Claims Management & Proactive Advocacy
While ZERO risk is the ultimate goal, the reality is that we can’t control everything, and losses may occur. At Lovitt & Touche we have dedicated claim advocates who act as a liaison for our clients, actively engaging in the claims process, from start to finish, to attain the best possible outcome. Collectively, our claim advocates have 150 years of invaluable experience in the insurance industry.
Many of our clients wear different hats throughout the day, with insurance/claims oversight being one of them. As both Workers’ Compensation claims advocates and “package” claims advocates, we act as an extension of our client’s team, taking on claims oversight and management, and seeing them through to closure.
Workers’ Compensation Claims
Employers expend substantial resources on Workers’ Compensation premiums each year. The Lovitt & Touché Workers’ Compensation advocates are licensed adjusters with real-world experience. Their expertise in the Workers’ Compensation arena allows them to talk at a peer-to-peer level with the adjuster, while educating the employer in terms that are easy to understand. They utilize their knowledge of the Workers’ Compensation system to move claims to conclusion in the most cost-effective manner possible.
- Compensability Decisions: Workers’ Compensation insurance is designed to cover employees who are injured during the course and scope of their employment. However, just because an employee experiences an event at work resulting in an injury, that doesn’t automatically create a compensable work comp claim. Our advocates work closely with clients to ensure the adjuster has all pertinent details and conducts a thorough investigation in order to make a compensability decision in a timely manner.
- Appropriate & Timely Treatment: When employees are injured, they usually just want the treatment necessary to feel better. Nothing can derail a claim faster than delayed or unauthorized treatment. Our advocates monitor claims to ensure:
- Injured employees get the appropriate level of care in a timely manner
- The treating physician has a definitive treatment plan
- Diagnostic procedures are reviewed for necessity and authorized in a timely manner
- Requests for surgical procedures are reviewed and authorized quickly, and that second opinions are requested when appropriate
- Adequate Reserving: We monitor the medical and indemnity aspects of claims and evaluate the reserves. We believe reserves should be based on probable outcome, rather than the worst-case scenario. When reserves are set, adjusters are asked to provide a line item account of the proposed reserve amount. Overinflated reserves are questioned, and the adjusters are pressed to modify the reserves appropriately. When an injured worker receives a medical maintenance award, reserves are reviewed to ensure they align with future medical exposures.
- Communication: Out of sight, out of mind often comes into play when injured employees are off work or the employment relationship has ended. The employer often has no idea what’s going on with the claim until it shows up on their EMOD. Claim Advocates follow the day-to-day progress of a claim and provide regular updates to the employer to manage expectations and avoid unexpected surprises.
Experience Modification Rating (EMOD) Management
For many employers, the Experience Mod (EMOD) is a critical component of their business. Not only can a high EMOD result in higher-than-average insurance premiums, but it can hinder a company from attaining new business contracts. Our advocates help clients control their EMOD by:
- Developing an aggressive return-to-work policy
- Diligently working to keep claims medical only, when possible
- Encouraging active/aggressive claim management to reduce the number of open claims
- Pushing for reserve reductions
We also pay special attention to accuracy, forecasting and analysis:
- Accuracy: There are a variety of inaccuracies that can occur during the calculation of an EMOD: using estimated payroll instead of audited payroll, exclusion of payroll, miscoded claims, failure to apply subrogation recovery, and inclusion of non-compensable/denied claims. We conduct a thorough review of EMOD worksheets and verify the accuracy of the data included. If we detect errors, we work with the insurance company to submit the correct data to the appropriate rating bureau.
- Forecasting: Even companies with the best safety programs can have claims. EMOD forecasting is a useful tool when preparing for upcoming budgets and prospective business opportunities. Advanced notice of an EMOD that is on the rise will give the employer an opportunity to strategize to minimize impact.
- Analysis: EMOD analysis can be helpful for evaluating “what if” scenarios, including:
- Changing policy effective dates
- Impact of an acquisition
- Changing class codes
- Impact of specific claims Potential premium increase related to a claim
- Breaking EMOD down by location, department, etc.
Best Practice Review
We conduct a Best Practice Review with all new clients, where we cover all issues from posting notices to claim reviews and everything in between. These meetings allow our team to walk through the new client’s workers’ comp policies and procedures, and provide an opportunity to discuss recommendations to improve the overall program.
We are always seeking new ways to help our clients reduce workers’ compensation costs. We have established relationships with service providers and negotiated reduced rates for products that have a proven track record for controlling claims and decreasing costs.
Education is a critical component to reinforcing a strong safety culture. We provide one-on-one or group training on topics related to workers’ compensation, such as:
- Work Comp 101
- Accident Investigation
- Managing Your Work Comp Program
- Cost Cutting Strategies
- EMOD 101
“Package” Advocates: Auto, Property, Liability Claims
Our “package” advocates have years of multi-line experience with extensive knowledge of insurance contracts and the claims administration process. We have unparalleled industry resources that allow us to analyze claims under all policies of insurance, including auto, property, liability, crime, directors & officers, cyber, and more. Package advocate focus includes:
We believe that successful claim management starts before a claim ever occurs. Our claim advocates assist clients with creating and implementing a detailed process outlining the dos and don’ts in the event of a claim, which helps streamline the claim process by providing the adjuster the necessary information in order to complete their investigation as quickly as possible.
Lovitt & Touché believes in providing personal service when it comes to claim reporting. Every client is assigned a dedicated advocate who stands ready to assist in the event of a claim. Managing the claim process, the advocate will gather pertinent information related to the claim, research applicable coverage, and present the claim submission to the appropriate carriers in a timely manner and even expedite when necessary.
We also enjoy educating clients on the claim process and the importance of cooperation from all parties involved: the insured, the adjuster and Lovitt & Touché.
Claims are frustrating, especially when a vehicle is placed out of service, property is damaged, or clients are threatened with a lawsuit. Add to that the aggravation if the adjuster assigned to a client’s claim is not responsive. Lovitt & Touché advocates are focused on maintaining proper communication between all parties to reduce frustration and help resolve claims quickly. We do this by:
- Getting appraisals of damage completed promptly
- Keeping the adjuster focused on first party damage to minimize downtime
- Ensuring liability claims are thoroughly investigated and that a strong defense is provided for our client
- Expediting defense counsel assignment to protect our client
- Take part in coverage disputes for outcomes that benefit our client
- Engage experts when necessary to assist with resolving unique issues or discrepancies to move the claim toward closure
- Coordinating meetings, either via phone or face-to-face, to discuss claim status and the strategy for resolution
Advocates follow up on claims on a regular basis to make sure that it stays on track and that the adjuster is focused on a claim resolution that is acceptable to our client.
Reserves are reviewed on a regular basis to make sure that they are appropriate based on the damages or liability exposure. Advocates request detailed information to support all reserves that are established and request reconsideration for overinflated amounts.