Are You Getting the Right Information from Your Third Party Claims Administrator?

May 15, 2019

Over the past decade, the claims world has been abuzz with data analysis and predictive modeling. Much of this focus is earlier identification of a potential severe claim to change the claim process to impact the claim outcome. These are great initiatives that impact employers ultimate claim costs.

However, there are additional ways using claims data to identify improvements in an organization’s operations. There are common indicators that can be used regardless of the industry. A few of these include:

Timely reporting of claims: Are claims being reported to the employer and then submitted to the TPA? Time is critical to assure the injured worker is contacted by an adjuster and understands the workers’ compensation claim process.
How long has the employee been with the organization: The tenure of the worker helps employers understand if employers are injured shortly after their hiring or well into their tenure with the organization. For the newly hired people, do they have the physical capacity to complete the job or is additional training needed? For the more tenured employees, are short cuts being used that may be more hazardous than safe work practices?
Number of days lost from the work injury: Are return-to-work strategies in place to keep the injured worker engaged and part of the organization’s culture.
What percentage of employees seek legal counsel: This is a good barometer of the organization’s relationship with employees as well as the claim process. If the percentage is high, then what can be done to improve communications with an ever-changing workforce?

The world of risk management has always relied on using past experience to predict the future. However, with increased information that future can be improved with enhanced information, not just data. Are you getting the right information from your Third Party Claims Administrator?

By: Ed Reasoner, Director of Risk Management