In claims management, preventive measures are still the best way to control costs. However, claims are going to occur, so having the right plan in place to manage them becomes critical.
A client’s claims-management functions can have significant impact on how insurers view the risk during the underwriting process. For property, liability and auto claims, claims-management practices can result in higher or lower premiums—and for workers’ compensation, they can result in higher or lower modifications as well as increases or decreases in the application of scheduled credits.
Click next for tips on how clients should respond to property, casualty and workers' comp claims.
FILING A MAJOR PROPERTY CLAIM
After a claim has occurred, the client should protect the insured property by securing the scene to prevent any further damage. The client must then make the following assessments:
- Can the electricity be used? Are the telephones operational? Can the client transfer business calls to cell phones if necessary? Can the product be salvaged?
- Part of the insured’s contingency plan should include a list of emergency restoration companies, and 24-hour contact numbers.
- The client should take photographs of any and all damage. A picture is worth a thousand words and perhaps thousands of dollars.
After this initial assessment, a more detailed report will be necessary. It should be clear, concise and include all necessary information (cause, mitigation plans, analysis of business interruption and all costs incurred).
WHEN CASUALTY CLAIMS ARISE
Casualty claims can encompass a host of situations, from bodily injury to property damage. The key to managing casualty claims is to:
- Collect information
- Be courteous
- Show empathy
- Mitigate to the best of your ability and everyone’s safety
- Do not admit fault or not-at-fault.
- Identify witnesses
- Document the situation
- Record your own assessment and recollection
It is important to review what types of coverage the client has in place. For example, is there coverage for crisis management, advertising or other public notifications? Is supplemental coverage, such as for cyber liability, needed? What kind of risk transfer do the client’s safety training and procedures engender?
Casualty claims potentially involve both emotional and physical injury. Bear both in mind when dealing with the client.
WORKERS’ COMP CLAIMS
When adopting best practices in Workers’ Compensation (WC) claims management, even simply identifying where to start can be intimidating for employers if they rely solely on their claims administrator. To achieve best outcomes, employers should take an active role in developing internal best practices and align them with a claims administrator who supports the same philosophy.
The key elements to a successful WC claims-management program will have both pre- and post-injury components. It’s said that “the best WC claim is the one that never happens,” therefore, the first step is avoiding claims through safety and health programs. The second is mitigating costs once a claim occurs.
With medical expenses accounting for more than 60 percent of a WC claim, injury strategies must address this cost driver through programs that keep employees healthy.
Fundamental Pre-Injury Initiatives: Prevention and Preparation
- Build an integrated safety and wellness program to avoid injuries and illnesses. Take a holistic approach and adopt communication programs that provide awareness and training on prevention at home, and at work.
- Create a company-specific claim management workflow and procedures on what to do when an injury occurs.
- Identify quality medical providers and establish relationships. Give the medical providers tools to assist them in developing a productive return-to-work plan.
- Explore options for a) Injury Prevention, such as ergonomic evaluations and education; b) Early Medical Intervention, such as RN triage to determine if the incident is best cared for by self-care, clinic or hospital; and c) On-Site Medical Treatment, including first aid and physical therapy.
Fundamental Post-Injury Initiatives
- Track claims to identify loss trends and make improvements to safety programs aimed at reducing these injuries.
- Immediately report all injuries and stay in communication with the adjuster throughout the life of the claim.
- Investigate accidents to determine the cause(s) of injury and implement plans to abate exposure.
- Keep in touch with the injured worker, address any questions s/he may have, and create a mutually agreed-upon return-to-work plan with the physician, employee and employer.
- Conduct regular claim reviews, with a focus on achieving the best outcome and closure. Request participation from all parties, including legal counsel, case manager and investigator, to see how each party can affect the outcome.
In California, SB 863 has attempted to address many components that today hinder best claim outcomes and increase claim costs. However, it will take time to fully implement these changes and to weigh the benefits to employers, employees and carriers. In the meantime, the best advice is to build your own best practices with the right claims-management partners.
For all types of claims, an insured’s preparedness can be improved by considering the following:
- In case of disaster, do you have a contingency plan, regardless of whether or not the occurrence is covered?
- Do your existing safety measures reduce the chance of loss?
- What is the estimate of the probable maximum loss; does your current insurance cover that loss?
- Do you have a claims management team? If not, it is imperative to organize one immediately. The team should fit the size and nature of your organization, and include the business owner or senior officer; safety manager; risk manager; CFO; insurance broker; accountant; and if you are in a consumer-facing industry, your communications team.