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Reserve Reduction
Workers’ Compensation Claims Management Services

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To effectively manage the rising cost of Workers’ Compensation, it is no longer enough to simply manage the claims. To successfully reduce costs, you must control the entire claims process: First, we identify any potentially high-cost claims. Then, we put a plan in place to shorten the amount of time those claims are open. Finally, we work to make the overall cost of those claims more stable and predictable. At Alper Services, our comprehensive approach to reduce the overall cost of your Workers’ Compensation claims includes the following:

  • Prompt Care for the Injured Employee and Accelerated Return to Work
  • Aggressive Management of Suspect Claims
  • Minimization of Medical Expenses by Avoiding Unnecessary Medical Treatment
  • Reducing Litigation Expenses and Settlement Costs
  • Reducing Premiums via Ongoing Reserve Monitoring and Reduction
  • Successful Closing of Stale Open Claims

 

“What are reserves?

Reserves are the insurance carrier’s estimate of
the medical and indemnity costs of a claim based
upon all known factors at any given time.

Why do they need to be monitored?

Reserves which are unnecessarily high raise a business’ total incurred losses, which has a detrimental impact on its experience modification. A high experience mod means higher Workers’ Compensation premiums.

 

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CASE HISTORY

Challenge
A Client had multiple Workers’ Compensation claims assigned by its insurance carrier to the same adjuster, who had a history of reserving her claims at the maximum amount.

One of the Client’s injured employees sustained a leg fracture, but returned to full-duty employment within one month of the accident. Despite this, the adjuster still had an indemnity reserve of $18,000 and medical reserve of $5,000 more than 3 months later.

Another of the Client’s injured employees fractured his shoulder in a slip and fall accident. Anticipating surgery, the same adjuster set high reserves.

Action
On the first claim, our Occupational Nurse Consultant recommended the adjuster to perform a thorough review of the indemnity reserve and the medical reserve. On the second claim, our Occupational Nurse Consultant requested an Independent
Medical Evaluation be performed.

Results
On the first claim, the adjuster reduced the indemnity reserve to $0 and the medical reserve to $2,500. The claim closed within
four months. On the second claim, the
results from the IME concluded surgery was not required. The medical reserves were reduced over $12,000.

 

Alper Services, LLC   |   60 West Superior, Chicago, IL 60654   |  p: 312.642.1000   |   f: 312.944.7000
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