Claims Administration

Risk Administration Resources, Ltd offers its clients a full spectrum of claims administration services.  We believe that our expert claims service coupled with our comprehensive risk control services will minimize your overall exposure and control your occupational accident cost.  Our expert claims service includes:

Reporting – Immediate reporting of injuries is essential.  It allows you to take full advantage of provisions set forth under your employee benefit plan; provide you the opportunity to establish a non-adversarial relationship with the injured workers and their families.

Investigation – When circumstances warrant, your Risk Administration Resources, Ltd client service adjuster will conduct an aggressive and thorough investigation of all questionable claims.

Three Point Contact - It is crucial to the management of work related cases that you maintain contact with the employer contact, injured worker and the medical provider.  Your Risk Administration Resources, Ltd client service adjuster will ensure that this three-point contact is in place in every occupational injury claim.

Processing - Risk Administration Resources, Ltd will promptly process all claims.  We will work directly with your insurance carriers to expedite reimbursement of claims that exceed your self-insured retention. 

Light Duty/Modified Work Program – Your client service adjuster can assist you in developing a light duty / modified work program to give your injured workers an extra incentive to return to work.

Subrogation – We will aggressively identify and pursue all subrogation possibilities.

Comprehensive Claims Reviews – Your client service adjuster will conduct quarterly file reviews of all your open claims.  This discussion will include current payments, anticipated final cost, and Risk Administration Resources, Ltd proposed strategies for claims resolutions.

Preferred Provider Network - Our network of hospitals, physicians and ancillary care providers will furnish high quality medical services at a reasonable cost to you.  Our medical providers were chosen specifically for their expertise in this area of work related injuries.  These medical providers will work with you and your Risk Administration Resources, Ltd client service adjuster to return your injured employees to work as soon as possible.  We will apply the fee schedule to all bills received and apply additional discounts when available.

Cost Containment - Our Cost Containment staffed by Registered Nurses, oversees Hospital Bill Auditing and Physician Bill Review programs which insures that the treatments and accompanying charges are reasonable, necessary and related.  Our personnel uses an automated medical bill review program which checks each medical bill for patterns of treatments as well as the appropriateness of care.  Our program employs everything possible to manage medical treatment and provide your injured employee’s with quality care at the lowest possible cost to you.

Medical Case Management – Our Medical Case Managers are available to work with you, your injured workers and their medical providers on the most serious claims.  These include spinal cord injury, severe burn injury, severe head injury, crushing injury, and amputation.

Litigation Services – Although our claims administration program makes every endeavor to avoid litigation process, there are times when it is inevitable.  At your direction, Risk Administration Resources, Ltd will engage your defense counsel and your client service adjuster will work with them on your behalf. 

Information Systems and Reporting -   You will receive Loss Analysis Reports on a monthly basis.  These reports will give you detailed loss runs showing individual claims information; the summary reports will statistically categorize claims experience by accident type, part of body injured, and paid incurred dollar amounts.  Should you wish, these reports can be prepared on a “by location” basis.  These reports include Loss Analysis, Check Register, Large Loss Summary and several different customized reports.

Third Party Administration Services
Service Expectations

Claim Services with RAR include the following:

	Intake of the Employee Report of Accident (EROA) and initiate claimant file
	Investigation with Doctors first report, Injured Person’s statement, Supervisor Statement, and Witness Statement
	First contact with Injured, Employer and Medical Case Manager (as needed)
	Reporting to Excess Carrier (as needed)
	Meeting to set up report specifications
	Monthly Reports
	Quarterly claims meetings
	Reserve Schedules
	Develop a Preferred Provider Network
	File custody for the life of the contract
	Indemnity Worksheet
	Zero balance accounts without reconciliation (does not include banking fees)
	Subrogation to conclusion, putting third party on notice (excluding field investigations and any expense)
	Medical Case Management, Pre-authorization, Private Investigations and Peer Review referrals (cost is separate)