Statutory claims best practices
When we are auditing we have the pleasure of seeing some really
effective management of statutory claims. The following is a
summary of practices found across a number of high performing
insurers. Please consider how adopting any or all of these
strategies will enhance your claims management practices.
Suggestions include:
- being proactive and contacting the worker when the incident
report was submitted (even before an application for compensation
was received)
- creating a statement template for injured workers to use when
making an application for compensation
- advising injured workers that although they are seeing a
company provided doctor, they have the right to choose their own
doctor
- sending an acknowledgement letter on receipt of a claim at the
claims unit, that includes the due date for the decision to be
made.
- advising claimants immediately about the reasons for potential
delays in determining the claim
- giving claimants the opportunity to comment on evidence prior
to liability being determined
- Claim acceptance letters have included:
- how the payment rate has been calculated
- worker responsibility for medical certificates
- a fact sheet explaining what aggravation means.
- making verbal contact with the claimant to explain the decision
prior to sending the rejection or cessation letter
- emailing communication to the line manager giving a summary of
the decision at the same time as notifying the claimant
- printing the decision letters on coloured paper to easily
identify them within the claim file
- notifying the claimant several days in advance of the cessation
or finalisation of benefits
- when sending out the independent medical examination (IME)
appointment details, providing supplementary information about what
is involved in an IME
- providing a summary and chronology of the claim with the IME
request for complex claims
- all communications with the claimant, line managers and
external providers were respectful and timely
- proactive contact throughout the claims process (keeping the
claimant informed about what was happening to their claim)
- Summaries found at front of file include:
- claim decision plan
- claim management action plan.
- retraining of workers under statutory claims where injuries
preclude them from returning to their original position.
