Ethical Claims Handling… Best practices for best results.

ETHICAL CLAIMS HANDLING “EVERY DAY OPPORTUNITIES ARISE IN THE CLAIMS PROCESS TO EITHER DO THINGS THE EASY WAY, OR TO DO THEM THE RIGHT WAY.”

ETHICAL CLAIMS HANDLING “TODAY WE ARE GOING TO FOCUS ON DOING THINGS THE RIGHT WAY.”

ETHICAL CLAIMS HANDLING What are some claim techniques to avoid pitfalls?

ETHICAL CLAIMS HANDLING How do you avoid making errors?

ETHICAL CLAIMS HANDLING How should an employer/human resources department deal with an employee after a workers’ comp claim has be filed?

ETHICAL CLAIMS HANDLING Do explanations of benefits (EOBs) provided to claimants by insurers and TPAs typically satisfy the ERISA claims procedures?

ETHICAL CLAIMS HANDLING Does the TPA have any responsibilities to the Plan Sponsor in this situation? To the Plan participants?

ETHICAL CLAIMS HANDLING What can employers do to mitigate the cost of a claim?

ETHICAL CLAIMS HANDLING What’s the big deal about proper reserving?

ETHICAL CLAIMS HANDLING How do you handle this?

ETHICAL CLAIMS HANDLING Should – can – the TPA notify the employer of the employee’s diagnosis? If so, when?

ETHICAL CLAIMS HANDLING CONCLUSION… QUESTIONS…

ETHICAL CLAIMS HANDLING