Each year, risk managers at employers of all sizes, along with claim adjusters and other professionals at insurance carriers and third-party administrators (TPAs), invest an average of more than 1,000 hours on conducting casualty claim reviews. Unfortunately, even though all participants agree this is a necessary and valuable process, the results often fail to meet expectations.
For the past two years, Aon has collaborated with more than 100 risk managers and 17 insurance company and TPA executives to take a deep dive into the entire claim review process. Our collective research efforts have produced several insights to help drive significant improvements in the claim review process and outcomes.
Whether your organization uses claim reviews to strengthen financial position (i.e., by accelerating claim closures and adjusting reserves); flag administrative issues, such as breakdowns in incident reporting and injured worker communications; or to drive operational gains by uncovering and addressing workplace hazards, here are 10 best practices that can help improve your ability to achieve desired outcomes. They are organized according to the three standard phases of any claim review process — pre-review, in-review, and post-review.
The success of any claim review calls for careful planning and attention to detail.
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.
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.
In concluding a review, you should also provide detailed reports that document various insights and opportunities resulting from the review and enable all participants to track next steps.
These measures were drawn from more than two dozen takeaways from the ongoing research being conducted on claim reviews in conjunction with a cross-section of industry participants. Risk managers and their claims teams currently applying best practices to claim reviews have already started seeing significant improvements in the ROI and value they gain from these enhanced processes.
Kevin Combes is director of U.S. casualty claims at Aon Global Risk Consulting. Based in Irvine, California, he has more than 30 years of experience in workers’ compensation claims, including the development of pre- and post-loss strategies, and the identification and implementation of solutions that represent sustainable economic improvement opportunities.
Opinions expressed here are the author’s own.
