Claim Reviews
The claim review is an opportunity for everyone to get on the same page with regards to how a claim is being handled and where it is heading. Typically our reviews are done with the insurance agent and their customer. Whenever possible, we get a representative from the insurance carrier or third party administrator to participate in the claim review.
Whenever we review a claim, our goal is to get it closed. When a claim cannot be closed for whatever reason, we work to get the outstanding reserves reduced. Whether the agency customer is self insured or on a guaranteed cost plan, all claim reserves have a negative financial impact on the customer.
The claim review process starts with obtaining updated loss runs for all policy periods and lines of insurance that are to be reviewed. We then contact the adjusters on all open claims and start the process of reviewing the claims. We use our claim handling experience to ask the adjuster questions to determine if the claims are being handled appropriately. For those claims that are not being handled aggressively enough, we make recommendations to get the claim back on track. We also determine if the claim is reserved properly and make arguments for reserve reductions. From there we prepare detailed claim status reports for review with the agency and their customer.
Whenever we review a claim, our goal is to get it closed. When a claim cannot be closed for whatever reason, we work to get the outstanding reserves reduced. Whether the agency customer is self insured or on a guaranteed cost plan, all claim reserves have a negative financial impact on the customer.
The claim review process starts with obtaining updated loss runs for all policy periods and lines of insurance that are to be reviewed. We then contact the adjusters on all open claims and start the process of reviewing the claims. We use our claim handling experience to ask the adjuster questions to determine if the claims are being handled appropriately. For those claims that are not being handled aggressively enough, we make recommendations to get the claim back on track. We also determine if the claim is reserved properly and make arguments for reserve reductions. From there we prepare detailed claim status reports for review with the agency and their customer.
When Are Claim Reviews Done?
Claim reviews can be done any time throughout the policy period. The most important time to conduct a claim review is prior to when your customer's experience modifier rating is calculated, which is mid-point or six months into the policy period. Whenever we get a get a reserve reduction or close a claim, this has a positive impact on customer’s experience mod rating. Consequently, it saves them money on their future workers’ compensation premiums.
The second most important time for a claim review is prior to the start of the renewal marketing process. While the mod rate will not be impacted when claims are closed or reserves are reduced, the insured’s loss ratio with the incumbent insurance carrier will be improved, which typically results in lower renewal premiums.
Depending on the frequency or severity of your customer’s claims, claim reviews can be done on a bi-annual, quarterly, or monthly basis.
The second most important time for a claim review is prior to the start of the renewal marketing process. While the mod rate will not be impacted when claims are closed or reserves are reduced, the insured’s loss ratio with the incumbent insurance carrier will be improved, which typically results in lower renewal premiums.
Depending on the frequency or severity of your customer’s claims, claim reviews can be done on a bi-annual, quarterly, or monthly basis.
What are the Results of the Claim Review Process?
Strengthens the Relationship with Your Customer:
The bottom line is that our work saves your customers money in the long run. It also shows them that you are taking a vested interested in the viability of their organization by proactively helping them to keep their insurance premiums down.
It Levels the Playing Field with the Competition:
Many agencies nowadays are offering some form of claim advocacy services to their customers and prospects. By providing this kind of service to your customers, you will at the very least level the playing field with any competing agent offering similar services.
Improve Contingency Commissions:
When we are successful in getting the insurance carrier to close claims or reduce the reserves, this has a positive impact on the agency loss ratio with the carrier. In turn, this results in higher contingency commissions at the end of the year. Many of our customers have been able to pay for our fees simply by us helping them to get higher contingency commissions!
The bottom line is that our work saves your customers money in the long run. It also shows them that you are taking a vested interested in the viability of their organization by proactively helping them to keep their insurance premiums down.
It Levels the Playing Field with the Competition:
Many agencies nowadays are offering some form of claim advocacy services to their customers and prospects. By providing this kind of service to your customers, you will at the very least level the playing field with any competing agent offering similar services.
Improve Contingency Commissions:
When we are successful in getting the insurance carrier to close claims or reduce the reserves, this has a positive impact on the agency loss ratio with the carrier. In turn, this results in higher contingency commissions at the end of the year. Many of our customers have been able to pay for our fees simply by us helping them to get higher contingency commissions!
