TPA launches claims advocacy program

TPA launches claims advocacy program | Insurance Business America

Workers Comp

TPA launches claims advocacy program

Program aims to provide compassionate claims services for workers’ comp

Workers Comp

By
Steven Byerley

American Claims Management, a third-party claims administrator, has announced the launch of its Claims Advocacy Program.

The initiative aims to provide compassionate claims service while simultaneously reducing workers’ compensation costs for employers and insurance companies.

“Restoring the health of injured workers is and should be the goal of workers’ compensation coverage,” said Dhara Patel, president of American Claims Management. “Our Claims Advocacy Program puts that goal front and center by bringing empathy, compassion and patience to support an injured worker.

“We’ve found that patiently listening to an injured worker and following an established protocol to advocate for their health gets people back on the job faster and away from the distraction of a legal process,” Patel said. “The Claims Advocacy Program has helped us resolve claims faster with less litigation and lower payouts, because the patient observes that the insurance company or employer is working with them, rather than against them.”

The Claims Advocacy Program encompasses various essential components, including protocols to ensure that the injured worker’s perspective is heard and valued throughout the claims process. It also features a dedicated return-to-work program, a specialized head injury claims program, a pre-surgery pain screening program, and utilization review procedures for claim denials related to surgery. This involves effective communication with the injured worker and the treating physician to determine an appropriate course of treatment. The program also emphasizes early intervention for high-risk claims, which is triggered when specific criteria are met.

“The good results we’re seeing in lower claims costs and faster returns to work are due to the Claims Advocacy Program protocols we’ve put in place, the training of our claims professionals, and the review and accountability to which our team commits,” Patel said.

Notably, disability payments were reduced by over 50% and legal expenses decreased by nearly $400,000 during the program’s initial quarter.

The Claims Advocacy Program is available to injured workers covered by workers’ compensation accounts serviced by American Claims Management nationwide. This includes the Arrowhead Workers’ Compensation Program, which is a specialized workers’ compensation program offered in Alabama, Arizona, California, Georgia, Nevada, North Carolina, South Carolina, and Tennessee.

American Claims Management, a division of Arrowhead General Insurance Agency, has developed this program in collaboration with a longstanding insurance carrier customer over the course of several years.

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