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Doing Bill File Review Can Be Costly Without Planning


Workers Comp Bill File Review – File Selection Critical To Success

A Workers Comp Bill File Review can cost you more $ than expected.

Our clients often ask us if a meeting with the Workers Comp claims adjuster on all files is a good idea.


Picture of Man Calculating bill with Stethoscope on table Bill File Review Workers Comp claims adjuster

As I have posted recently in the past few blogs, it is a good idea to be very prepared before the file review. The adjuster’s reserves are being reviewed, but the other side of the coin is that often an adjuster will review all files before meeting with you.

There may be files where a reserve increase is indicated, costing your company more $ than you may save with a file review.


Not all files need to be reviewed. Reviewing certain files may cost more premiums than if no files are reviewed. As I said in the last post, BE PREPARED. Covering the files that have high reserves is your mission, not covering the files where the reserves are low and need to be increased. Remember, your premiums are based on Total Incurred. Total Incurred on a file is the Paid + the Reserves (Total Incurred = Paid + Reserves). There is little you can do about the paid amounts on files, as the funds have been spent. The area to zero in on with a laser-like examination is the open reserves.

Picture Hand Pointing Towards Bill File Review Reporting Concept
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The key is to know which files to review and which ones to leave alone. The adjusters will eventually get around to adjusting the reserves on all of your files. However, you do not need to point them out to the claims staff. Timing your reserve review on your Unit Stat cycle is also critical. Please see our other posts on the Unit Stat date.

How do you know which Workers Comp file review to examine? As I posted previously, it takes an adjuster about 5 -7 years to feel comfortable with setting reserves on files. Can your agent help you? Yes, if they have a claims background (which is HIGHLY unusual) or an experienced claims analyst on staff. That is also very rare.

Calling in a Workers Comp premium auditor and a claims expert may be a good idea. In a recent survey, the premium dollars saved (Return on Investment) is about $6 in premium savings to $1 in fees paid to a premium auditor or claims expert.

Next Up – Self-Insureds and Workers Comp File Reserves

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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