Medical Only Claims – A Short List of Concerns
Medical only claims turn out to be the worst Lost Time claims if not monitored properly. How can a few $250 claims cause such havoc?
The old saying concerning “Big things come in small packages” applies very well to this situation. The least monitored claims can blow up very quickly. Why?
I coined the the term claims festering approximately 10 years ago. Yes, the term came from what happens to an ignored sore. The ignored claims sometimes:
- Stays reserved with the automatic amount ($250 or $500) too long
- Increased just to pay a bill
- Not reviewed due to small dollar amount – one cannot expect an adjuster to examine a $450 claim.
- Keeps being handled and reserved for a low dollar amount for months
- No supervision = no control of the medical
- Festered medical only claims usually turn into large claims headed down the wrong path – think snowball from hell
How does a claims department and/or employer avoid this mess? The question begs to be answered in this manner. Technology – not claims analytics may be the best answer.
A very talented medical only adjuster knocks the claims monitoring out of the park. I have experienced this often with medical only claims adjusters who worked with or for me in my claims career.
Getting the file transferred to a lost time status is a critical step. A good experienced medical only claims adjuster generates this transfer most of the time. Asking an overloaded claims supervisor spells trouble for a festering claim.
The main concern coming from a festered claim is the lack of supervision over a very acute claim. A laughable situation occurs when a lost time investigation commences six months too late. Technology sounds great as the solution. It does not suffice in this instance.
Picking out a festering claim from a list of what can be thousands of medical only claims will be a monumental if not impossible task.
Why did I write this article? I just reviewed a loss run with 125 medical only claims. Five of those were deemed festering claims. Five of `125 claims may not seem that large of a percentage. These claims were tracked by a spiffy claims analytics software package.
Some types of software track the festering better than others. An IT person would input the level where a warning would be given if a claim festers too long, not an adjuster.
Oh, my, human intervention wins again even with the small medical only claims.
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