How can clients get a handle on this process to forestall nasty surprises? A claim review at the insurer's location can assist. If you are not conducting periodic claim reviews on open claims, start doing them.

Here are five specific tips to help manage the reserve process and to avoid any "gaming" of reserves for purposes unrelated to the severity or defensibility of a claim:

1. Go to the insurance company's offices and ask that the adjusters who handle the claims attend, not just the company's designated claim review person.
2. Also ask that a claim manager and a nurse case manager be present.
3. Communicate with the latter any concerns about the claimants (not just the reserves) and ask them to work with you to get the claims settled.When you visit their office in-person, it sends the message that you view the meeting as very important. A different psychology occurs when the claim reps come to your venue. Sometimes when claim adjusters visit your office, they feel as if they are on holiday and can say that they left information back at their office or will have to check with supervisors.
4. Signs of adverse loss reserve development on open claims may indicate that adjusters lack complete information about the claims. Especially on serious workers' compensation claims (death, permanent total, permanent partial, survivorship payments, etc.), the affected files may be in the insurer's pension unit and receive only cursory, and infrequent, review. You may need to rattle the cage to get interested and focused attention. A formal claim review is where to start.
5. If you are on a paid loss retro program and reserve increases result in additional premium, put a hold on your payments until you get some satisfaction about reserve increases. That is the best leverage many risk managers have against unwarranted reserve hikes.