When we reviewed our client’s population of open indemnity claims, we clearly identified a growing trend for future medical claims. Because that trend had begun to escalate, we determined it was important to discuss the issue with the client, and to jointly develop a strategy to address the growth of these claims. The objective: to identity the drivers behind the trend, and to curb the growth of future medical claims within their overall claim population.
We determined this challenge could best be addressed by focusing our efforts in two areas:
- Individual claims – To best address the individual open claims, we worked closely with the client to gather as much information on each claimant as possible. This additional intelligence allowed for the development of extremely focused strategies for each open future medical claim. Beyond the strategic implications, the information allowed us to better understand the types of claims and/or claimants most likely to end up in a future medical status. This information was critical to our goal of minimizing the growth of the population of claims in the future.
- Organizational reengineering – At the same time, we analyzed in great
detail how future medical claims were being administered for this program. We looked closely at staffing models, processes and procedures. Our goal was to engineer an innovative approach to managing claims. We wanted to create a focused environment that would allow our staff to maximize closure opportunities and drive down the total open inventory of future medical claims.
By gathering additional information on each of the claimants, we were immediately able to accelerate claim closures in several instances. An additional benefit of the information-gathering process was the development of an in-depth understanding of these claims, and the challenges this population of claims might present in the future.
But the greatest benefit came from the organizational reengineering process. We were able to build a dedicated future medical claim-handling unit with unique caseload requirements and administrative support structures in place. We provided rigorous training for the individuals within the unit, and provided them with very specific claim-handling guidelines. The ultimate outcome is a highly focused, specialized staff that has delivered very favorable trends for the client.
For more information about this project, please see our white paper:
Future Medical – A Claim on the Rise (pdf file)