TPA Best Practices Include Loss Reporting, Claim Assignment, Assignment Procedure and Coverage Verification

Nothing Succeeds Like Success…

A leading international third-party administrator for large self-insured organizations, provides workers’ compensation, auto, and general liability claims handling.

Part of this multi-national company’s success stems from their best practices regarding workers’ compensation procedures. The claims staff divides procedures into fourteen discrete areas. Let’s look at four steps.

1-Loss Reporting

Prompt loss reporting is a key aspect of timely loss notification. Prompt reporting has three advantages.

1. Prompt quality contact with all involved parties results in reduction of claimant representation and litigation.
2. Prompt investigation
3. Reduction of overall cost per claim

2-Claim Assignment

An effective assignment process helps to ensure proper handling of claims at the appropriate technical level. The claim assignment process may include gathering additional information beyond what is available in the Employer’s First Report of Injury.

The TPA practices a team approach to claim management, distributing the work to the most appropriate level of technical expertise to gain the highest possible efficiency.

3-The Assignment Procedure

Upon receipt of a first report from the call center, fax or e-mail, a four-step process is initiated.

1. Supervisory evaluation of first report of injury for type of loss (medical only/lost time).
2. Supervisory review and direction to the appropriate claims examiner.
3. Creation of a Central Index Bureau referral for lost time claims and medical-only as required.
4. Case management services should be utilized as appropriate. (It should also be noted the claim classification and technician assignment can change throughout the life of the claim if a significant change in complexity level occurs.) (workersxzcompxzkit)

4-Coverage Verification

Coverage verification process includes confirmation of the client’s self-insured retention and valid contract and/or verification of a client’s policy of insurance with the carrier, limits of coverage, and effective dates. Coverage issues are recognized, investigated and addressed with the carrier.

All of the i’s are dotted and t’s are crossed…the claims are handled well.

Author Robert Elliott, 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.

Podcast/Webcast: How To Prevent Fraudulent Workers’ Compensation Claims
http://www.workerscompkit.com/gallagher/podcast/Fraudulent_Workers_Compensation_Claims/index.php

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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