Quality Assurance Standards

Two-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 7 days.

• Index check
• Proper referral for surveillance is made
• Statements are secured when warranted
• Client position statement is obtained

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 60 days
• Notes reflect appropriate follow-up on all open items

Subrogation potential is recognized and pursued.

Appropriate 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.

• Independent medical exams, independent medical reviews and peer reviews are conducted as needed

Premium impact studies are performed on all lost-time claims.

• Studies are imaged and documented in claim notes

Appropriate and timely communication is maintained until the claim is closed.

• Points of contact are employer, injured worker, physician, Managed Care Organization and Bureau of Workers’ Compensation

Documentation is appropriate, timely and written in a logical and sequential order.

• Explains all actions and decisions

Litigation management is controlled by the examiner, and cases are referred to counsel in a timely fashion.

• Examiner maintains control, assisting with counsel activity and reviewing status reports from counsel

Client’s special account instructions are documented and followed.

• Total compliance is reviewed