General Liability TPA Should Have Specific Plan of Action (SPOA)

In the never-ending quest to lower business costs, employers must consider using a fully integrated general liability service provider with solutions unique to the business. Fully integrated here means a service that covers everything from property damage to bodily injury to product liability designed for the company, its risk management program and the owners.

1. Thorough investigations.

When looking for a general liability service provider look for one who will design a program unique to your business by becoming completely familiar with what you do, how you do it, the legal issues, and your vision for success. Then expect them to create an integrated claim service team who can meet your company’s needs. Select an account manager based on chemistry and experience, supported by a multitalented team of:

A successful program optimizes the claim process starting with 24/7 intake system, creating a specific path for your claims and your custom escalation protocols. Customer service representatives should be employees of the service company, trained to capture the data you need and the information necessary to allow the claim professionals to act quickly. These professionals must also be appropriately licensed and supported so they can perform thorough investigations.

After analyzing the facts and issues, claim professionals work with physician advisors, subject-matter experts, and supervisors as needed to create a Strategic Plan of Action (SPOA). The Strategic Plan of Action sets goals and identifies the steps necessary to assist those presenting legitimate claims and protects you from those trying to take advantage of you.

The SPOA prepares for litigation early by employing a multifaceted-litigation management program designed to minimize legal costs and create the optimal outcome. The claims professional creates a proactive litigation plan and budget and is involved in all decisions regarding the case.

Your service provider makes clinical expertise one of your greatest strengths by using medical bill review, physician review services, critical incident review, pharmacy protocols, and review of specials packages to help discover the true value of each claim. Should legal counsel be needed, legal bill review can help ensure defense fees are appropriate and within reason.

Senior risk analysts provide an added tier of expertise. Each analyst typically has more than 25 years of experience and extensive training in handling complex claims. If a claim meets a certain requirement such as a catastrophic loss or high-exposure, it can trigger the senior risk analyst’s involvement. They offer a broader analysis of the claim and advise the claim professional on coverage, reserves, litigation strategy, and proper disposition. Your senior analysts have the ability to take on several advanced roles. They can handle special projects, train your staff, manage inventory, and look for trends within the data to lower overall risk cost.

Remember, you want a program using tools tailored to your systems, processes, and expertise to complement your needs. If your company experiences a large volume of liability claims, your provider must be able to establish a client-dedicated service team at a centralized location.

1. Day-to-day communication.

The right result requires the execution of a thoughtful game plan.

Contributor: Broadspire providing workers compensation third-party administrative services. For more information, contact Broadspire by calling 1-866-625-1662 or emailing us at [email protected]; www.choosebroadspire.

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