Three Types of File Organization Claims Auditors See

When a claims file auditor reviews a claim file for the first time, the claims auditor will normally see one of three types of file organization.  
The three types of file organization are:
1.      The jumbled mess.   In the jumbled mess file, there is no organized approach to the file. File documentation has been added haphazardly with medical documentation mixed with state forms mixed with claim investigation mixed with indemnity documentation, etc. The adjuster is relying on memory to handle the claim as locating anything in the file is very time consuming. Fortunately, the jumbled mess is becoming a dinosaur as most companies are now using computerized files where the computer programming sort documentation into varies types (though some careless adjusters can make even computerized files a jumbled mess by placing documentation in the wrong category).
2.      The chronological file. In the chronological file, everything is in the date order by when the file documentation was received. The chronological file can be either with the most recent information on top (paper files) or first displayed (electronic files), or with the oldest information on top (paper files) or oldest information displayed first (electronic files).
3.      The organized section file. This is the claims auditors dream. The file is broken down into clearly identified sections for claim investigation documentation, medical documentation, indemnity documentation, state forms, hearings & legal documentation, medical management documentation, vocational rehabilitation documentation, etc. The documentation is in each section is then organized by date or other clearly identifiable procedure.
I don’t think there is any good outcome to sloppy file handling where one losses details that may be necessary for defense in the future. A neat, orderly file allows you to hand off the file to another employee for additional handling. This is critical to department efficiency. Short term thinking where things are tossed randomly into the file without any organization will ultimately cost more. You might save time the first time you toss something into the file, but next time you need it then have to hunt it will take TWICE the time and if you are looking for a detail to give your defense attorney or your medical advisor to allow them to create a detailed IME cover letter, having those details is necessary.

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: .


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