Initial Investigation

The initial investigation involves a thorough three-point contact between the claimant, employer, and physician. This investigation is our first basis for determining the best course of action for a claim.

Statistics show that approximately 15% of workers’ compensation claims are responsible for 80% of the total claims cost. Our techniques are aimed at identifying these potentially catastrophic claims during the initial investigation so that particular attention is given to monitor and contain the cost of these claims.

Claims can be reported through our secure online reporting system on a 24/7 basis. This allows our claims team to begin managing the claim immediately. The earlier they intervene in a claim, the more control they can exert over the course the claim will follow. The option of submitting claims via phone or fax is also available so that employers can choose the method that is most convenient to them.

Following the initial investigation, a case plan is developed based on the type and severity of the injury. A claims management approach is customized for each claim to allow for maximum savings and a speedy return to work. Return to work benchmarks are set for each claim based on the specific diagnoses, in accordance with the URAC medical guidelines. This allows the adjusters to determine if a claimant is following anticipated recovery time, receiving excessive treatment, or exhibiting symptom magnification. They then work to identify the reason a claimant is not back to work by that time so that the issue can be specifically addressed and, if possible, eliminated.