• Menu
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

  • About
  • Contact
  • Privacy
 
ARCADIA: Stronger Settlement Partnerships. Innovative Solutions.

Amaxx Workers Comp Blog

Reduce Workers Compensation Costs By 20-50%

Header Right

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login

Mobile Menu

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login
  • About
  • Contact
  • Privacy
You are here: Home / Claim Management / Claim Audits & File Review / How To Get the Most From A Workers Compensation Claim File Audit

How To Get the Most From A Workers Compensation Claim File Audit

August 16, 2018 By //  by Michael B. Stack

How To Get the Most From A Workers Compensation Claim File Audit Self-insured employers, insurers, third party administrators, and government entities all use workers’ compensation claim quality audits to measure the performance of the claim adjusters, supervisors, and over-all claim staff. Common uses of claim file audits include measuring compliance with Best Practices, verifying the accuracy of reserves, identifying leakage, preventing fraud, and improving subrogation recoveries. As self-auditing often results in the inability to see the forest due to all the trees, claims management frequently turns to an outside independent claim file auditor to ensure unbiased and objective opinions in the claim audit.

Both Closed and Open Claims Files Should be Audited

Critics of claim file audits often complain that audits are retrospective, as the Best Practices have already been missed or the leakage has already occurred. The critics are correct if only closed files are being reviewed. However, when open claim files are audited, and the audit results are acted on promptly, substantial savings can be had.

Click Link to Access Free PDF Download

“Workers’ Comp Claims Review Checklist: 9 Must-Have, Serious-Impact Elements”

When open workers’ compensation claims are reviewed, issues that have been missed can often can still be corrected. This is true because once the claim is paid and closed, it is too late to investigate compensability, arrange for an earlier return to work, provide proper medical management, adjust incorrect reserves or negotiate a better settlement.

A complete claim file audit not only provides a report on the correct or incorrectness of individual files, but also includes an aggregate report of the various claim handling procedures that have been reviewed. The most common way of tabulating or scoring an audit category is based on 100%. Usually, a score of 90% or higher is considered acceptable, and a score of 95% or higher is considered good. Hence, a score of 96% in the category of medical management would be good, but a score of 76% would indicate a lack of quality in medical management and the need for the adjuster to improve in this area.

When the claim file audit is limited to open files, the adjuster/supervisor/claims manager has the opportunity to correct files where an important part of proper claims handling has been missed. In the above theoretical example where the claims office scored 76% in the medical management category, the aspects of the medical management that have been missed could be completed. This would positively impact the overall medical cost of the claim and possibly also reducing the indemnity portion of the claim by getting the injured employee back to work faster.

FREE DOWNLOAD: “Workers’ Comp Claims Review Checklist: 9 Must-Have, Serious-Impact Elements”

Management Benefits By Identifying Weak Spots In Claims Handling

By identifying both individual files where claim handling errors occurred and by identifying claim handling categories where either an adjuster is weak or the entire claims office is weak, management benefits in several ways, including:

  • Management can focus training resources on specific issues, whether with a single claims adjuster or the entire claims office
  • Data provided can be used by claims management to support the need for procedural changes, additional personnel, or personnel restructuring
  • Reserving data can be used to verify the accuracy of, or the need to adjust coverage underwriting

By having an independent claim file audit, the self-insured employer, insurer, third-party administrator or government entity can use the information gathered to improve the overall quality of the claims handling, and in doing so, significantly impact the cost of workers’ compensation claims. For more information on how an independent claim file audit can improve claim quality and reduce the cost of claims, please contact us.

Michael Stack - Amaxx

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

FREE DOWNLOAD: “Workers’ Comp Claims Review Checklist: 9 Must-Have, Serious-Impact Elements”

Filed Under: Claim Audits & File Review

Related Articles

File Reviews: The Who, What, When, Where, and How to Conduct One

File Reviews: The Who, What, When, Where, and How to Conduct One

Your Roadmap To A Successful Workers Compensation Claims Audit

Your Roadmap To A Successful Workers Compensation Claims Audit

Select the Right Claims for a Workers’ Comp Claim Audit Category Claim Audits & File Review

Select the Right Claims for a Workers’ Comp Claim Audit Category Claim Audits & File Review

The Main Goal of a Workers’ Comp Claim Audit or Review

The Main Goal of a Workers’ Comp Claim Audit or Review

Part 3: What to Do AFTER a Workers’ Comp Claim Audit

Part 3: What to Do AFTER a Workers’ Comp Claim Audit

Part 2: Select the Right Claims for a Workers’ Comp Claim Audit

Part 2: Select the Right Claims for a Workers’ Comp Claim Audit

Part 1: Stop Wasting Time Doing Workers’ Comp Claim Audits

Part 1: Stop Wasting Time Doing Workers’ Comp Claim Audits

One Tip To Make Claims Reviews an Effective Use of Time

One Tip To Make Claims Reviews an Effective Use of Time

16 Point Checklist To Determine If You Need A Workers’ Comp Claim Audit

16 Point Checklist To Determine If You Need A Workers’ Comp Claim Audit

19 Points to Cover in a Proper Workers’ Comp Claim Investigation

19 Points to Cover in a Proper Workers’ Comp Claim Investigation

Five Factors to Review in Your Workers’ Comp Claim Files

Five Factors to Review in Your Workers’ Comp Claim Files

6 Ways to Make Workers’ Comp Claims Audits/Reviews Impactful

6 Ways to Make Workers’ Comp Claims Audits/Reviews Impactful

Free Download

Workers' Comp Claims Review Checklist: 9 Must-Have, Serious-Impact Elements - FREE Download Click Here Now!

Train to Succeed

BECOME CERTIFIED IN WORKERS’ COMPENSATION

Proven Course Catalog & WC Toolbox Give You The Power To Achieve Lower Costs and Better Injured Worker Outcomes

VISIT WORKERS' COMP TRAINING CENTER

Previous Post: « Proper Claim Management Requires a Strategic Plan of Action
Next Post: Overcome Catastrophic Claim Settlement Resistance With Support »

Primary Sidebar

FREE DOWNLOAD

Workers' Comp Claims Review Checklist: 9 Must-Have, Serious-Impact Elements - FREE Download Click Here Now!

Our Sponsors

ARCADIA - Enhancing Settlement Outcomes

The Structured Settlements Company
 

Catastrophic and Risk Solutions, Case Management Solutions, and Specialty Networks
 

Post-Settlement Administration
 

Medcor

Injury Triage, Onsite Clinics

Read Our Award-Winning Blog

Blog Categories

Search Our Archive

Subscribe to Our FREE Newsletter

Return-to-Work Essentials

Footer

Search Our Archive

Search our continually growing archive of over 2500 articles about Workers' Comp issues.

Quiclinks

  • Calculators
  • Terms & Abbreviations
  • Glossary of WC Premium Terms
  • WC Resources
  • Best Practices
  • Industries
  • Return-to-Work Essentials

RSS Recent Blog Posts

  • Use a Medical Director to Reduce Workers’ Compensation Costs
  • Focus on the Workers’ Comp Fundamentals – Part 2
  • Focus on the Workers’ Comp Fundamentals – Part 1
SUBSCRIBE TO OUR FEE NEWSLETTER
Let Us Help You Stomp Down the High Cost of Workers' Comp!
Top of Page ↑
  • Home
  • Training Center
  • Search
  • Membership
  • Products
  • Blog
  • About
  • Contact
  • Subscribe
  • Login
Copyright © 2022 Amaxx, LLC. All Rights Reserved. · Privacy Policy / Legal Notice