CLAIMS ADVOCACY

One of the most overlooked services of a top tier agency is their claims handling. Proactive claims handling and strong advocacy can have a dramatic impact on your organization.

PROACTIVE RESOLUTIONS

J.J. Doorhy has dedicated claims specialists whose sole responsibilities are aimed at resolving claims within your best interest. This includes reviewing the circumstances surrounding every claim, working with our insured and carrier to establish a strategy surrounding the claim, reserve reviews, proactive follow ups, consistent communication with our insureds, and Experience Mod Analysis.

Initial Review

Getting a handle on claims in the early onset of a claim is the first step toward ensuring a claim is resolved within your best interest. Here our claims advocates:

  • Review the circumstances surrounding the claim.
  • If situation the situation calls for it, ensure that the carrier is utilizing all it’s investigative tools.
  • Work with both the insured and carrier to establish a strategy for defense or resolution.

Cost Containment

Both cost containment of existing claims and prevention of future claims are part of our risk management roles.

  • Ealy claim analysis for cost containment.
  • Facilitation of early return to work program.
  • Risk management consultation to reduce chances claims repeat themselves.

Reserve Advocacy

The reserves adjustors choose to set on claims has a direct impact on your experience mod. We advocate for these reserves to be as minimal as possible to ensure the least impact on your mod possible.

  • Review justification of reserves.
  • Ensure legal and investigative tools are being exhausted to justify reserve.
  • Advocate for possible reduction of reserves.

Experience Mod Analysis

J.J. Doorhy is partnered with numerous carriers that offer complimentary Nurse Triage service along with workers’ compensation coverage.

  • How claim reserve levels impact your future experience modification.
  • Experience Mod scenarios to project your EMR using different claim scenarios.

Communication

Consistent communication throughout the lifecycle of the claim keeps you abreast of new developments.

  • Proactive claims updates.
  • Consistent follow ups with adjustor to ensure the claim is moving along in as timely a manner as possible.

Nurse Triage

Injured employees receive immediate 24/7 medical advice from registered nurses.

  • Self treatment consultation results in cost containment.
  • Self treatment leads to fewer claims: data suggests in some cases, more than 40% of injuries reported result in injured employer going back to work without a claim.
  • Expedited claims reporting leads to reduced cost of claim.