What to Expect from your Workers Compensation Third Party Administrator

If you’re self insured or carry a large deducible or retention, chances are a third party administrator (TPA) is handling your workers’ compensation claims and you’re paying for their services. Your TPA is fundamentally a service provider. Understanding what to expect and holding your TPA accountable are significant components of successfully managing your program.

Your TPA is a business partner who not only handles your claims and provides service but also should be engaged in protecting your bottom line. While it’s the job of your TPA to handle and manage claims, vigilance in the oversight of those claims internally will contribute toward the overall success of your program and in reducing claim costs. That’s best accomplished by an experienced claim professional working at your organization to hold your TPA accountable and ensure dollars are spent appropriately.

Your TPA handles claims according to their best practices and complies with your service instructions. Any deviations of either is an exception, not the rule. There’s a lot of very detailed work involved requiring the entire team to perform well together to successfully accomplish the goal (a well handled file with a cost effective, prompt closure) so work with your TPA to have the right players involved.

Pay only benefits owed and no more. Partner with your TPA to help them prevent payment errors. Let the adjuster know immediately the names of employee’s who have returned to work so benefits are suspended in a timely manner and talk about any suspicious claims at the on-set of worker injuries.

The TPA treats all of your employees fairly and respectfully including injured workers and anyone else contacted in the course of the investigation or handling of the claim. Adjusters with the proper level of expertise are assigned to match the complexity of the claim. Supervision in your files should be visible. Open and frequent communication is critical to the successful handling of your claims. Your TPA needs to keep you well informed and you need to keep your adjusters informed, also, to prevent surprises and end claim results must be accurately forecasted.

Scoring Adjusters and teams If a TPA provides numerical scores for their adjusters expertise, it’s an excellent indication the organization has confidence in their capability to provide excellent service. Adjuster scores should be part of the internal quality control program.

Your TPA detects and shares trends with you for collaboration in determining improvement focused solutions. Assistance in negotiating pricing with vendors is another area where your TPA also lends their expertise including possibly taking advantage of existing relationships the TPA has with vendors.

You should expect top-notch service and partnering from your TPA so all your service needs are met, your claims are well handled and expenses are controlled by negotiating vendor fees. Remember, it’s your money the TPA is spending.

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By: Private investigator with 25 years experience.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.

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