How your claims are reported is an important decision, and can make the difference between whether your employees return to work rapidly or whether they are out of work for an extended and often unnecessary period of time. It is almost as important as selecting the best TPA, so evaluate procedures carefully: do not automatically choose the TPA's default procedures unless you are sure it meets your needs.  

Plan a "chair-side" visit with your third-party administrator or carrier to see how their typical intake is done and ask how the most proactive and involved clients handle intake. Ask to see every possible vendor available for intake solutions.

It is important to see how these work in practice by sitting with intake coordinators. Ask them, "What happens next? And, what follows that?"  

Here are several considerations when developing new procedures and evaluating vendors. 

• Hours: The call center should be open 24/7/365. Languages: Intake representatives should include bi-lingual staff as appropriate to your workforce.
• Escalation Procedures: Based on established procedures critical losses must be escalated for immediate attention. 24-hour pager contact must be available.
• Recorded Calls: Each service call is recorded and some are rated for voice tone.
• Call Scripts: Employers provide customized questions depending upon workforce needs and post injury response procedures.
• Answer Time: Calls are answered within a maximum of 25 seconds, but usually less.
• Quality Control: Every claim is reviewed for location code and policy number accuracy before it is assigned to an adjuster.
• Nurse Triage: Immediate contact with medical personnel ensures employees are directed to the right type of treatment.

There are no two claims that are exactly alike, the same way that there are no two adjusters that are identical.  But why are some claims accepted when other similar ones are denied? 

Why is this kind of plan so expensive? Employers with insurance through an assigned risk plan should start immediately to take steps to improve their loss history.