Claims Management Assessment

Assessment Introduction

Page 1

Welcome to the Claims Management IQRM!

In today’s competitive and litigious claim climate, effective claims management is critical to your organization. Claims management is a process to efficiently manage the timely payment of claims and to restore losses, whether suffered by your organization or by others to whom you are legally responsible. Claims management involves controlling loss payment and expenses, thereby promoting your organization’s financial health.

Please click below to begin a 17 statement survey to gain your organization’s IQRM Effectiveness Risk Audit Score for Claims Management.

Question 1
Question 1


 

To what degree has your claims management process proactively reduced claim frequency and severity?

 

Question 2

How effective has your agent or broker and carrier been in reviewing claims including investigative, medical, disability, litigation, subrogation and special investigation techniques?

Question 3

How effective has the claims coordinator (who was assigned to your organization by the insurance carrier/third-party administrator) been in handling claims administration goals, the claims adjusting process, and claims administration management?

Question 4

How effective is your organization in obtaining and reviewing loss runs at a minimum on a quarterly basis?

Question 5

How effective is the organization in conducting a qualified evaluation of reserves on a regular basis?

Question 6

How effective do you believe your agent or broker and carrier are in providing knowledgeable support in areas such as reporting procedures, claim reviews and reserve analysis, claim handling protocols as well as pre-unit report consultations on your workers’ compensation line of business?

Question 8

How effective do you believe your Risk Management Service Plan has been in holding the agent or broker and carrier accountable for sensitive service commitments including claims management?

Question 7

To what degree does your Special Claims Handling Guidelines represent a comprehensive set of written “special service instructions” outlining reporting requirements, reserve changes, settlement authority, and return to work policies as well as subrogation discussions?

Question 9

How effective is your organization at routinely reviewing medical panels at least annually?

Question 10

How effective is your Return-To-Work (RTW) program at helping injured employees return to work more quickly and safely while they heal?

Question 11

To what degree have you implemented annual pre-unit workers’ compensation claim reviews with the goal of understanding the premium calculation?

Question 12

How effective is your Back-On-The-Job Coordinator in overseeing workers’ compensation claims management as well as the injured employee rehabilitation process?

Question 13

To what degree are your settlement discussions with your broker and insurance carrier/TPA effective in insuring that claims are being handled in a manner consistent with your claims administration goals?

Question 14

How effective are your scheduled claim reviews with your agent or broker in getting claims closed?

Question 15

How effective are your claims metrics in guiding you in reducing claims frequency and severity?

Question 16

How effective is your business continuity/crisis management plan in safeguarding human life, preserving business operations and ensuring an efficient and effective resumption of operations to pre-event status?

Question 17

To what degree have you achieved organizational “buy-in” and participation as relates to risk management?

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