Claims Advocate Services
Our company provides unique corporate claims advocate services on behalf of Carriers, Employers, and Third Party Administrators.
By gearing our focus toward the injured party and taking an advocacy approach to your company’s workers’ compensation claims, we help create an environment that allows for 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 cost effective resolution.
Our Unique Approach
Our Founder and team members speak directly with the claimant at the beginning of each claim, opening the lines of communication and making a connection with the injured worker. The story about our founder’s long personal journey as a claimant in the workers’ compensation system creates a unique bond. The trust factor that develops between our Founder/team and each claimant is one that no adjuster, advocate, or counsel can emulate unless they have had direct experience navigating their own workers’ compensation claim. To our knowledge, no other claims advocates can provide your company with comparable services. All our services are custom tailored to each client’s specific needs, as each claim is unique.
Throughout our process, we maintain an open dialogue with our clients, providing them with valuable feedback that emphasizes strategies for reducing cost expenditures on claims. Our goal is to achieve satisfaction for the injured worker. Our impact is a decrease in future claim and litigation costs.
PG Resolutions Group’s claims advocate services are a powerful and cost-effective tool for your company. Claims advocacy and our optional one-day settlement services reduce administrative costs.
Claims Advocacy Data
The Johns Hopkins School of Medicine conducted a study in 2008 based on claims paid by the Louisiana Workers’ Compensation Corporation. The study, The Relationship Between Attorney Involvement, Claim Duration, and Workers’ Compensation Costs, examined 738 claims with attorney involvement and 6,200 paid claims without attorney involvement. The Johns Hopkins study demonstrated empirically that in those cases where there was no need for/ additional benefits to be gained by engaging an attorney, claims durations were in fact longer and claims costs higher.
The California Workers’ Compensation Institute (CWCI) also published findings involving litigated claims in that state, specifically the Los Angeles basin. The study, Attorney Involvement in California Workers’ Compensation, compared the average cost of a litigated case of $62,652 to the average cost of a non-litigated case of $8,251. Of all the claims reviewed, including medical-only claims, 11.65% involved an attorney. If a claim involved an indemnity payment, then 38% of the claims involved an attorney. The findings indicated the cost of claims grew exponentially because of attorney involvement.
Claims Advocate Services Process of Engagement
PG Resolutions Group will provide specific days and time frames to the client so the adjuster/ case manager can schedule an appointment for a conference call with the PG Resolutions Group Claims Advocate to contact the claimant.
Our Clients will provide via email to PG Resolutions Group with the claimant’s claim or file number when required for contact information and appointment time window selected.
The initial call/ contact will be made by a licensed registered nurse conducted via telephonic communications for triage of the claim. Upon the initial contact, the nurse will share a brief introduction at the end of the call of our Founder and CEO. Paul’s story with being a past claimant, creates and cements the foundation for building trust with the current claimant who has been in the very same place as the claimant prior and walked in their shoes.
All subsequent calls will be made via telephonic communication by either a licensed registered nurse or a claims advocate team member. These follow-up calls will serve as a fact gathering information process for the client, in addition to managing the claimant’s expectations, in accordance with our client’s protocol as our service provides custom tailored solutions for our clients. The feedback received on the initial call and any subsequent calls to follow, will be detailed in a report within a PDF file and emailed to the client within no more than twenty four hours of the completed call.
Our software utilized may consist of excel, word files, and finalized PDF files, customized and integrated options for our client’s specific needs with various industry known software programs may be requested by the client to be addressed and discussed in more detail.
PG Resolutions Group recommends that the initial call take place as soon as possible; preferably, within the first twenty four hours of a newly opened claim, or at minimum within the first week of the newly opened claim, dependent on the claimant’s availability and condition. Subsequent calls will take place every two/three weeks scheduled for the next day after the last completed physician appointment. This will all be based on the client’s specific needs determined by customized frequency option services selected by our clients. PG Resolutions Group Claims Advocate Services will end upon the claimants return to work, closure of claim, or when terminated by the client for any reason with the specific claim in question.
A pro-rated credit consisting of the number of unused prepaid services remaining will be provided on the clients account for use and transferable to any other client’s claim at the request of the client.
During each two/three week interval, shall the claimant have any issue arise, the claimant can make contact with their adjuster and/or case manager to schedule additional calls with their assigned claims advocate when requested. All issues can be addressed promptly for feedback with resolution options in conjunction with the carrier, employer or third party administrator, keeping the claimant on course for the fastest recovery period and return to work. Our unique claims advocacy service utilizing a past claimant to new claimant model can defuse situations that may arise by the connection and trust created.