Claim Control

Like any other variable that can impact the financial status of your entity, you have to keep claims in check. We offer strategic claim management with a focus on workers' compensation claims. Services may also include monitoring of claim reserves and solutions for reducing them.

Claim Management Policies
Turnkey Injury Response System

Reserve Monitoring & Reduction
Independent Claim Reviews

Turnkey Disability Management System

Total Claim Control

Our Claim Stewardship services will put you back in control from the first day of injury to claim-closure and will help you to minimize the ultimate cost of every claim. Our services include:

Claim Management Policies

Having strong Claim Management Policies is the first step in maintaining control of your workers' compensation claims. Our service provides four (4) policies that directly affect employer control and claim compensability:

Statement of The Organization's Claim Management Process;
Incident Investigation and Reporting Procedures;
Fraud Policy (depending on the state, a fraudulent claim can be legally declined);
Substance Abuse Policy (depending on the state, being under the influence of drugs or alcohol may affect compensability).

The focus of these policies is to take the mystification out of the claim process and clearly explain employer and employee responsibilities.

Our service also provides two (2) policies that directly affect disability management in accordance with state and federal laws:

Temporary Duty Policy

Leave-of-Absence Policy

Implementing these policies consistently and in accordance with state and federal laws will give your company a significant degree of leverage over employees who choose not to comply with the organization's claim management procedures, particularly those that apply to work-related disabilities.

Turnkey Prompt Injury Response System

Prompt Injury Response is the first step in taking control of each claim. We will provide easy-to-use solutions in the following areas:

Surveying and arranging proper communication with your occupational clinic;
Developing and providing claim service directives to be provided to your insurance carrier prior to each renewal;
Providing an Employee Packet to the injured employee. This packet will explain your claim management process, encourage the employee to contact you rather than an attorney, and reduce employee fear and insecurity;
Providing a Physician Packet to be given to the occupational clinic after every claim. Clients find that this immediately puts them and the treating physician on the same page and gets vital medical information back within 48-hours;
Supervisory training and resources in how to conduct prompt accident investigations;
Turnkey resources to identify fraud, illegal drug and alcohol use, and subrogation opportunities;
Human resource compliance resources to help you navigate the American With Disabilities Act, the Family Medical Leave Act, HIPPA, and workers' compensation laws.

Turnkey Disability Management System

Lost-time claims not only drive up your claim costs and experience modification; you lose vital productivity as well. We will provide easy-to-use solutions in the following areas:

Develop of ADA-compliant job descriptions;
Turnkey resources to present available temporary duty jobs to the treating physician. This is critical to controlling the disability management process;
Turnkey resources to offer the medically approved temporary-duty position to the injured employee;
Human Resource compliance resources.

Independent Claim Reviews

The average workers' compensation claim adjuster handles, on average, over 300 claims at a time. As a result, they struggle to accurately determine if the claim is compensable, manage the many bills and medical opinions they receive from healthcare providers, and stay on top of lost-time claims. Periodic claim review meetings with your claim adjuster are designed to collectively review specific claims and openly discuss any problems, disagreements and claim management strategies. There are several benefits derived from claim review meetings, including:

Your company's relationship with the adjuster is reinforced and enhanced;
The claim review meeting allows both parties the opportunity to update files and share current information;
Claim management strategy is solidified on individual claims.

We provide independent workers' compensation claim reviews of every open workers' compensation claim. These claim reviews are conducted both by telephone and/or in person with your full attendance and involvement. A written report with recommendations is provided for each open claim and, with your permission, we will take the necessary action on your behalf to resolve any issues and get the claim adjustment process back on track.

Reserve Monitoring and Reduction

Most adjusters put workers' compensation claims on a 30-day diary. While they follow-up on most claims, it is possible the adjuster is not aware that the claim may be "ripe" for closure. Leaving the claim open will inflate the total incurred cost on your workers' compensation loss run.

Also, your insurance company must report the status of all claim reserves to the rating bureau that calculates your workers' compensation experience modification. If the reserve in overstated, your workers compensation experience modification will be overstated. This, in turn, will increase insurance premiums for years to come.

We will closely monitor all claim reserves until closure and take proactive steps to correct any errors.
We will conduct an annual review of all open claims just after each policy renewal to ensure that the reserves are accurate and contest any errors BEFORE they hit your workers' compensation mod.
All our activities are totally transparent to you and fully documented to your satisfaction.

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