Reduce Workers Comp Costs | Claims Software | CriticalPath LLC

Assisting the WC Claims adjuster dramatically affects the claims cost as well as the reserves...

The casualty insurance line, Workers’ Compensation Insurance is the only line of insurance that has a controllable cost linked to the insured’s judgment and actions. The cost may be substantially reduced based on control of losses and losses may be controlled from eliminating the incident all the way through assisting the claims adjuster regarding the claimants’ return to work along with claim data availability. Claim settlement with the appropriate data will facilitate prompt litigation response and shorten settlement turnaround time thereby controlling reserve amounts. Closed claims have reserve amounts of zero or less.

Managing a claim and it's associated costs is controlled by:

1. Eliminating the claims from occurring with tools akin to pre-employment screening.
2. Assisting the insured in creating and maintaining the necessary data to establish the facts surrounding a work-related injury.
3. Assisting the claim adjuster starting from the First Report of Injury and related claimant facts through return to work, medical supervision and claims settlement and closure.

Adjuster advocacy: the adjuster is responsible in most claims operations for contacting and obtaining fact details from the employer, the claimant, the medical providers. The adjuster must determine how to process the claim and with which resources. These include the potential activities of engaging SIU (Special Investigative Unit), Independent Medical Examiner, utilization review nurse or case manager, vocational rehabilitation services, in addition to the legal elements that include forwarding the claimant’s petition to the legal department and monitoring comp board hearings as well as settlement negotiations and lump sum settlement offers.

We are not done. The adjuster is carrying the weight of monitoring (in some operations actually making) payments to the providers; medical legal, medical consulting, surveillance and document services. After monitoring the accounting records, medical diagnosis prognosis and considering the legal status of the claim, the adjuster’s ultimate responsibility is calculating the incurred cost of the claim. This includes payments made to the valuation date as well as possible payments to be made in the future (also known as reserves).

CriticalPath provides the software and instructions to the insured to avoid claims and if there is still an incident, how to establish and deliver the claim facts to the adjuster. CP works with the adjuster to obtain all the necessary injury incident, claimant personnel and medical data and proceed to move the claimant from the injury stage to working recovery and subsequently full and complete claim closure.

Working the claim incident from the insured’s location to the adjuster’s file is CriticalPath’s formula for claim cost control. The claim costs are controlled and substantially reduced with a net fee cost to the insured that the program is the most cost-effective way to control the Workers’ Compensation line of insurance.