Moore: Medical-Only Analysis: Little Claims That Wreck Budgets

Wednesday, June 22, 2022 | 0

I have written about performing a medical-only claims analysis quite often in the past.  Now that I am reviewing more loss runs, I still see a pattern that may make you rethink your workers' comp loss run reviews. Festering, tiny claims often fly under the radar.

James Moore

Check out this article on how a $400 medical-only claim became a $1 million claim in today’s dollars to see why your medical-only analysis may prevent a huge claim.

Five suggestions

The most important step is establishing a workers' comp medical network that will provide your injured employees with the best medical care possible that will return them to gainful employment.

These steps can be accomplished easily by tracking them using a simple Excel spreadsheet. Review your loss runs (medical and lost-time claims) at least monthly.

• Stop analyzing the medical-only claims like they are lost time unless the claims have an indemnity reserve open with no benefits paid to date.
• Set a maximum medical-only claim value. For instance, $10,000.
• Set a length of treatment maximum claims value. For instance, one year.
• Do not ignore the small medical-only claims. The ignored claims can turn into the most costly ones. You may not want to email the medical-only adjuster on every little claim. Track the claims as they progress using your spreadsheets as part of your medical-only analysis.
• Email the medical-only claims adjuster with an inquiry when the reserves exceed the values in suggestion No. 2 or the time limit in No. 3. Check with the adjuster at least every 90 days on the claims with excessive values.
• Bonus: Status inquiries on any claim are best done by email. Check out this article on why emails are recommended for contacting any claims staff.

Online claims access saves time and effort

If you have online claims access — and you should for all your claims — you may be able to avoid contacting the medical-only adjuster. The claim notes may provide an explanation as to the excessive reserve values or why the medical-only claim has stayed open past the one-year mark.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.