$250,000 Claim Reserve Level Creates Many Critical Responsibilities
The $250,000 claim reserve level causes many necessary actions. Some of them are obvious. The other not-so-obvious actions are just as important.
Please note that the Reinsurer and Excess Insurer are the same for this article.
Usually, a claim that reaches this level involves Vice President or Examiner approval to input the reserve into the system. The checklist action plan can be enormous at this level to the claims adjuster.
Some of those tasks are:
Reinsurance reporting – This area can slip by if one is not careful. The $250,000 claim reserve level will likely cause some type of flag to the reinsurer. It never looks good if the reinsurer has to ask the claims staff for the report. The reinsurer should have some prescribed report they wish to receive at the $250,000 and higher claim reserve levels. Each reinsurer may require a totally different type of report.
Employer reporting – Completion of this task needs to occur before they reserves are entered into the system. Apprising an employer of this reserve level will save many headaches in the future. Many times we receive loss runs where a large reserve exists on the file with no explanation.
Assigning to Field Case Manager or Rehabilitation Nurse – When a file hits the reserve level, better late than never to assign out a rehabilitation nurse Is there any reason to not assign it out to one? Medical control is mission critical along with a strong return to work plan. The rehab nurses are one of my favorite risk management techniques.
Subrogation Liens Must Be Covered – An interesting fact from a report by Mark Walls of Safety National is 24% of all huge claims in their inventory result from automobile accidents. Obtaining a police report is an easy task. Do not be the adjuster that forgets to cover their subrogation. We see no effort to pursue subrogation in files quite often. Writing a subrogation lien letter takes such a short amount of time.
Employer Involvement – Claims that reach this level must be followed closely by the employer. Did you send the employee to your carrier or TPA’s recommended industrial-minded physician? Do you have a modified duty job available? Are you in contact with the injured employee and keeping up with their medical treatment? What restrictions does the injured employee have at this point? An active employer usually reduces the cost of the claim while providing their injured employee with the best care.
These are a few things to cover when a claim is initially set or increases to a $250,000 claims reserve level.
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