Nagging Claims That Won't Go Away Might Be Ripe for 'Double Play'

If you're looking for a way to quickly close a claim for the right amount and don't mind spending extra time and effort, you might want to take a team approach. The "double play" strategic alliance brings together everyone involved in managing a claim to determine how best to resolve it.

"It's basically a staging conference for seeing if the claim is settleable," said Jake Reason, director of Medicare set-aside services for CompPartners. "If it's not, then what is the next best course of action?"

The process involves assembling a defense team, including the appropriate attorney, adjuster, an investigator, a clinical expert, the claims examiner, a third-party administrator, possibly a Medicare set-aside professional, the supervisor, and the head of the claims office. While logistically challenging, the process works.

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"You get a lot of discussion, so there might be something in the file that I see that leads to another question, that leads to another question," Reason said.

Reason said the strategy has resulted in reducing settlements in some cases by 25 to 50 percent because the legal strategy had not been defined. "You might be in the situation where nobody knows what happened or why on earth you're facing the situation."

"The purpose is to develop the claim strategy and all of the tactics that are required for that strategy," said Barry Bloom, principal for risk management consulting firm BDB Group. "Then a plan of action is agreed upon in the session and memorialized in the claim file. Everybody leaves that double play knowing what their responsibilities are and what needs to get done to close the case."

The double-play method was developed by an insurer several years ago and is now used by some private employers as well as the California Self-Insurers Scurity Fund. Bloom said the process works extremely well for older cases, such as those left unresolved from defunct self-insured employers. But it also works for any case where the employer, TPA, or insurer is motivated to close it soon, for the right amount.

"It's done for payers that have an urgent need and appropriate exposure that would require them to put additional resources on a program to close those cases," Bloom said. "The deployment of a double play could easily be done on relatively early litigated cases to put it on track so it doesn't become an older, expensive file that couldn't be closed."

The time required for the double-play process to be effective depends on the case.

"We've had circumstances where it took most of the day," Bloom said." We've had circumstances where we could do four or five double plays in one day."

Read more at the WorkersComp Forum homepage.

November 11, 2010

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