We are a specialized industry and need to operate/handle claims differently
We have clients that require us to manage the claims with their approval
The MGA or risk pool manages the claims program because it knows best what our clients want
We are too small to run our claims program like the larger companies/insurers
We operate in X state(s), which is a very difficult environment
We are a public entity, and we don't need to follow the same standards as insurers and corporations
Our procurement process requires us to select the cheapest TPA/vendor
We cannot afford the claims system that we need to manage our claims effectively and efficiently
We cannot find the right people in our location to manage the claims effectively

While there may be a very small grain of truth in some of these reasons/excuses, in most cases they are a sign that:

The person or group running the program is inexperienced in claims management, whether it is a Risk Manager or someone else who has been identified by the company to oversee the claims program
The leader has acquiesced to others and has stopped trying to improve the program because of inappropriate pressure exerted by others or due to frustration arising out of past attempts to improve the program that have been blocked without appropriate consideration of the claims costs
The organization operates in a vacuum. It has handled its claims the same way for many years, and has not sought an outside view or asked for comparisons to other organizations that might bring new ideas to the program

Special Reports /

Don't Swim with the Shirks