Claims Oversight

Introduction

RiskSolutions, Inc. Claims Oversight monitors the workers' compensation claims management by the insurance carrier for accuracy and aggressiveness in moving the claims to closure. Reserves are constantly reviewed and our internal staff keeps accurate records of any increases or decreases. RiskSolutions aggressively negotiates the reserves for the employer.

The broker receives an initial claims assessment report by employer at the end of the first month with RiskSolutions. Thereafter, the broker receives 90 day update reports. On new claims within any given month, the broker receives a 30 day status report outlining the Plan of Action for that new claim. At the end of each month the broker receives a statistical analysis report of the activity done during that month.

Benefits

• Better claim visibility for the Employer & Broker
• Lower Reserves
• Shorter Length Claims
• Better Claims Closure Rate
• Confidence that claim issues are being correctly addressed
• X -Mod Analysis and Reduction
• Client Retention

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Day One Medical Triage Services

RiskSolutions, Inc. utilizes registered nurses with claims management experience that work an injury from the initial treatment to closure. RiskSolutions, Inc. intervenes with the employer, medical provider and the injured worker to control a claim and keep it from exacerbating into an indemnity. Insurance carriers typically do not work "medical only" claims. They have stop-loss measures to ensure that if the "medical only claim" goes past a certain dollar amount or becomes a lost time claim they assign the claim to an adjuster. Through RiskSolutions, Inc., contact is made with the employee to answer any questions they may have about their treatment plan, discuss benefit delivery, and show that their employer cares about their injury. The employer is contacted for an effective early return to work program that provides modified duty and is appropriate for the injury. SB899 has made the employer responsible for the first $10,000 of medical costs for delayed claims. RiskSolutions, Inc. monitors the case for appropriate medical services from the start.

Nurse On Call

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Most claims reviews consist of the insurance carrier sending a client representative with several short claim synopses giving reserve information as well as basic claims status information. RiskSolutions gathers information prior to the claims review meeting and is ready to ask proactive questions designed to get the claim moving toward closure and have reserves accurately reflect the potential loss on the claim.

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Some brokers prefer to have detailed claims oversight prior to the unit statistical filings for employers. Ninety days prior to your employer's unit stat RiskSolutions, Inc. can review all open claims for 1) appropriate reserves, and 2) claims that should be closed and reserves removed entirely. This is beneficial in reducing X-MOD for your employers.

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At a time when you may have cut back your internal staff, RiskSolutions, Inc. can assist you in providing high level of service to your clients. RiskSolutions, Inc. has expertise in CalOSHA exposure assessments. We can schedule a walk-thru with your clients and provide a detailed report that identifies any additional exposures. In addition, RiskSolutions, Inc. can assist your clients in development of safety programs including IIPPs, respiratory protection, hazardous materials management, First Aid/CPR training and any other safety needs. We have bilingual trainers available. We are here to help in to keep you in front of your clients.

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