Plan of Action Report Helps Direct Where Claim Is Heading
- Investigation of the claim to determine compensability
- Strategy to manage medical treatment, return to work issues, and potential permanent disability if applicable
- Issues such as subrogation, excess carrier reporting, legal issues, state form filings, etc.
- Key points should be clearly stated in bullet format using stated verifiable facts that are already documented within the claim notes.
- Adjuster’s thought processes for the key points in the plan of action should be evident. These thoughts should be free from expression of opinion or negative comments. Those points can be pointed out in a discussion/summary/opinion paragraph at the end of the report.
- The Official Disability Guidelines (ODG) should be mentioned based on the known severity of the injury. Use of ODG guidelines towards maximum medical improvement (MMI) allows you to outline the appropriate steps and actions that need to be completed to being the claim to eventual closure/resolution.
- Goals that will lead to ultimate outcome of the claim based upon known risk drivers such as age, location, claimant attitude and compliance, injury type and severity, comorbidities, etc.
- The actual steps that the adjuster needs to complete to achieve the stated goals of the claim
- A timeline for completion of the actions needed to complete the claim goals.