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Health care organization lowers comp costs by proactive claims management


A large health care organization with over 1,500 employees and multiple locations.


The company had several large open claims that were negatively impacting its Experience Modification Factor and felt the prior agency had been lax in identifying and monitoring the open claim. In fact, the company had been told by the carrier that the open claim reserves could not be lowered.


In reviewing the data, Certified WorkComp Advisors (CWCAs) and the Claims Advocate reviewed the company’s losses and identified the open claims that required attention, prior to their unit stat card filing date, which the current agent had overlooked.


Using the skills learned at IWCP workshops, the Claims Advocate began communications with the claims adjusters and the company to identify possible opportunities to either close claims or reduce the reserves.


The Claim Advocate was able to secure 14 claim reductions, which will save the company more than $150,000 over the next three years. The reductions totaled over $175,000, with the largest being $46,621. The Claims Advocate was also instrumental in obtaining subrogation recovery on a claim that was over $25,000. By lowering both the Workers’ Compensation cost and Experience Modification Factor, the company increased its profitability.