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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