Quick Claims Closure – Two Areas That Can Cause Problems
Setting a goal of quick claims closure causes problems in two areas. Yes, closing out a Workers Comp claim rapidly causes the most rapid reserve reduction. I am all for quick claims closure once all proper benefits have been paid on the file.
Falling Off Diary System
A claim adjuster’s file load can make their time a precious commodity. Reviewing or having a diary for closed claims usually does not exist for an adjuster. Keeping up with open claims remains task one.
Some action or event outside of the claim, such as further medical treatment or a worsening of condition , or having an injured worker start missing work again, lacks the risk control of an open file. Claims festering occurs in this space often.
The diary system of most carriers and TPAs (for self-insureds) revolves around open files. One could think of having to reopen a claim as “starting all over” when it comes to the diary system.
The same can be said for the next problem – having to restart reserves.
Too Quick Claims Closure – Reopening Reserves
One cannot think the reopened claims will have the same reserves without going through the sometimes long and arduous reserve increase approval process. Yes, the file may be reopened the same day as the claims staff receives notice.
I have not seen a claims system that allows the replacement of the exact same reserves that previously existed on a file. Ouch!
If a file comes back across a claim supervisor’s/manager’s/VP’s desk, a heightened level of scrutiny will likely occur in the approval process/final sign-off.
Hey, Wait a Minute!
Yes, the idea of problems with quick claim closures is outweighed by the always-present goal of closing a claim file as soon as possible after paying the applicable benefits. I would think of it as more of a balancing act between the two concepts.
