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