The 7 BIGGEST Mistakes Employers Make When Working with their TPA*
- Not visiting the TPA’s claim offices and sitting "chair-side" with an adjuster. Not meeting the team!
- Not meeting with all vendors and services offered by the TPA at the beginning of the relationship and periodically thereafter.
- Not having on site file reviews regularly and not attending reviews.
- Not using an MD to review medical records and reports – relying on adjusters to make decisions based on their review of medical records and reports.
- Not customizing the Account Handling Instructions.
- Not closely monitoring all claims; abrogating responsibility for your employee’s medical care and return to work to the claims adjuster.
- Trying to do these things alone, without input and assistance from the broker.
These are only a few of the many concepts you will find in the Improvement Plan Modules of Workers’ Comp Kit®.
The insurance arrangement and claims system must be structured to support your processes. Build a solid team approach to workers’ compensation program improvement. The TPA administers claims, but you – the employer – should be "managing" the workers compensation cost control process because it is an internal process at your company, with your employees.
Forms and Documents for Working with Your Insurance Company:
All forms and documents you need are in the Working with the Insurance Company Module of Workers’ Comp Kit®:
- Kick Off Letter to TPA Introducing New Workers’ Comp Program
- Letter Requesting Account Handling Instructions
- Account Instruction Checklist
- Letter to TPA Requesting Vendor Day
- Vendor Day Agenda
- Letter to Broker Requesting File Review
- Claim Review Follow-Up Action Item Letter
- Questionnaire to Adjuster
- Letter from Injury Coordinator to Adjuster About Causality
- Thank You Letter to Adjuster
* Insurance company claims are administered by either the insurance company claims administrator or an independent third-party administrator (TPA). For ease of reference, I use these terms interchangeably. Even though the services are slightly different they serve the same function – administering workers’ comp benefits on behalf of a company (the insured).