Coordination Closes Complex Claims
Many claims examiners face complex cases that snowball out of control, seemingly out of nowhere. Claims involving opioids, injuries to multiple body parts, comorbidities, high reserves, suspected fraud or scheduled litigation quickly become high-exposure cases.
Closing these claims is critical not just for workers’ compensation providers, but for injured workers as well – a lengthy and expensive claim benefits no one. To rein in these cases, claims examiners can implement a “double play.”
Barry Bloom, principal, The bdb Group, laid out this strategy in a Dec. 7 session at the National Workers’ Compensation and Disability Conference & Expo in Las Vegas titled “The Double Play Process: A Blueprint for Closing Complex, High Exposure Claims.”
In baseball, turning a double play requires coordination among multiple players. Same goes for a “double play” in workers’ comp.
The term refers to a face-to-face meeting of all the key players in a claim, including the claims examiner, defense attorney, investigator, structured settlement partner, MSA partner and excess carrier. The goal is to walk away from the meeting with a specific plan of action for resolving that claim.
“You’re not doing a file review of 22 cases; you’re focusing on one. You need a ‘do it now’ mentality.” – Barry Bloom, principal, The bdb Group
The claims examiner acts as “team captain” and ensures that every participant has comprehensive information about the claim. But every player has to come prepared as well – coordination can’t happen if stakeholders don’t know the claim details inside and out.
The key is to remain focused on the case at hand and maintain a forward-looking perspective.
“You’re not doing a file review of 22 cases; you’re focusing on one,” Bloom said. “You need a ‘do it now’ mentality.”
When executed successfully, a double play can expedite claim closure at an appropriate cost, help to re-evaluate and fine tune reserving, and provide a measure of quality control for the claims team. &