Author: James Moore
Claims loss run reviews have become one of the most requested post-pandemic services from our clients. The top five changes we have seen compared to before 2020 contain good and bad news. See my overall conclusion at the end of the article.
Carrier and TPA Closing Rates Up (Good News)
Many of the claims loss run reviews showed an interesting trend. We started noticing that carriers and TPAs had closed more files than usual. One could estimate the reason for the trend. I will not go into exactly why the closing has increased recently. The reasons would be the basis for a future article.
Reopened and Not Reclosed Files (Semi-bad News)
Two nice articles that cover this subject can be found in these two articles – Check them out.
This could be the pandemic effect of lagging medical bill submissions from various providers. Look for the “R” in the status of your claims loss run reviews.
Adjuster Turnover – How To Discover During Claim Loss Run Reviews (Good/Bad News)
One method (old school) is to print your loss runs or at least save them even though you may have my heavily recommended online claims access. You may also see the name change inside each claim’s file notes. If the adjuster changes multiple times, continuity can be compromised by the new adjuster’s lack of knowledge of the previous file occurrences.
If a new adjuster’s name pops up, one can send the adjuster an email (not call) or any major questions or file history. Yes, adjusters are supposed to review the files they absorb – but that can be a daunting task on older or files with major injuries.
The good news part is that if one wishes to use that term, comes from the claims field being a worker’s market with so many work-from-home opportunities – who can blame an adjuster for seeking higher pay, more benefits, smaller file loads, etc?
Lower Number of Medical-Only Files (Stumped Me)
This one has me stumped. I can give no good reason for this phenomenon. My assessment would be – more first-aid claims, avoidance of treatment at physicians’ offices due to COVID, and only lost time claims were sent for medical treatment (all guesses).
No Carrier or TPA Shopping Seen in Claims Loss Run Reviews (Good News)
If an employer changes TPAs or carriers every year, the loss runs would be numerous. Employers seemed to have stayed with one carrier for longer terms. If the employer decided to keep jumping ship, the relationships between the carrier/TPA and claim staff would never have been established due to the temporary nature of the one-year and jump strategy.
Conclusion/Bottom Line
The pandemic did affect what happened in claim files. Claims loss run reviews remain a critical part of what an employer should be doing at least quarterly. When the premium audit bill arrives from the carrier should not be the time to take action. Start today.
The employers that are performing loss run reviews regularly pay less premium. Self-insured pay less out of pocket. That concept will never change.
Publication Date: March 8, 2024
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