As your claims management specialists, it is our goal to assist you with any issue pertaining to your Workers’ Compensation program. Reviewing and analyzing open claims is only part of the services that we can offer. Our expertise in California Workers’ Compensation will allow us to tailor a written program of information and claims management services that best suits Client.

We will offer the following as an example of immediate service goals and objectives:

Initial Services

• Initial Claims Review – We will request and obtain currently-valued loss runs from the insurance carrier for the past five-years. We will review all loss and claims data to formalize understanding surrounding the circumstances and natures of existing claims, areas of exposure and determine current status of all open claims.

• Experience Modification Review – We will obtain and review the current Experience Rating Worksheet for accuracy and identify those claims which have or may have significant impact on current and future experience modification factors.

• Claim Status Reports – We will request claim statuses reports on all open indemnity claims to determine the current status and reserves. We will identify opportunities for reserve reductions and/or closures and offer recommendations to the claims adjusters to move the claims
  to resolution.

Ongoing Services

• Claims Management – We will work with the carrier to aggressively manage open claims. In the present workers’ compensation environment, claims management is vital to controlling costs. As one of the largest brokers for many carriers, including State Fund, we have developed relationships that afford us the unique ability to work directly with the adjusters to coordinate medical management issues, third-party subrogation and investigation of “red flag” triggers on individual claims. Each member of our claim services team has several years of experience in the workers’ compensation industry and our department provides a specialization we feel is unique to InterWest.

• Claim Reviews – Prior to renewal and prior to unit statistical filing we will coordinate an in person claims review with Client, providing a current summary of all open claims. Following the review, we will aggressively audit each claim to ensure reserve integrity, appropriate plan development for timely resolution, and appropriate settlement posture.

• Loss Analysis History – We will monitor on-going claim activity by reviewing Loss Analysis Summaries on a monthly basis. Monitoring any changes to posted reserves as well as medical and indemnity payouts.

• Experience Modification Projections – Within 60 days of the formal unit statistical filing with the WCIRB, we will forecast the future experience modification for Client for the next year. This will provide you with a projection for budgeting purposes of potential future insurance premium expenses.

• Unit Statistical Evaluations – We will review unit statistical filings and published Experience Rating Worksheets for accuracy. We will work with the WCIRB and the carriers to correct and revise experience modifications factors as needed.

• Education and Training – We would like to identify opportunities for training and discussion among management and supervisory staff. We will strive to keep Client informed of any Workers’ Compensation legislation developments, labor code changes, and potential policy changes that could impact your existing program. We have formalized training programs for the following areas:
  
  
  • SB 899 Work Comp Reform Laws
  • First Aid Claims
  • Pre-Designation and MPN’s
  • Claim Management & Investigation
  • Return to Work/Modified Duty
  • Experience Modifications
  • Customized Topics as Requested
    
    
• Other Services – We offer a variety of services based on the needs of our clients including coordinating loss control services with the carrier, assisting with pre-designation and MPN implementation, facilitating program development for First Aid and Return to Work and consultation for workers’ compensation issues.