Claims Handling Manual

[lostinconnecticut]

I started writing a Claims Handling Manual. Anyone want to join me.
I kinda wrote page one.

Royal Screw Insurance Company
Claims Handling Manual for Worker’s Compensation


Welcome to Royal Screw Insurance. As new claims adjusters, please read the claims handling information carefully. We at Royal Screw have built our business by working to see the premiums paid to us stay in our hands where they belong, rather than being lost to the problems of others. As you enter the exciting world of claims handling, please remember two simple words. Deny and Delay.

Sincerely,

Ben Dover, CEO Royal Screw Insurance





Claims Handling 101

All claims adjusters shall evaluate claims with a mindset to escape liability.

1.) Initial evaluation Is there someway to avoid liability immediately?

Ex. Non employee tactic (Person doesn’t work here)
Didn’t occur at work tactic (No proof it occurred at work)
Not reported correctly tactic * (Failure to report injury in
a timely manner)
*Often a worker will wait to see if the injury gets better.
This can not be tolerated and claim should be denied.

If it is indisputable that injury occurred to a valid employee while at work and was reported properly then proceed to step #2

2.) Evaluate injury If the injury is indisputably our responsibility then make every effort to minimize the injury. Injuries that are obvious such as broken bones, bleeding wounds, dismemberment should be paid immediately because to do otherwise would make us look bad.
Remember we should appear to respond quickly and properly if we can’t get out of it. Additionally, these injuries are usually relatively inexpensive, we can look good and it won’t cost very much.

If the injury can not be seen, but the injured is able to obtain medical evidence to substantiate it, use the following tactics to deny it..

[CRABBY]

I love it.....I'll try and add a little later with ya

[jdx4]

Above all you must remember to NEVER answer the phone! This would give the 'injured' worker a false sense that you cared. Your time should be spent exploring avenues of denial, not on the phone. If you do happen to answer, say if you were expecting a personal call (which is ok), feel free to say whatever you think they want to hear. Their only concern is about money, always wanting to know where their check is. Tell them that we are prepared to cut a check tomorrow pending.... (Choose option below). When tomorrow comes repeat process until they stop calling. Eventually they will have no money to pay their phone bill and they won't be able to call. Problem solved.

Options -
We are waiting for,
1) forms from Dr. ...
2) your employer to...
3) the investigator to interview (may be used multiple times for different individuals)
4) the preliminary report from the investigator
5) the final report from the inestigator
Get creative! If you think it sounds good and will make them stop calling, go for it!

[lostinconnecticut]

"They won't be able to pay the phone bill and will stop calling" LMAO


The pre existing condition tactic
Immediately screen employee to find out if they ever injured that body part (ex. Knee injury: Perhaps employee fell off bike when a child, and scraped that knee. Perhaps employee is older and we can claim normal degenerative condition) If there is ANY evidence of pre existing injury, immediately deny claim