Steps to drive results during casualty claim reviews
Gain insight into the latest best practices for claims review, based on research from Aon Global Risk Consulting.
Each year, risk managers at employers of all sizes, along with claim adjusters and other professionals at insurance carriers and third-party administrators (TPAs), invest an average of more than 1,000 hours on conducting casualty claim reviews. Unfortunately, even though all participants agree this is a necessary and valuable process, the results often fail to meet expectations.
For the past two years, Aon has collaborated with more than 100 risk managers and 17 insurance company and TPA executives to take a deep dive into the entire claim review process. Our collective research efforts have produced several insights to help drive significant improvements in the claim review process and outcomes.
Whether your organization uses claim reviews to strengthen financial position (i.e., by accelerating claim closures and adjusting reserves); flag administrative issues, such as breakdowns in incident reporting and injured worker communications; or to drive operational gains by uncovering and addressing workplace hazards, here are 10 best practices that can help improve your ability to achieve desired outcomes. They are organized according to the three standard phases of any claim review process — pre-review, in-review, and post-review.
Phase I: Pre-claim review/planning
The success of any claim review calls for careful planning and attention to detail.
- Start with clear and meaningful objectives. This fundamental groundwork enables risk management and claims professionals to apply more strategic approaches to all aspects of the claim review process.
- Be diligent in the selection of claim files. The selection of any claim files to include in the review should align with the objectives. Besides saving time, focusing on relevant claim files will make the effort invested by all participants more productive and increase the likelihood of the review achieving the desired result.
- Include all key participants. Invite all appropriate team members, both internal and external, to participate in the review process. Besides obtaining a wider range of insights and perspectives on individual claims being reviewed, the involvement of multiple team members will help build a more complete strategy for handling individual claims. This applies especially to those claims that may be more complex, such as those involving co-morbidities. As we learned during the COVID-19 pandemic, you can easily widen participation to include remote participants by using video conferencing and related technology-based resources.
Phase II: In-Review Best Practices
These measures help ensure the efficient presentation of claim status (based on risk management’s objective and preferred format). They also are geared to help facilitate a productive discourse on individual claims.
- Focus individual claim discussions and presentations on the risk manager’s objectives. This helps facilitate a more focused, productive and efficient review process.
- Present current status and direction of individual claims. Presentations that explore “where are we at and where are we going” with respect to current claims generally save time and lead to more productive discussions.
- Avoid non-relevant historical narratives. These discussions are often superfluous and tend to be counter-productive and waste valuable time. You can also save time by having presenters forgo reading reports circulated to participants in advance of the review. This helps focus more discussions time on addressing barriers to resolution/closure and achieving results.
- Establish a cadence for claim review presentations and related discussions. Stick to a schedule of presentations and have the next presenter on standby 10-15 minutes prior to their discussion. This helps minimize downtime and will facilitate more productive meetings.
Phase III: Post-review reporting and follow-up
These best practices involve assessing how effectively the claim review process aligned with objectives, including an evaluation of results achieved. Results of any claim review should be tracked and available to guide future claim review discussions, further improving efficiency for all stakeholder/participants.
- Share agreed-upon action plans to reaffirm accountability and track progress. Post plans on a standard spreadsheet, appropriate project planning software or tool accessible by all participants on a risk management information system.
- Assign responsibility and set timelines for action items. Designate specific individuals or team members to follow-up on action items listed during the claim review and set target dates for the completion of each action. In addition, ensure steps are completed as scheduled and updating all parties on progress.
- Obtain and communicate risk management’s feedback. Find out what risk management deemed went well and areas for improvement. Share with all participants to drive steady gains in the process.
In concluding a review, you should also provide detailed reports that document various insights and opportunities resulting from the review and enable all participants to track next steps.
These measures were drawn from more than two dozen takeaways from the ongoing research being conducted on claim reviews in conjunction with a cross-section of industry participants. Risk managers and their claims teams currently applying best practices to claim reviews have already started seeing significant improvements in the ROI and value they gain from these enhanced processes.
Kevin Combes is director of U.S. casualty claims at Aon Global Risk Consulting. Based in Irvine, California, he has more than 30 years of experience in workers’ compensation claims, including the development of pre- and post-loss strategies, and the identification and implementation of solutions that represent sustainable economic improvement opportunities.
Opinions expressed here are the author’s own.
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