Why an Assessment of Your Claim Handling Process is a Must Have

Posted by Veritas Administrators on Nov 2, 2017 3:09:59 PM
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Claim handlingMany employers have a false sense of security when it comes to their Workers’ Compensation claim handling process. This despite following their claims provider’s “best practice” guidance to immediately report incidents in the framework of a standard intake script. Immediate reporting alone does not guarantee that a claim will get adequate control or have a good outcome. There is an opportunity for every employer to fortify their process in ways that are unique to their organization and culture. Isolating your specific potential requires an assessment process.

What the Assessment Should Focus on

A proper assessment does not follow a template or checklist, but does focus on general areas as follows:

  1. How well your employees understand the statutory WC benefit, their role in the post-loss process, and their expected responsibilities including efforts to return to a modified job.

  2. How supervisors and other key parties interact in the WC process, including the investigative aspects, employee advocacy, return to work, and maintaining communication.

  3. The breadth of information and insight you strive to include in every first report of claim. This should go well beyond the intake script and include factors that only you may know about the employee’s situation and motivations.

The financial implications of your WC program to your company. For example, loss sensitive programs with direct cost allocation to operating units incite powerful urgencies among internal supervisors and managers to follow good protocols as per the items above.

Claim handlingThe Assessment Process

A valid assessment process should engage distinct avenues of discovery. The approach should be as open and consultative as possible, not reliant on the constraints of templates or checklists. As a general example, avenues of discovery can include:

  1. Review of all internal documents relative to the program’s structure and expected process: policy and procedure, related safety material, policies, financing, prior stewardship reports, internal reporting, and metrics, etc.

  2. Interviews with all parties involved in the WC process and all parties who would otherwise need to be involved. In the case where an employer has no prior involvement of employees or operations people in the WC process, the assessment process should facilitate focus groups to include these new parties. This is important to assess the baseline awareness and “buy-in” of these groups.

  3. A technical review of a cross-section of claim files, mixing some new, some recently closed, some with better outcomes and some with poor outcomes. This assessment portion will identify actual issues and opportunities for improvements. Missed opportunities often point back to lapse in employer vigilance, contribution and/or engagement.

  4. Review vendor service requirements and interview key vendor service representatives. This will assess the quality of performance, the integration of services into the greater process, and the ability to be flexible and adapt to findings and recommendations to come. Note that this assessment portion would take place after the file review since file review findings would be the foundation of most lines of questioning.

  5. Review of data as currently tracked or shared versus data that is available for additional monitoring and trending. The expectation is that new program recommendations will open new opportunities for tracking and measuring.


Any employer who wants to improve their WC performance should engage an independent consultative assessment process to identify specific opportunities for impact. Standard “best practices” are only a starting point, and status-quo protocols dictated by claims or other providers strives to be efficient for them but not necessarily effective for the employer.

claim handling

Topics: General Liability

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