Maximize Insurance Claim Results

The 7 BIGGEST Mistakes Employers Make When Working with their TPA*

1. Not visiting the TPA’s claim offices and sitting “chair-side” with an adjuster. Not meeting the team!
2. Not meeting with all vendors and services offered by the TPA at the beginning of the relationship and periodically thereafter.
3. Not having on site file reviews regularly and not attending reviews.
4. 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.
5. Not customizing the Account Handling Instructions.
6. Not closely monitoring all claims; abrogating responsibility for your employee’s medical care and return to work to the claims adjuster.
7. 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:

These are the forms and documents you’ll need:

• 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).