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5 Best Practices for Effective Claims Reviews

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With the cost of insurance for businesses rising across many types of coverage, staying on top of trends in the claims portfolio is more important than ever. Spotting problem areas and opportunities sooner makes it easier to develop and implement steps to reduce risk pre-loss and better control costs post-loss. For this reason, many insurers and TPAs promise to conduct claims reviews with their business customers on a regular basis, but the rigor can vary greatly. Practices that have been common historically often lack the nuance and precision that can unlock the maximum benefit for each customer’s unique situation.

Here are five best practices for a wide variety of customers across a range of industries:

1. Assemble the right team

Typically, only the person overseeing claims at the business attends the claims review with key claims staff from the carrier. However, this small team limits the potential for brainstorming solutions and getting full buy-in to implement them. In addition to claims experts, it may also be helpful for the carrier’s loss control team to attend, as well as agent/broker staff.

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From the business customer side, it is helpful to include all key personnel who can facilitate immediate decisions that will impact the ultimate resolution of the claim in an efficient and timely manner or provide other insightful information. This often includes the risk manager, and may also encompass employees from legal, human resources, safety, operations and even the CFO, in some cases.

2. Develop a clear understanding of the customer to set the claims review objective

Broadly speaking, the goal is always to minimize loss costs to help manage the price and coverage of the overall insurance program. However, each business and claims portfolio is unique. One company may be most concerned with how claims reserves are affecting budgets. Another company may have an unusually high experience modification rate that they want to bring down by reducing the frequency of worker injuries. Yet another company may be changing part of their operation and want to monitor claims activity associated with it more closely than business-as-usual activities. The policyholder’s unique objectives should drive decisions about how often to conduct the claims reviews, what types of claims to include and where to dive into the greatest detail.

3. Fully understand and account for the impact of claims on the insurance program

In the initial design of the insurance program, certain coverages may have been limited due to a problematic claims record. For instance, frequent third-party claims for premises liability may have led to restrictions on Med Pay coverage or a higher deductible to give the customer a bigger stake in safety measures.

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Or perhaps the customer hoped for a loss-sensitive program but could only secure a guaranteed cost program due to lack of an internal pre- and post-loss management platform. The claims review should be designed to account for how frequency and severity may affect underwriting decisions so that the policyholder can move toward its coverage objective

4. Choose claims for review according to objectives, not simply dollar value

The default choice for what claims to review is often based on dollar value—e.g., all open claims with incurred losses of $25,000 or more. This approach may miss underlying trends that could lead to severe loss, however. For instance, perhaps a restaurant chain experiences a high frequency of slip-and-fall claims from workers in its kitchens. While these may all have been minor, but it may only be a matter of time until a severe injury occurs.

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With the objective to reduce frequency and the risk of serious injury, the claims review should examine all slip-and-fall claims using data and analytics to uncover causal factors such as food and liquid dropped on floors or seasonal workers with little safety training.

5. Track reserving on a micro level relative to all factors that can affect open claims

Typically, reserving is only tracked from a macro perspective, but this can overlook a variety of factors that could help better manage reserves and ultimate outcomes. For example, are the latest technologies being consistently used to manage costs? Advances in artificial intelligence and data and analytics now allow us to identify treatment providers associated with the best outcomes for injured workers, but how well are companies taking advantage of the recommendations? Early resolution techniques for auto and general liability claims may lower the ultimate cost of claims but cause a short-term bump in claims payments that needs to be accounted for in the customer’s budgeting process.

Potential Benefits

Claims reviews based on these best practices can yield significant benefits, especially when used as part of a holistic approach to managing risk and reducing losses. For example, an early claims review for a new manufacturing customer identified sprain and strain injuries as a problem area. The loss control team then surveyed the manufacturer’s operations and uncovered increased risk due to various manual lifting tasks, such as loading 8-foot-tall plastic silos with heavy equipment in a confined space. Based on that finding, the insurer’s team conducted onsite job hazard analysis supervisory training that included a safe lifting program, online courses and ergonomic risk assessments on a variety of tasks. As a result, within about two years, the program cut the manufacturer’s workers compensation loss ratio roughly in half.

Travel Risk Management for LGBTQ+ Employees

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LGBTQ+ travelers can face unique challenges when traveling abroad—many countries do not legally recognize same-sex marriage and more than 70 countries consider consensual LGBTQ+ relationships a crime. If an employee travels on business to a country where their sexual orientation or expression of gender identity is criminalized, an extra layer of complexity is added to duty of care responsibilities. Corporate risk managers need to consider how to best protect employees in a way that doesn’t make them feel singled out, working with them to stay safe and respect local laws without compromising their own values. 

This process begins by providing up-to-date guidance on laws and cultural variations as part of an organization’s duty of care. Attitudes towards the LGBTQ+ community vary considerably around the world, and employers therefore need to shape their duty of care policies around a wide range of considerations, both legal and cultural.

Understand the Law

Risk managers need to ensure they have relevant and up-to-date information at hand to fully understand the traveler’s destination. There are nuances within each country’s legislation, and acceptance can vary dramatically even within different regions of the same country, also evolving over time. Employees need to be informed of the laws to which they will be subject at their destination before they travel. Duty of care procedures should incorporate pre-travel advice and awareness, educating employees on what to expect when on business travel as well as how to respond and whom to contact in an emergency.

Legislation may impact an employee’s behavior in a given destination and travel managers can provide advice on best practices. In the United Arab Emirates for example, transgender, gay and gender nonconforming people have been arrested for violating a law against men “disguised” as women. To the extent possible, it is best for travelers in these countries to remain in resort areas and for same-sex couples to refrain from holding hands, hugging or kissing in public.

Understand the Culture

In addition to local laws, social norms are another factor to consider for deciding whether a destination is safe. While many countries officially recognize homosexuality and allow gender confirmation measures, some communities within these “safe” countries still harbor prejudice against the LGBTQ+ community. In such environments, LGBTQ+ travelers who engage in open displays of affection with each other or appear gender nonconforming may be at risk of harassment and assault, and may also feel intimidated when reporting the incident to local police. There may be few or no local venues that provide a safe space for members of the LGBTQ+ community and the risk of hate crimes and police raids at such establishments cannot be ruled out. Travelers are advised to maintain a low profile in countries that lack full protection for the LGBTQ+ community and exercise caution about where and with whom to discuss related topics in public spaces.

Social media can also put travelers at risk. For example, while dating apps can help people connect with local members of the LGBTQ+ community when traveling or relocating for work, employees should be advised to exercise caution if they plan to use these in communities that are not LGBTQ-friendly. In Russia, where prejudice is widespread and a law against “gay propaganda” has been in effect since 2013, far-right activists and gang members have used dating apps to lure gay men to assault and extort them. Prior to travel, risk managers should advise employees to review privacy settings on social media platforms and reconsider the use of dating applications while abroad.

With some countries still refusing to accept—let alone recognize—the LGBTQ+ community, LGBTQ+ employees often feel compelled to take additional precautions that others would not have to even consider. However, corporate risk managers can help employees to stay safe while on business travel by being aware of the local laws and social norms of the destination before departure.

For other guidance on how to support LGBTQ+ employees and advance diversity, equity and inclusion programs, check out these additional pieces from Risk Management Magazine and the Risk Management Monitor:
Beyond Pride: Building Strong Diversity and Inclusion Programs
The LGBT Travel Risk Dilemma
The Benefits of Diversity & Inclusion Initiatives
Engaging Employees in Their Own Duty of Care
Developing a Strategy for Transgender Workers
The Case for Effective DE&I Training

New York City’s New Biometric Information Law Governs Collection and Use of Consumer Health Data

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For risk professionals, the COVID-19 pandemic has increased the importance of ensuring customer and employee safety measures are incorporated into operations, processes and future strategies. As many businesses reopen from pandemic shutdowns or return from remote work arrangements, some enterprises are now exploring both the effectiveness and the risks associated with conducting health screenings that collect biometric information and other personal health data.

This month, New York City released the Biometric Information Law, a new measure that goes into effect on July 9 and imposes disclosure requirements on businesses that collect consumer biometric information.

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It also sets parameters on what they can do with that information, most importantly, prohibiting the exchange of biometric information for anything of value.

As detailed in recent client notice from the law firm Reed Smith, highlights from the law include:

  • The measure requires a business that “collects, retains, converts, stores or shares biometric identifier information of customers” to place a “clear and conspicuous sign” near all consumer entrances that, in plain language, discloses the collection, retention or sharing of biometric information.
  • It stipulates that it is unlawful to “sell, lease, trade, share in exchange for anything of value or otherwise profit from the transaction of biometric identifier information.”
  • It establishes “an ‘aggrieved’ consumer’s private right of action,” meaning that “[a]ny person who is aggrieved by a violation by this chapter is entitled to commence an action to enforce its protections.”

There are key exclusions, however, as “governmental agencies, employers, or agents” are expressly excluded from compliance with any provision.

New York is not the only state to enact a law attempting to govern how organizations can use biometric information. Arkansas, California, Illinois, Texas and Washington have also set guidelines for businesses.

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Indeed, the recent Risk Management Magazine article “Preparing for Biometric Litigation from COVID-19” addresses the imminent and critical questions businesses must answer when collecting and handling such data.

Sensitivities surrounding the confidentiality of biometric and other health information are not new in certain industries, such as healthcare. Further, even before COVID-19, risk professionals were already grappling with the risks associated with new biometric technologies and the data collected, especially with regard to facial recognition, wearables and even the rise in popularity of telehealth.

Now, with every organization on high alert about infectious diseases and how quickly they can interrupt business, health and safety have become top priorities for every risk professional in every sector.

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As risk professionals look to new technology for help with these concerns, monitoring the emerging regulation and security risks around health and biometric technology will become increasingly critical in balancing benefit and risk to their organizations.
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Data security will continue to remain a significant threat, but New York’s Biometric Information Law should serve as a reminder that what the organization does with that data can also have a lasting impact on the enterprise’s reputation and consumer trust.

For more information to help risk professionals manage new health technology and data, check out these articles from Risk Management Magazine:

Employee Engagement is Key in COVID-19 Recovery

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Businesses and their employees have had to rapidly adjust to the shutdowns and disruptions caused by the COVID-19 pandemic, and their ability to adapt and pivot will continue to be critical as organizations start to recover from the impacts of the crisis.

To further compound these circumstances, the ability to maintain engaged, empowered, and satisfied team members has proven challenging for many. While some organizations have thrived under their modified operating conditions, others have struggled to respond to change and keep team members engaged and productive. While rates of vaccinations are bringing some hope about the pandemic’s eventual end, the tidal wave of change we have experienced is unlikely to ebb any time soon.

When creating your COVID-19 recovery plans, the value of engaged and satisfied team members in this fast-moving environment must not be understated.

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Engaged employees will support your organization to achieve its mission, execute its strategy and generate results, particularly as times remain uncertain.

As leaders, we must ask: how can we leverage the rapid change we have experienced over the past year, continue to drive growth and sustain employee satisfaction and engagement? Here’s how:

1. Accept remote or hybrid work environments as the “new normal”

The days of office cubicles and open floor plans for all employees are gone. We now operate in a world where some of our team members will continue to work where it is the safest, most suitable, and most empowering for them.

Many organizations across industries have already embraced the fact that working remotely, in some form or fashion, is here to stay. This shift has had many benefits—such as being able to recruit talent outside of your typical geographic area and eliminating lengthy commutes from home to office. However, the shift has not been without challenges and very real risks.

As we move into a recovery phase, leaders must remain alert to the challenges brought by an environment with minimal face-to-face interaction, the potential for feelings of social isolation, the need for different ways to access information or support, and the natural distractions of being at home.

For leaders, scheduling regular check-ins and establishing rules of engagement has not changed, regardless of whether you work in an office or at home. However, with a majority of our workforce currently at home, we need to get creative in the way we support and engage our teams.

2. Manage the new risks

This shift from in-office environments to hybrid or remote work environments has brought to light many physical, psychological and technological risks. Leaders must build out their risk management framework to incorporate a broader lens.

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It is now paramount to ensure team members have access to resources to work from home safely and comfortably, with the right technology support and a focus on open lines of communication.

The pandemic has also brought on feelings of isolation and fear for many. If you have yet to adjust your workplace mental and physical support offerings, do not neglect these critical needs any longer. Ensure such offerings are also set up for those workers continuing in a hybrid or fully remote setting.

3. Prioritize communication

How we communicate and engage with our teams is as important as ever. Whether it’s Zoom, Slack, Webex, Microsoft Teams or any of the other platforms we have increasingly relied on over the past year, we need to provide opportunities for both formal and informal communication to flow.

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Through informal social connections, leaders can demonstrate emotional support and consideration for their team, which ultimately leads to higher engagement.

When leaders are engaged, supportive, and available to their employees, it helps reduce feelings of isolation and reinforces your strong company culture. At the end of the day, when team members feel they work for an organization that supports their ambitions and wellbeing, it increases productivity, retention, and cost savings. This translates to bottom-line success.