Claims Reviews - What You Should Expect from Your Claims Team

Claim Review Photo

An effective claims review meeting should engage key participants in strategizing about how to best resolve claims and return injured workers to their jobs. A successful meeting should focus on the following key items: assessing the current state of your claim, identifying next steps to move forward, and collaborating to resolve the issue and close the file. 

Your claims team should be proactive, forward-thinking, and focused on ensuring that there is a strategy and action plan in place to bring the claim to conclusion. This is where collaboration is vital for all members of the meeting including the claims service manager, claims adjuster, broker, and other key stakeholders. The main focus should be helping your employees get back to work safely and quickly. Here, we will highlight the key items to look for when working with your claims team.

Your claims team should follow these basic principles:

Targeting claims:

  • Identify claims they can have an impact on
  • Focus review on getting employees back to work
  • Have a solid action plan to resolve files

Approaching the meeting:

  • Treat meetings as strategy sessions
  • Discuss plans and time frames
  • Be actionable – document a 3 to 4 item game plan outlining what happens next
  • Be collaborative

Following the meeting:

  • Have ongoing communication
  • Follow through on items discussed
  • Know and understand next steps
  • Resolve the claim effectively and efficiently

A claims handler addresses your needs, understands your concerns, and focuses on getting you the best results possible. As an employer, you want to know that your employees’ claims are being handled effectively. Finally, it’s important to feel confident in your claims handler’s ability to manage your money by driving claims to resolution in a cost-effective manner. For information on PMA’s claims services, visit our website at https://www.pmacompanies.com/claims.

Lisa Romeu, Vice President

Lisa is the Vice President of Claims Client Service for PMA Companies. She is responsible for providing leadership and management of the Claims Service Manager (CSM) function for both our insured and TPA operations.