By relying on paper loss runs, insurers and TPAs have been severely rationing information shared with their customers. We are at the tipping point of a much higher standard of reporting. Dashboards, alerts and special reports promote a coherent, action-promoting view into all aspects of work injuries: safety, claims, medical care, and personnel.
In this light, the very concept of a traditionally-designed loss run is thrown into question.
The loss run is nothing but an extract of the claims record, which the adjuster sees on his or her screen. The claims record is there for the adjuster to manage the myriad details in a claim's lifetime.
The claims record and its extract, the loss run, do not provide the employer with an accurate view of its agenda for safety and injury management across the spectrum of injury risk and operational units.
A workers' comp consultant to employers says that claims information is so important to the employer that the selection of insurer or TPA can ride on that factor alone. James Moore, in Raleigh, N.C., says that better claims reporting can make up for a 20 percent difference in pricing among bidders.
Until recently, employers learned about the status of injury claims in only two ways: a hard copy of this extract, and by a phone call with the adjuster. Oh, how pre-Internet!
One simple step to improve the information flow is to distribute the loss run by e-mail attachment or on a Web site. This removes printing constraints and can allow for access on demand. It cuts down phone calls by maybe 90 percent.
In a typical scenario, the employer logs onto the Web to order ad hoc reports. Perhaps the reports can be downloaded into Excel. But that doesn't get to the twin issues of content and ease of interpretation.
Marsh's Lynn Magill has a long list of edits to the claims extract that are valuable for employers. They include listing claims that have had a big change in financials within a time period. She also likes reports on the lag time in reporting claims and on the operating locations with highest frequency and severity.
Many large insurers and TPAs have introduced onto their Web sites dashboards with varying degrees of proficiency in presenting data. The idea is that the employer wants selected information without the bother of searching loss runs and manipulating Excel worksheets.
The dashboard for today allows for multicolor displays of graphs, such as on trend lines over time, pie charts and color-coded data. Also for today are e-mail alerts, which the main employer contact can forward along to colleagues in the pertinent operating locations.
California's San Bernardino County may have the state-of-the-art dashboard. This county self-administers workers' comp and liability claims for 65 operating units. It brings into its claims dashboard data from human resources and fleet management, making one clean picture of what is going on.
The county's managers can view how they and all other departments are hitting performance targets. The system alerts them when work injuries or liability claims pass a threshold that triggers remedial steps.
TPAs and insurers build their own reporting systems or subcontract that work to a specialized IT vendor.
A robust system can save about 10 percent of claims costs.
PETER ROUSMANIERE is an expert on the workers' compensation industry.
October 15, 2009
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