Imagine Series – Crusty the Claims Adjuster

imagesHere’s the scenario… you’re the Risk Manager for an organization that has a passel of Workers’ Compensation claims. But not to worry! You’ve got Eunice – a mean and crusty 30 year claim manager that recognizes every trick in the book and puts the iron thumb on any potential runaway problems. All of a sudden you’re attending Eunice’s retirement party and wondering how you’ll replace her, especially with the 10% budget reduction your department has been “requested” to achieve this year. Imagine, if you will, that you had technology that could accumulate Eunice’s 30 years of knowledge and imbed those “triggers” in your RMIS Claims database. Even if you missed the opportunity to download Eunice’s brain before she walked out the door, most of the larger brokers are staffed with a few crusty old 30 year claims consultants. Make a list. Embed a trigger that alerts you when a doctor recommends surgery on a wrist before any therapy is attempted; somebody needs to take a look. When a claimant is out of work well beyond the Reed disability guidelines, perhaps a private investigation is recommended. I once saw a video of a long term disabled delivery driver that was playing center ice on his local hockey team. A fight broke out and our disabled employee pummeled his opponent into submission. And what about repeaters? When a repeater keeps repeating (even with repeat claims from another employer as evidenced by an ISO index query at time of incident), perhaps some action is triggered. With new technology capabilities (not the “legacy” stuff you’re accustomed to) this is pretty easy to implement (you can do it yourself). Many of your peers are currently doing this with great success!

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