Broker Role in Preventing and Resolving Disputes with Third Party Administrator (TPA)
Q. What should be the role, if any, of the broker in preventing/resolving disputes? More pointedly, what are the reasons behind why a broker may fail to serve this function?
Brokers often have the primary role. TPA/Carriers can also play a leadership role. Brokers can do the following:
1 – Facilitate regular, frequent communication of TPA and insured. Weekly calls, monthly meetings are good. Annual stewardship meetings are not enough.
2 – Take clients on a tour of the claims office. Let them sit with each adjuster: intake, med only and lost time, and have them walk you through each step of a few claims. The employer should ask as many questions as they can think of. What’s this, why that, etc.
3 – Set up a “Vendor Day” where all insurer services are described, examples provided and costs established and questions asked. Make it a structured, group brainstorming session and ask the insurer for their suggestions on how the services can be used proactively. Include the adjusters. They often have great ideas. E.g. – Recently, an adjuster mentioned that my client needed to have a written description of how the accident occurred. Great idea, but no forum to mention it to client, so she opened up to me when I was sitting with her.
4 – Basic problem: Employers “don’t know what they don’t know” so they can’t ask for it. The broker may not dedicate the resources (only national accounts get these services) or they may not have the esources to identify and correct the problem. This is NOT the forte of most brokers. This is the reason I developed Workers Comp Kit® so any size company can quickly, easily and cheaply get an assessment and recommendations; and they don’t have to rely on the broker or carrier.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
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