WC Claim Auditing - client services

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WC Claim Auditing  

Employee injury in the workplace is an inherent exposure with any business. Even when controlling exposure with risk control techniques claims occur. How your claim is handled and monitored during the life of the claim is critical.

Claims, if left unattended, can quickly become out of control. Claim adjusters are responsible for 200-300 claims at once, limiting the time they can spend on your claim to ensure it is handled efficiently, effectively and closed at the lowest but correct value.

CMR works with a team of licensed adjusters, case nurse managers, and consultants with extensive backgrounds in workers compensation claims handling to audit the insurance companies claims file to assure the appropriate amount is paid, reserves are properly set and your experience modification is not adversely affected due to improper handling.

Our team has no affiliation with any insurance company so you can rest assured they have your interest as their number one priority!

Your workers compensation costs are impacted by your Experience Modification Factor, which is heavily weighted by open claim reserves. Reserves are regularly set "conservatively" (somewhat higher than what file documents support) to help bolster financial strength ratings and to meet insurance department solvency criteria. Unfortunately this "conservative" reserving practice works against employers resulting in increased experience modification factors and higher workers compensation premiums.

CMR audits these reserves with our independent team of professionals through proper file documentation. A reduction in your open claim reserves can provide a significant savings to your workers compensation premiums. Here is an example of how the slightest reduction in open claim reserves can have a substantial impact on your Experience Modification Factor:

  Situation A Situation B Situation C
Open Reserves $150,000 $125,000 $100,000
Actual Paid $100,000 $100,000 $100,000
Total Incurred $250,000 $225,000 $200,000
Divided by Expected Losses $175,000 $175,000 $175,000
Experience Modification 143% 126% 114%
Standard Premium $100,000 $100,000 $100,000
Modified Premium $143,000 $126,000 $114,000
    $17,000 Savings $29,000 Savings