or analyst but on complex kinds of cases. For example, I do some legal malpractice defense work where I am hired to represent attorneys by insurance carriers and I report to a claims counsel. In that kind of work it helps if the claims examiner is an attorney. The coverage issues in those cases can be more involved as well. I've had some friends go from defense counsel to claims counsel and they are generally happy. Some examiners I report to are not attorneys but are very knowledgeable on law and legal malpractice issues, but those examiners are very experienced usually.

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Thank you for clarification.

When an insurance company uses house or panel counsel for ID (not coverage), from my perspective, they don’t make the decisions on the claim, but ultimately the insurance company listens to them. Especially in highly regulated markets. For instance if the claim adjuster believes the treatment is excessive the adjuster ultimately decides how much of it will be covered, but if ID believes it’s short sighted, ID can educate the adjuster on why the cut off date might not or will not prevail and generally explains why, such as differences due to venue or other reasons. When the ID job is compared to doing plaintiff work, the ID work is generally considered a coveted position because your not fighting to get cases working, enjoy your vacation time because someone will back you up, and it’s a reliable paycheck and you’re not at the whim of the senior partner or owner of the plaintiff firm. I hope this helps, even if it’s not exactly fitting your question.

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