Claims Management Advocacy
ESM provides the tools and training for employers to return an injured worker back into a productive team member. Many factors influence and impact the outcome of a workers’ compensation claim, which can be a time of discomfort and uncertainty for the employee, and requires additional time, effort and expense for the employer and coworkers. Easing the transition back to normalcy occurs when all Parties are given a clear understanding of the process and know what to expect. Our team provides you with expert advice focused on helping you make the most ethical, financial and legal decision when managing your Workers’ Compensation claims.
Client Track Record
Why Claims Advocacy
Aligning all of the Workers' Compensation stakeholders ensures maximum benefit. Here are just a few ways ESM has an impact on our client's Worker’s Compensation claims management:
Provide Workers’ Compensation technical expertise to employers
Facilitate ongoing communication between employer and insurance carriers/TPA
Interpret loss runs and other loss data
Establish action plans for the resolution of claims
Analyze claim statuses and critique carrier action plans
Analyze reserves for accuracy
Provide reports to employers regarding action plans and reserve recommendations
Analyze experience modification worksheets and complete X-mod projections
Strategize litigated claims for optimum resolution
Verify employer compliance with Workers’ Compensation requirements
Resource for Workers’ Compensation claims issues
Audit of Third Party Administrator
Evaluate Medical Provider Network (MPN)
Critical Time Lines in Claims Management
Unit Stat Valuation
18 months after inception of the policy
All claims are valued for use in the next year’s X-mod calculation
Open claims include paid and outstanding
The outstanding balance is negotiable
Are the outstanding reserves accurate?
Is there any subrogation potential?
Any other pertinent underwriting information?
Are Safety issues addressed?
Is the Return-To-Work program implemented?
Has the Medical Provider relationship changed?
ESM's Claims Management Goals
Provide valuable oversight and direction with the claims administrator to ensure that the employer has the information and resources to make the best financial, legal and ethical business decision for the management of their Workers’ Compensation claims.
Empower the employer with assistance in best practices that will provide ownership and internal management of their Workers’ Compensation claims.
Act as an advocate for employer and liaison with the claims administrator to ensure that the claims are positioned for cost effective resolution and are accurately reserved.