Claims Audit Verification
Available from CriticalPath Claims Services/Adjuster Assistant®
Claim administrators, insured, their accountants, brokers, agent, consultants, risk managers and claims managers, third party administrators and insurance carriers have dealt with the issue of reserving practices and the costs associated with the reserves. The reserve provides a charge that is hopefully representative of a reasonably accurate final cost. Losses paid are a variable factor that bears directly on the claims practice of the adjuster. How may an insured determine the accuracy of the insurance invoices applicable to Workers' Compensation premiums, aside from the payroll class allocations?
How can an underwriter determine the appropriate rate modifications if the losses are not properly reserved and paid? For example, 20% of all claims are considered to be fraudulent. What percentage of claims has the adjuster investigated? Finally, recognition of the reserving conflict of interest inherent in the experience rated and loss-sensitive insurance rating plans will aid in providing a cost-effective and equitable solution.