High Service Experience and Low Net Costs
Claims adjusting results directly affect the pricing of Workers' Compensation policies. You can save money this year and have it shift higher costs to you over the years to follow when your state’s Rating Bureau makes annual adjustments to your Experience Modification. With that in mind we have contracted the best providers to work for us on behalf of our clients. Our claims adjusters regularly reduce claims payouts by 30% or more from prior experience with other carriers and programs.
Reserving Practices
One of the most critical functions of claims management is to establish timely, accurate reserves. Our specialty program claim firm’s reserve philosophy is consistent with Generally Accepted Accounting Principles, or GAAP. Under GAAP rules, reserves must be established at the estimated ultimate settlement value of the claim. To arrive at this number, claims examiners must use all available information to establish and continually evaluate reserves.
Information taken into consideration when establishing reserves may include but not necessarily be limited to the following:
- - Type of injury
- - Severity of injury
- - Age of the injured employee
- - Occupation
- - Local cost of treatment
- - Expected length of disability
- - General health and motivation of the injured employee
- - The experience of the claims examiner
Quality Control
The bill review, case management and utilization review is provided by our specialty claims adjusting Managed Care and is fully integrated into the system; allowing examiners to work closely with the nurse case managers and peer review doctors to control costs.
In addition to regular external audits, claims adjuster’s Quality Assurance department conducts routine unannounced internal audits to ensure claims policies and procedures are being adhered to.
Our adjusters are SAS 70; type 2 certified and have regular SAS 70 internal audits as well. Claim reviews are done on a quarterly basis.
