Phase I: Pre-claim review/planning

The success of any claim review calls for careful planning and attention to detail.

Start with clear and meaningful objectives. This fundamental groundwork enables risk management and claims professionals to apply more strategic approaches to all aspects of the claim review process.

Be diligent in the selection of claim files. The selection of any claim files to include in the review should align with the objectives. Besides saving time, focusing on relevant claim files will make the effort invested by all participants more productive and increase the likelihood of the review achieving the desired result.

Include all key participants. Invite all appropriate team members, both internal and external, to participate in the review process. Besides obtaining a wider range of insights and perspectives on individual claims being reviewed, the involvement of multiple team members will help build a more complete strategy for handling individual claims. This applies especially to those claims that may be more complex, such as those involving co-morbidities. As we learned during the COVID-19 pandemic, you can easily widen participation to include remote participants by using video conferencing and related technology-based resources.

Phase II: In-Review Best Practices

These measures help ensure the efficient presentation of claim status (based on risk management's objective and preferred format). They also are geared to help facilitate a productive discourse on individual claims.

Focus individual claim discussions and presentations on the risk manager's objectives. This helps facilitate a more focused, productive and efficient review process.

Present current status and direction of individual claims. Presentations that explore "where are we at and where are we going" with respect to current claims generally save time and lead to more productive discussions.

Avoid non-relevant historical narratives. These discussions are often superfluous and tend to be counter-productive and waste valuable time. You can also save time by having presenters forgo reading reports circulated to participants in advance of the review. This helps focus more discussions time on addressing barriers to resolution/closure and achieving results.

Establish a cadence for claim review presentations and related discussions. Stick to a schedule of presentations and have the next presenter on standby 10-15 minutes prior to their discussion. This helps minimize downtime and will facilitate more productive meetings.

Phase III: Post-review reporting and follow-up

These best practices involve assessing how effectively the claim review process aligned with objectives, including an evaluation of results achieved. Results of any claim review should be tracked and available to guide future claim review discussions, further improving efficiency for all stakeholder/participants.

Share agreed-upon action plans to reaffirm accountability and track progress. Post plans on a standard spreadsheet, appropriate project planning software or tool accessible by all participants on a risk management information system.

Assign responsibility and set timelines for action items. Designate specific individuals or team members to follow-up on action items listed during the claim review and set target dates for the completion of each action. In addition, ensure steps are completed as scheduled and updating all parties on progress.

Obtain and communicate risk management's feedback. Find out what risk management deemed went well and areas for improvement. Share with all participants to drive steady gains in the process.

Special Reports /

Steps to drive results during casualty claim reviews

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