Claim Review

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Claim Review Process

The claim review process provides the most effective way to determine if your claims are being handled aggressively, proactively and above all as economically efficient as possible. The claim review provides insight into the overall quality of the claim operation and how they are administering your claims. After the audit has taken place, we meet with our client to review our findings as well as to develop an action plan for follow up work that is needed on their claims. The status reports that we prepare also establish a baseline for future claim reviews.

Here are the primary areas of concentration that are addressed during the our audits:

Initial Claim Investigation

Are your claims being investigated proactively and within a timely manner? Are subrogation opportunities identified and investigated? We determine if your claims are being investigated appropriately and we help to make recommendations for future claim handling.

Appropriate Use of Outside Vendors

Is your claim handler using vendors to successfully manage and keep the overall claim exposure down? Are there any opportunities to reduce the use of vendors without reducing the quality of how your claims are being handled? We will help identify opportunities to save money by using your vendors efficiently.

Litigation Management

Are your claims being handled proactively and efficiently by your defense attorney? Are you being billed appropriately? We will review the entire litigation management process and identify ways to save money in the future.

Adherence to Best Claim Handling Practices

All claim handlers should have best claim handling practices that are followed while handling your claims. Additionally, you should have special claim handling instructions in place that specify how your claims are supposed to be adjusted. If special claim handling instructions are not in place, we will help you to devise appropriate guidelines to ensure that your claims are handled appropriately.

Review of the Reserves

Is your claim properly reserved by the insurance carrier? Any excess or unnecessary reserves have a negative impact on your claim experience. Your reserves are one of the driving factors of your insurance premium. We look for any opportunity to reduce the reserves on every claim that we review.

Settlement Negotiation

Are your claims being settled proactively and aggressively by your claim handler or are they only initiating offers when forced to do so in connection with pre-trial hearings? Are settlement opportunities recognized at an early and appropriate stage?

These are the primary areas that we concentrate on in our claim review. However, there are several other things that are being reviewed and checked during the audit. If there are specific issues that need to be addressed or particular areas of concentration that require changes, we work with our clients to perform the audit to their liking.