Claims management review checklist

The start of the year is a good time to take a step back and assess your overall claims process. Balancing a macro and micro approach to claims is key to ensuring that you are achieving the best possible outcomes. Here is a claims management review checklist:

  • All claims reported in 24 hours or less following incident.
  • All claims periodically diaried, reviewed and documented?
  • Examiners and supervisors have manageable claims case loads?
  • Subrogation potential comp claims identified and pursued?
  • Fraud potential compensation claims identified and pursued?
  • Litigation control of comp claims practiced and managed?
  • Reporting of open, reserves, and closed claims on a timely basis?
  • Claims consistently settle higher or lower than reserves?
  • Claims ultimately close within 10% -15% of reserved amounts?
  • Reserves on Unit Stat filings match claims file amounts?
  • All open case claims reserves adjusted on a timely basis?
  • Changes in reserves slow in reaching computer loss runs?
  • Excessive claims reserve recoveries or salvages detected?
  • Injured worker payments sent on accurate and timely basis?
  • Payments to injured workers verified on a regular basis?
  • Payments provided to questionable or fraudulent comp claims?
  • Expenses accurately provided and on a timely basis for claims?
  • Payment accompanied with adequate supporting documentation?
  • Payments made in excess of claims examiner authority levels?
  • Supervisors review claims files on a regular periodic basis?
  • Have all claims been assigned to the proper state?

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