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Four Workers Comp Claim Review Strategies

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Workers Comp Claim Review  – Four Methods

I wrote four Workers Comp Claim review strategies many years ago.  This is an excerpt from the manual found here that I wrote many years ago. The info is basically timeless. Claims reviews are an integral part of a premium reduction program and even more critical if you are self insured.

Graphic Of Business Workers Comp Claim Strategy Concept
StockUnlimited

There are four possible methods to review your WC claim reserves:

Claims Office Review

Advantages – reviewing the claims files in your insurer’s claims office is the most accurate way to review the claims reserves; the employers can examine everything that was involved with the file and will call attention to the insurer that your company takes the reserves on the files very seriously; the adjuster or adjusters on the files will usually meet with you face to face.

 

Disadvantages – the review may not be feasible if the claims office is in a remote location; the cost of travel; takes up an employer’s time, especially if the claims office is in another state.

Claims Review at the Employer’s Location/Agent’s/Broker’s office

Advantages – saves the employer travel time and the cost of traveling to the claims office; adjusters will sometimes adjust their reserves before the meeting if the adjuster believes the adjustments are necessary.

 

Three woman reviewing Workers Comp Claim paper
Wikimedia Commons – John Budnik

Disadvantages – insurers rarely bring files with them, more of a “canned” review as the adjuster has reviewed everything and will present their reasons for the reserve levels; more of a public relations/marketing meeting; the adjuster or claims department usually controls the subject matter of these meetings; this type of meeting takes adjusters away from their files; the employer may pay an extra premium to have these meetings.

Online Review – Full access to all adjuster notes, statuses, reserve levels, and reserve history is very important.

Advantages – saves the employer travel time and the cost of traveling to the claims office; immediate and accurate claims review if the employer has full access to the claims files; reviews can be done at any time and can follow the recommended timetable on the preceding page; the employer has control of the review.

Disadvantages – there are little or no disadvantages to online reviews with full access to all reserves, statutes, adjuster notes, etc.; if the employer has limited access to the files, then the employer may not know the justification of the reserve levels.

Employer Self Review

Advantages – the employer controls the review; saves time and cost of travel, as the employer does not have to incur any travel; all parts of the claims file are available; can be combined with the Online Review or by using loss runs from the insurer.

Disadvantages – the employer has to keep copies of all forms, notes, and any other pertinent file material; the employer may spend an inordinate amount of time and expense in retrieving all file material from the insurer, treating physician, and other parties; privacy rules may be an issue.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt 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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