Claim Liaisons working either for a broker or TPA play a vital role in the business of claims management. There are times issues require attention that’s simply beyond the scope or expertise of the TPA or a client’s resources and a Claim Liaison may be the ideal solution. The account executive often serves as a liaison.
Ways to Know if You Need a TPA Liaison. TPA Staff serve this role.
The old adage holds true that “the squeaky wheel gets the grease.” Don’t hesitate to bring your concerns to the table for attention. Understand your TPA’s structure and the roles of each person involved with your program and how each can help in strengthening overall results – and your bottom line.
1. If your workers’ compensation claims are spread among multiple jurisdictions, multiple claim offices and multiple adjusters within those offices, a TPA liaison will work to ensure cohesive handling.
2. If claim reviews are an integral part of your program, a TPA liaison can coordinate the reviews with each of the claim offices. Your liaison can participate in the reviews to address non-technical and/or procedural issues arising beyond the responsibility of claim professionals. The best written service instructions (SI) contain areas sometimes subject to interpretation and the liaison helps negotiate resolution or at least makes a recommendation to the TPA management staff.
3. If you require benchmarking or stewardship data or reports, a TPA liaison provides the requested information and even assistance in presenting this information.
4. The liaison helps the TPA staff understand your company’s culture and procedures.
5. If you simply feel your program doesn’t receive the attention necessary to perform at its best and working with the adjuster and management staff didn’t do the trick, a TPA liaison may be the answer. A liaison will provide assistance to you in diagnosing problem areas such as file closure ratios and drill down to the specific office causing the problem. Once you’ve established there is a problem with any area, the liaison can be asked to take responsibility for and work with the TPA’s management staff to put a plan into place to improve whatever problematic areas you’ve identified.
4 Ways to Know if Your Company Needs a Liaison. Brokers serve this role.
1. If total claim costs or the volume of open claims increased during a particular period an internal liaison experienced in claim handling and responsible to set the bar and oversee claims helps reign-in claim costs and regain control.
2. If your field staff responsible for reporting losses is uneducated or under-educated in the world of claims, an internal liaison provides the necessary training for them to know how, when and what to report and also how to appropriately follow up with the TPA.
3. If your company locations are charged back financially for claim costs and would like a better understanding of the process to enable them to assist in controlling claim costs, a liaison may be just the solution.
4. If you’re self-insured or have a large retention or deductible, an internal liaison serves as a strong steward of money spent by ensuring claims are handled well, that cost-savings programs are in place and your management staff is well informed. (workersxzcompxzkit)
Consider the value liaison brings and make a request of your TPA or broker to provide these additional service or hire your own to meet your program needs. The liaison will tighten your program and ultimately reduce claim costs.
Author Robert Elliott J.D. executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: [email protected] or 860-553-6604.
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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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