Broken System, Analyzing Too Much Data, Claims Advocacy with Risk Management Settlements for a Cost Effective Approach.

The industry has finally reached a pivotal turning point with an amazing shift transpiring as the future of claims advocacy and settlements are now.  Carriers, Employers and Third Party Administrators have been moving to a less adversarial model with the utilization for an independent claims advocacy approach with highly specialized risk management resolutions.

As claims age administrative costs continue to rise including the total cost of risk incurred for the claim. Countless carrier resources have been spent time and time again with no resolution in sight, only to continue with claims outstanding three years, five years, or ten years, the list goes on.  We all know the national average numbers and scenarios, continuing throwing good money after bad isn’t the answer. If this was your own dollars being spent, would the same decisions be taken by a risk manager today or would they think twice? Good question. Let’s address how we arrived here before moving forward with the most innovative solutions in Workers’ Compensation today.

We have a problem in the Worker’s Compensation industry.  It’s an expensive, inefficient, and time consuming problem.  This problem involves an archaic process that nobody likes, but to which everyone continued to subscribe. Working toward the resolution of Workers’ Compensation claims, insurance carriers and TPA’s majorly overspend through a process they have been utilizing for decades. This outrageously expensive process is somehow prioritized before a simple examination of the overall spend for the Total Cost of Risk (TCOR) incurred. The strategic management on new or long term existing claims have a direct impact on the administrative costs incurred per claim, as all claims are unique.  But the current process utilized in the industry does not allow for this strategy.

Insurers and TPA’s take the same course of action and rarely change their position once litigation on a disputed claim has begun. This inefficient approach – from the over-utilization of Independent Medical Exams and physician evaluation services, to the endless legal fees- contributes to a vast array of unnecessary administrative costs. When aiming to settle a case for a specific reserve mark, all carriers lose sight of the big picture with regard to costs incurred for the claim. The majority of these claims could have been settled prior, at a fraction of the expense.

When was the last time you or one of your firm’s key executives attended a workers’ compensation claim hearing? Are your company’s resources being spent in a cost effective manor for these claims? How often has your company taken a hard stance on a disputed claim once litigation has begun trying to achieve a reserve mark on a claim? More often than not, your firm will overspend in trying to achieve this desired resolution.

When is too much data, too much?  In a data driven industry, the in-consumable amounts reviewed on a daily basis for the justification of risk decisions may just be part of the culprit at times for higher claim costs. Data saturation inhibits the ability when reviewing and collecting this information and becomes less productive for employees. Based on the Lockton report of 273,000 claims from 2013-2017 were reviewed and is discussed here with a short option by risk and ) providing eye opening information about rising costs for denied workers compensation claims which could have clearly been avoided. Claims initially denied only to be approved one year later carried a 55% higher cost per claim.

While this is certainly a growing trend, a common question is, “Why isn’t everyone doing this already?” One major difference in the advocacy model is that there is no one size fits all standard approach.  An advocacy risk management service must be custom tailored to your company’s specific needs, as each claim is unique. This makes it difficult for untrained in-house claims managers to implement. A qualified risk management advocate will solidify trust with a claimant relationship and close a claim within 30 days or less of a full file provided.

Utilizing an outside specialized risk management resolution advocacy service with a previous claimant to new claimant model creates a unique bond that can’t be matched by any other service in the nation. No one can understand what a current claimant is going through, unless they have been in their shoes. The trust factor that develops here is one that no adjuster, advocate, or counsel can emulate, unless they have had direct experience navigating their own workers’ compensation claim.

Communication style is only one factor here. Time is an equal contributor. The longer a claim takes to resolve, the greater the potential is for mistrust. Eventually, the claimant sees the dispute as a never ending cycle of resistance and bureaucracy. Impatience and emotional investment contribute to what becomes a highly toxic and unproductive relationship between the claimant TPA and carrier.  Once the claimant feels this isolated, they have no choice left but to pursue litigation. Given these scenarios, it is no surprise that the growing trend in the Workers’ Compensation arena has carriers directing their focus toward the injured party by using a specialized risk management advocacy approach.

This new strategy creates an environment that allows the claimant to feel heard. Addressing the needs and concerns of the injured worker builds and nurtures trust from the very beginning of a claim. This level of customer service lowers the rising costs of litigation, prevents the common breakdown in communication between the claimant and carrier, and ultimately leads to a faster and more cost effective resolution.

The goal of risk management resolution claims advocacy is to achieve greater satisfaction for the injured worker. To ensure success, the advocate must maintain an open dialogue with carriers, third party administrators, and/or employers.  Part of this open dialogue includes providing them with valuable feedback in real time, as the data obtained directly from the claimant is provided within hours that emphasizes strategies for helping the claimant resolve all current issues, and receive the treatment necessary for return to work by staying the course within the process. The direct impact is a decrease in future claim and litigation costs that vastly improves the carrier’s bottom line while helping claimants return to work faster and get on with their lives.

I have devoted all my time to codifying and refining the most innovative and efficient method for settling workers’ compensation claims.

Being the nation’s only 100% contingency claims advocacy risk management resolution service  with a highly specialized niche for workers’ compensation, utilizing a unique past claimant to new claimant process, solves not one but multiple problems for the industry.  We drastically reduce administrative costs for our clients, help the claimant move forward with their life, providing an option for final resolution of their claim being completed promptly.

We stand behind this process one hundred percent which ultimately benefits all parties involved and offer our clients contingency based options. Our firm believes in being a true strategic partner for our clients.  Shall our team not find an amicable final resolution of claim, there are no charges incurred for our services.

Pay for results, not promises!

We are unique to our own merits being a highly specialized niche as an extension of our clients risk management team with a claims advocacy resolutions approach.

Our claims advocacy model with early intervention is focused on getting the claimant the treatment to heal and return to work as fast as possible while defusing any situation that arises during the course of claim when required. In addition to offering a second set of eyes for risk management oversight moving claims to prompt closure. There are no major changes required to your company’s current system in place with our services. Implementation of new services always carry an incurred cost. Our company stands behind our service being a true strategic partner by investing in our clients success with the guarantee of our claim resolution services provided or no costs will be incurred.

We are the Workers’ Compensation Problem Solvers for our clients!

Written By:

Paul Gold

Founder & CEO

PG Resolutions Group

Tel: 800-473-4450