Moore: Post-Pandemic Claims Loss Run Reviews

Tuesday, February 6, 2024 | 0

Claims loss run reviews have become one of the most requested post-pandemic services from our clients. The top five changes we have seen compared to before 2020 contain good and bad news.

James Moore

Many of the claims loss run reviews showed an interesting trend. We started noticing that carriers and third-party administrators had closed more files than usual. One could estimate the reason for the trend. I will not go into exactly why the closing has increased recently. The reasons would be the basis for a future article.

Reopened, not reclosed

Two nice articles that cover this subject can be found here and here.

This could be the pandemic effect of lagging medical bill submissions from various providers. Look for the "R" in the status of your claims loss run reviews.

Adjuster turnover

One method (old school) is to print your loss runs or at least save them even though you may have my heavily recommended online claims access. You may also see the name change inside each claim’s file notes. If the adjuster changes multiple times, continuity can be compromised by the new adjuster’s lack of knowledge of the previous file occurrences.

If a new adjuster’s name pops up, one can send the adjuster an email (not call) or any major questions or file history. Yes, adjusters are supposed to review the files they absorb, but that can be a daunting task on older files or files with major injuries.

The good news comes from the claims field being a worker’s market. With so many work-from-home opportunities, who can blame an adjuster for seeking higher pay, more benefits, smaller file loads, etc.?

Fewer medical-only files

This one has me stumped. I can give no good reason for this phenomenon. My assessment would be more first-aid claims; avoidance of treatment at physicians’ offices due to COVID; and only lost-time claims were sent for medical treatment (all guesses).

No carrier or TPA shopping seen

If an employer changes TPAs or carriers every year, the loss runs would be numerous.  Employers seemed to have stayed with one carrier for longer terms. If the employer decided to keep jumping ship, the relationships between the carrier/TPA and claim staff would never have been established due to the temporary nature of the one-year-and-jump strategy.

Bottom line

The pandemic did affect what happened in claim files. Claims loss run reviews remain a critical part of what an employer should be doing at least quarterly. The premium audit bill's arrival from the carrier should not be the time to take action. Start today.

The employers that are performing loss run reviews regularly pay less premium. Self-insured pay less out of pocket. That concept will never change.

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.