Welcome to 2020, The Changing of an Industry for Claims Resolutions & Advocacy.

The cost-effective closure of claims is becoming an issue for most Carriers, Third Party Administrators & Employers. Utilizing a true claims advocacy approach with a less adversarial process with understanding the big picture of claims resolutions in relation to the overall administrative costs incurred can provide dramatic savings while helping the injured party and mitigate risk for the Carrier, TPA and Employer with the right strategic partner program in place.

As claims continue to age, we all know administrative costs rise out of control with no cost-effective end in sight. When a strategy is not cost effective why continue with it? The Workers’ Compensation system has so many moving parts which not many fully understand all components in-depth.

Let’s look at some basics. Everything starts at the heart of each claim. The breakdown in communication internally within the claim itself along with the claimant’s specific components and caseloads on adjusters today make it harder to overcome many obstacles with closing claims from the gate. When discussions occur with claimants directly, industry professionals must remember to not use industry terms from the onset. Claimants are going through a difficult time period already and what we as claim professionals take for granted is a foreign language to them. This doesn’t translate to the claimant and we all must do a better job at explaining to a claimant from the onset in plain English or simplest terms possible with not utilizing industry language.

I can’t stress enough as this all begins with the approach taken by the Carrier, TPA and Employer or adjusters at times who all become the catalyst for claimants to seek counsel due to these breakdowns.

The industry has invested enormous amounts of capital over the years into employee training yet has been focused on the archaic process and mindset which is now counterproductive for a successful claims advocacy model. It’s 2020 and the industry has demanded a less adversarial approach whereas new training in this trending area is a required component on all sides, especially for adjusters on the front lines as they are trained on archaic model approach.

Problems closing claims. Administrative costs are at an all-time high with additional obstacles by the breakdown of communication on all sides. How does closing a claim that is 13 or 14 months old from the time a complete file is provided to a strategic partner within only one day from when an advocacy request of authority approval is provided sound? We have and continue to strive to close completed claim files while mitigating risk securing terms of final settlement within 24 hours when possible from requested authority granted for final resolution. Claims can be closed with early intervention as well, but each claim is unique to its own merits.

For example, a claimant is represented by counsel and incomplete or missing file information-requests for medical information is unanswered or ignored by adjusters. This isn’t their fault due to the training imposed over decades along with caseloads helping to encourage passing the buck to defense counsel. Can we say more billable hours for counsels! Repeatedly this is becoming an industry standard of complacency promptly contributing to the major inefficient and unnecessary delays resulting in additional administrative costs. The list goes on and on, but you get the point.

Being a past claimant personally for years within a broken system and prior entrepreneur has given me a valuable insight developing a driving passion with the workers compensation system. My experience and education have allowed me to identify these breakdowns creating a unique patent pending process with over 15 years for codifying and refining the most innovative strategies for prompt claim resolutions with being a true strategic partner providing results for our clients.

Feel free to inquire about our contingency pilot programs letting our clients pay for results not promises to begin. We stand behind our process and successful model 100%.

Paul Gold
Founder & CEO
PG Resolutions Group