By JOHN D'ALUSIO, executive vice president, claims, at Avizent, a national risk management service and provider of claims management, medical managed care, self-insured groups, alternative risk financing and RMIS software
Claims adjusters are, by the very nature of the claims management process, the front line in identifying subrogation potential. Because their duties encompass so many aspects of claims resolution and their workloads are often very heavy, subrogation specialists can make significant contributions to subrogation success by performing the technical subrogation functions and the administrative processes of pursuing recovery.
The ultimate key to successful subrogation is close coordination and collaboration between adjuster and specialist throughout the process. Here's a high-level overview of how an effective adjuster/specialist subrogation process can work.
Step 1. Subrogation specialists review all incoming files for subrogation potential using their knowledge and expertise to pinpoint the most likely candidate files for pursuing subrogation.
Step 2. If indicated, subrogation specialists refer cases to specialized experts for issues relating to the cause and origin of the incident, engineering and construction practices and codes, medical diagnostic and treatment experts, or other specialized areas of investigation.
Step 3. The claims adjuster documents the subrogation potential, identifying all parties that may be involved, and makes sure all the investigations and documentation required to successfully pursue subrogation are in place.
Step 4. The adjuster then notifies all potentially responsible parties in writing, including relevant documentation of damages, investigative material and other supporting information, as well as the request for reimbursement
Step 5. As needed, the subrogation specialist works with the adjuster to identify additional investigation needed to successfully pursue subrogation--this collaboration is essential for the process to succeed.
Step 6. The subrogation specialist identifies, if warranted, alternative dispute resolution mechanisms, such as mediation, arbitration, settlement conferences, or other methods that are available to resolve disputes over liability or damages.
Step 7. Claims with very large potential for recovery may also be referred to subrogation legal counsel.
Step 8. While the claims adjuster is responsible for normal handling and reserving of active files, the subrogation specialist manages any collection and recovery matters through conclusion.
The adjuster normally turns the case over to the subrogation specialist once all normal claims activities, such as investigation, wage and medical payments, bill adjudication and settlement, are completed. The specialist, however, will keep the case active until recovery is made or all avenues, including litigation, are exhausted.
PURSUING YOUR OWN SUBROGATION SPECIALIST
Because subrogation can contribute so significantly to financial performance, companies facing the challenges of a tough economy have a great incentive to seek out, or at least consider, resources for specialized subrogation capabilities.
The National Association of Subrogation Professionals focuses on enhancing subrogation professionalism through education, training and information-sharing. You can also inquire with leading claims management providers about their specialized subrogation services.
April 1, 2009
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