Three-point contact is achieved within 24 hours.
- Process time for all points of contact is measured.
Claim investigation is initiated during the contact phase and completed within 14 days to determine compensability and develop a strategy.
- Index check with updates at six-month intervals
- Proper referral for field investigations is made
- Statements are secured when warranted
A plan of action is developed within 30 days.
- Plan identifies outstanding issues, resolution and expected closure
- Plan is updated as circumstances evolve, or every 90 days
- Notes reflect appropriate follow-up on all open items
Subrogation and recovery are recognized and pursued.
Appropriate medical cost containment measures are utilized and considered on a case-by-case basis.
- Supporting medical documentation is obtained
Disability management and vocational rehabilitation measures are utilized to pursue an early return to work.
- Return-to-work strategies are focused on early return to work
- Timely and appropriate referrals are made to nurse case managers
- Independent medical exams, independent medical reviews and peer reviews are conducted as needed
Reserves on all lost-time claims adequately reflect the current exposure in the file.
- Review for stair stepping
- Rationale identified in claim record
All claim payments are made in a timely and accurate manner.
Appropriate and timely communication is maintained until the claim is closed.
- Points of contact are employer, injured worker, treating physician and counsel, as required
Documentation is appropriate, timely and written in a logical and sequential order.
- Explains all actions and decisions
When warranted, cases are referred to counsel in a timely fashion while examiner maintains control in directing counsel activity and reviewing status reports from counsel.
- Settlement and alternative dispute resolution are proactively pursued
Client’s special account instructions are documented and followed.
- Total compliance is reviewed