Products & Services

Claims Consulting

Claims consulting is one of the four key components necessary for a comprehensive risk management program.

A claim can have a substantial effect on your costs and insurability. By properly identifying risk factors, we develop an action program focused on reducing the duration, value, and ultimate cost of your claims, which significantly affect your short- and long-term insurance premiums.

This specialized approach seeks out claim issues and processes, provides custom solutions for these problems, and gets your program on the right track.

• Claim audits and reports
• Experience modification analysis
• Loss trending analysis
• Return to work programs
• Review & implementation of designated medical providers
  

We utilize the results in a coordinated effort with our Loss Prevention Division to positively impact your injury trends. While the final physical document is a comprehensive illustration of your current situation, you’re also receiving a fully customized action plan working synergistically to impact your total cost of risk.

CLAIM AUDITS

• Perform periodic audits of open claims
• Verify proper loss reserves for the injury and associated future costs
• Strive for loss reserve reductions
• Actively manage claims and pursue resolution
• Propose recommendations to adjusters to facilitate claims settlement

EXPERIENCE MODIFICATION ANALYSIS

• Identify controllable Experience Mod
• Audit current Experience Mod for accuracy
• Projections for upcoming year
• Mod manipulation

LOSS TRENDING ANALYSIS

• Graphs and charts to identify loss frequency and severity
• Average costs of all medical only and lost time claims
• Notification of causation trends to Loss Prevention Division

CLAIM REPORTS

• Claims summary reports provided as needed:
  
• Claims status updates
  
• Detailed plans of action
  
• Breakdown of incurred reserves
  
• Documented reserve adjustments with explanations
  
• Detailed file information from all parties involved - physicians, attorneys, adjusters

PROVIDER REVIEWS

• Locate, interview and facilitate selection of your designated workers’ comp. health care provider
• Develop list of preferred providers (PPO Networks)
• Facilitate meeting between designated provider and client claim staff

PERSONAL INTERACTION

• Educate your staff on claim procedures
• Communication of proper procedures to ensure the most efficient outcome
• Assist in developing return to work programs
• On-site claim reviews and/or conference calls as needed