Workers Compensation Online Access Nets Insured $85,000 Subrogation

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Workers Compensation Online Access – Subrogation Claim Discovered

Having Workers’ Compensation online access creates $85,000 subrogation claims missed earlier by the insured.  How did this occur?

burning fake workers compensation online access fake money
Wikimedia License – Clemensmarabu

I review claims for many companies as part of J&L’s services.   Recently, a new agency account asked me to review their claims and make E-Mod predictions for their client’s budgets.

The insurance agency had the tough task of asking each carrier for online access.  I usually require online access so that I do not miss anything.  The following example stands out why online access = premium $$$ saved for employers.

I accidentally came across a closed claim where no attempted subrogation recoveries were attempted by the adjuster.  The file reflected 100% liability by the driver of another vehicle involved in an auto accident.   Why was the file closed without pursuing subrogation?

The adjuster notes subrogation possibilities on the file.  The file settled for approximately $85,000 in total payouts.   Would the Workers Comp file receive all of the $85,000  paid on the claim?

Receiving all $85,000 back as part of an auto liability claim rarely, if ever, happens in Workers’ Compensation.   As the old saying goes, “It never hurts to ask.”   Subrogation funds left to sit on a file means one of three things – the adjuster  was:

  1. Overloaded and closed the file without pursuing the funds.
  2. Never trained in subrogation and how to pursue a third party
  3. Switched mid-file to another adjuster who performed a quick review when they received the file.

Please note – I am, and no one should place blame on the claims adjuster.  The supervisor or manager should have caught this as the file authority levels reached beyond the adjuster’s reserve authority.  In other words, the file had to pass across a few more desks than just the adjuster’s review.

The claim occurred in Rhode Island – The Ocean State.   Some states eliminate or severely limit a workers’ comp insurer from pursuing any possible responsible third parties.   Rhode Island has a case on the books where there was an anti-subrogation angle.  The case does not likely apply to this situation.

If an employer or anyone has workers compensation online access to the files, the answer usually appears in the file very early during the initial investigation.  Claims staffs discover subrogation at the outset of the claim.

The first report of injury usually has the subrogation information included.  Always ask for a copy of the police report on any auto accidents.

Adjuster’s Action Plan

Check out my recent article on what the claim adjuster’s action plan reveals concerning a claim.   The usual claims action plan covers:

  • What has occurred on the claim
  • The adjuster’s actions due to the past claim occurrences
  • Upcoming expected occurrences
  • Adjuster’s plan for the upcoming claim occurrences
  • Reserve levels
  • Closing plan

The list above covers the overall plan.  My recent article covers many questions that an action plan answers very quickly.   Still yet, Workers Compensation online access allows the employer to team with the claims staff on the claim.  Online access also cuts down on calls and emails on the status of a claim.

The claims adjuster will often cut and paste their action plan and status and email to the employer.  Why waste the adjuster’s time when they could be working on your files?

As I have said often, a claims adjuster works on a file for a limited amount of time.  Why have them spending time cutting, pasting, and emailing what shows in the file login screens if you have workers’ compensation online access?

 

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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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