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Claims Loss Run Reviews – Top 5 Things We Are Seeing Now

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Claims Loss Run Reviews – Top 5 Changes Seen Post-Pandemic

Claims loss run reviews have become one of the most requested post-pandemic services from our clients.  The top five changes we have seen compared to before 2020 contain good and bad news.  See my overall conclusion at the end of the article.

pic good news is coming claims loss run reviews
Wikimedia Commons – Jon Tyson 

 

Carrier and TPA Closing Rates Up (Good News)

Many of the claims loss run reviews showed an interesting trend.   We started noticing that carriers and TPAs had closed more files than usual.  One could estimate the reason for the trend.  I will not go into exactly why the closing has increased recently.   The reasons would be the basis for a future article.

Reopened and Not Reclosed Files (Semi-bad News)

Two nice articles that cover this subject can be found in these two articles – Check them out.

Reopened  Files  Watch Them Closely 

Reopened  Files – Watch The Reserves  

This could be the pandemic effect of lagging medical bill submissions from various providers.  Look for the R in the status of your claims loss run reviews.

Adjuster Turnover – How To Discover During Claim Loss Run Reviews (Good/Bad News)

One method (old school) is to print your loss runs or at least save them even though you may have my heavily recommended online claims access.  You may also see the name change inside each claim’s file notes.  If the adjuster changes multiple times, continuity can be compromised by the new adjuster’s lack of knowledge of the previous file occurrences.

If a new adjuster’s name pops up, one can send the adjuster an email (not call) or any major questions or file history.  Yes, adjusters are supposed to review the files they absorb – but that can be a daunting task on older or files with major injuries.

The good news part is that if one wishes to use that term, comes from the claims field being a worker’s market with so many work-from-home opportunities – who can blame an adjuster for seeking higher pay, more benefits, smaller file loads, etc?

Lower Number of Medical-Only Files  (Stumped Me)

This one has me stumped.  I can give no good reason for this phenomenon.   My assessment would be – more first-aid claims, avoidance of treatment at physicians’ offices due to COVID, and only lost time claims were sent for medical treatment (all guesses).

No Carrier or TPA Shopping Seen in Claims Loss Run Reviews (Good News)

If an employer changes TPAs or carriers every year, the loss runs would be numerous.  Employers seemed to have stayed with one carrier for longer terms.  If the employer decided to keep jumping ship, the relationships between the carrier/TPA and claim staff would never have been established due to the temporary nature of the one-year and jump strategy.

Conclusion/Bottom Line

The pandemic did affect what happened in claim files. Claims loss run reviews remain a critical part of what an employer should be doing at least quarterly.   When the premium audit bill arrives from the carrier should not be the time to take action. Start today.

The employers that are performing loss run reviews regularly pay less premium.  Self-insured pay less out of pocket.  That concept will never change.

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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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