- Claims & Risk Management
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The Safegard Group has extensive experience in assisting clients with claims management issues. The team has been structured with the goal of providing the services needed to manage our client’s claims in today’s difficult environment.
Once a claim occurs, the level of service being provided by the Insurance Company’s claims department will significantly determine the ultimate cost of the loss. In essence, the ability of the claims adjuster assigned to the client’s program can significantly impact your bottom line. Furthermore, following up on individual claim matters is a time-consuming process. We have found that aggressively supervising the insurance company’s claims department activities allows us to significantly improve the quality of the service being provided. With this focus, we are able to reduce your overall risk by lowering claims payments and closing claims efficiently. Services performed by The Safegard Group to mitigate the ultimate claims dollars incurred include the following:
Develop & Implement Claim Reporting Procedures
Within ten (10) days of the beginning of a policy term, our client is provided with a Claims Manual that will offer general reporting instructions and requirements. We also provide assistance in developing internal procedures for reporting claims to ensure that all claims are reported accurately, with all relevant details and completed in a timely manner.
Develop Claims Handling Procedures to be Followed by the Insurer
Over the years, The Safegard Group has worked with clients on how claims should be handled, and has guided the insurance carriers in their handling of claims. These guidelines include: requests for authority for payment or denial, contact procedures during an investigation, instruction for loss run distribution and directions for using outside vendors.
Reporting & Monitoring of Claims
The Safegard Group reports claims, where necessary, on our client’s behalf. Depending on the type of claim, we generally prefer the claim to be reported to us. However, with some primary coverages and many common claims, it is often beneficial to report the claims directly to the carrier. In conjunction with you, we determine which claims, if any, you wish to report direct and which will be reported via Safegard. We also advise how best to document your claims prior to submitting them to the carrier. All claims are monitored on an ongoing basis by our staff. Our sophisticated diary system ensures all claims are managed effectively from the start of the claim until final resolution.
Act as Liaison between our Client and the Insurer
Our primary responsibility is to solve any problems that may arise regarding claims handling; from acknowledgment through investigation to the final payment. The Safegard Group effectively communicates the scope of your operations and claims handling philosophy to the carrier representatives to ensure proper handling of your losses. When necessary, we visit the site of a loss to obtain a first-hand understanding of the event in order to aid in our monitoring of the claim. We will assist our client in understanding the steps the adjuster is taking in the handling of the claims. Direction to the handling adjuster will be provided as needed to bring our client’s insurance claims to the fairest and most efficient conclusion possible.
Monitor and Control Reserves Set by the Carrier
Safegard will aggressively monitor claims reserves set by the carriers on an ongoing basis. All discussions and correspondence associated with negotiating reserves are communicated to our client. The Safegard Group will make suggestions to the handling adjusters regarding the appropriateness of the reserves set based on knowledge, judgment, past experience and the law. We aggressively pursue reductions whenever appropriate.
Contract Review and Liability Assessment
We review all contracts that impact our client’s involvement in claims situations. We aggressively pursue your subcontractor’s insurance carriers to ensure that they are rightfully involved in those claims where they are liable and where required to investigate, indemnify, and defend our client’s interests per the contract terms.
Resolve Coverage and Compensabiltiy Issues
The Safegard Group will review and analyze any and all coverage questions or concerns that may arise. We analyze reservation of rights and coverage declination letters to assist in formulating the necessary response. We will present our client’s position to the carrier or adjuster, and when needed, respond on your behalf. It is our goal to reach an agreement that is in our client’s best interest; however, it is our duty to advise you of the available options if an agreement cannot be reached.
Identify Claims Management Related Experts
The Safegard Group will identify experts related to various claims management situations. When an expert resource is needed, we identify appropriate resources and assist in the selection.
Assist with Establishing Medical Panels/Selecting Initial Care Medical Providers
A key to controlling the medical costs associated with your Worker’s Compensation Program is to select physicians that understand your business and the jobs that your employees are doing every day, and will work with you to achieve the best medical outcomes for both your employees and your business. The Safegard Group will assist you with setting up a strong and effective physician panel to treat your injured workers. We will regularly evaluate your satisfaction with these preferred doctors and assist you with making any necessary changes.
Claims Management Training and Education
The Safegard Group will provide workshops/training sessions to your personnel to advise you of the latest developments facing our clients in the claims management arena. We also recommend and accompany you and/or your staff to offsite seminars presented by outside sources to increase your knowledge of claims management and insurance related issues.
Continually Monitor the Changes in the Insurance Law and Development of New Rules and Decisions
The Safegard Group will continue to keep our client fully informed of all significant law changes in all jurisdictions where you operate/conduct your business. This includes court decisions, appeals, law changes as they affect your policies of insurance (Workers’ Compensation, Automobile Liability, General Liability, Employment Practices Liability, D&O, Cyber) and the way your claims are managed.
Perform Claim Reviews and Analyze Claim Data
Claims will be reviewed with our client based on the following:
- Semi-Annual Claim Review – (Conducted quarterly if warranted by claims.) A detailed examination of all claims focusing on initial handling, the current claim status and action plan for the file are presented. This assists in facilitating a roundtable discussion of our client’s open claims to review the cause of accident, current medical and work status, possibilities for an employee returning to work, current reserves, wages, and all other pertinent information available. We utilize the knowledge available from all parties, the adjuster, and your staff to develop an action plan to bring each claim to the best possible conclusion. Included in these discussions are different options available to our client in the handling of each claim, from independent medical examinations and designated doctors, to private investigators and related hearings. This process, along with the claims handling guidelines, enables The Safegard Group and our client to best monitor the insurer’s settlement procedures.
- Claims Data Analysis – Along with the claim review process we will also perform claims data analysis to detect trends, causes and types of claims in order to give viable loss control suggestions. The Safegard Group will prepare ad hoc reports utilizing data gathered from the insurance carrier’s online system and provide commentary on our findings. We will provide feedback to the insurance company on your behalf and recommend enhancements to better service our client’s needs.
From time to time, the need may arise for claims to be reviewed on an independent basis separate from the schedules indicated above. We proactively set up conferences calls including the adjuster, defense counsel, nurse case manager and yourself, to discuss claims situations that need immediate attention and strategy. We have found that this type of immediate action has helped to achieve better results and claim resolutions for our clients.
Safegard Subrogation Specialists
Subrogation is defined as the substitution of one person or group by another in respect of debt or insurance claim, accompanied by the transfer of any associated rights and duties. Subrogation recoveries are crucial and can directly affect the client’s bottom line in any given year. Subrogation occurs in many lines of insurance, including General Liability, Automobile Liability, Property and Workers’ Compensation coverages. The Safegard Group adds value to our clients that cannot be matched by most of our competitors. Our Claims Department works aggressively to recover our clients’ claims dollars by subrogating against other responsible parties on each claim. By reducing these claims, our Subrogation Unit benefits our clients in two vital ways. First, much of the money we recover is below our client’s deductible, thereby returning funds directly into our client’s pockets. Secondly, by reducing the total incurred claims, we lower the expected losses for our clients. This ultimately lowers the renewal premiums for our insureds, matching our philosophy of reducing our clients’ long-term cost of risk. In less than two years, with the claim department’s diligence, Safegard has recovered an impressive $2,000,000 through subrogation on behalf of our clients.
Safegard can assist your business with claims management everyday, contact us to find out more.