Effective claims management has become a sophisticated process and one that draws upon numerous areas of expertise including data analysis, accident investigation, managed care, return to work, subrogation, alternative dispute resolution, structured settlements, and Medicare compliance as well as more traditional areas of claims expertise. Technology is continually evolving allowing the risk manager improved decision-making capabilities. Strong claims management fundamentals can apply to any major line of coverage including general liability, workers’ compensation, and auto liability. This session will explore how to identify key cost drivers, ways to better integrate claims resources, how to achieve faster reporting, the use of performance standards and guarantees, and how to evaluate the quality of your current claims services.
Part 7 claims procedure guide - motor vehicle insuranceOptimuminsurance
A motor vehicle claim form or verbal advice should be provided as soon as practical to your insurer broker or insurer. A quotation for repair is generally required. Some insurers have repair centres so if you are unsure where to take your vehicle to obtain a quote, they can assist you with either providing details of one of their preferred repairers or if they have an assessment centre, you can take your vehicle their and they will look after the repair process.
Part 7 claims procedure guide - motor vehicle insuranceOptimuminsurance
A motor vehicle claim form or verbal advice should be provided as soon as practical to your insurer broker or insurer. A quotation for repair is generally required. Some insurers have repair centres so if you are unsure where to take your vehicle to obtain a quote, they can assist you with either providing details of one of their preferred repairers or if they have an assessment centre, you can take your vehicle their and they will look after the repair process.
Risk management is the process of identifying, assessing and controlling threats to an organization's capital and earnings. These threats, or risks, could stem from a wide variety of sources, including financial uncertainty, legal liabilities, strategic management errors, accidents and natural disasters
Risks which are not capable of avoidance, prevention, reduction to a large extent or assumption may be transferred from one party to the other party. The basic objective of insurance is to transfer the risk of a person to the insurance company which has easily spread it over a large number of persons insuring similar risks. As such, for handling risks which involve large financial losses or which are dangerous, insurance is a means of shifting such risks in consideration of a nominal cost called premium.
Created an insurance claim management pitch deck. The problem, Solution, competitive analysis, marketing analysis, Financial analysis, roadmap, and GTM.
Caseless Mediclaim is the best insurance policy as it has number of benefits. This policy offers insured person all the charges of the hospitalization and treatment. The most important point is we recharge the entire claim if you ever exhaust your health cover.
Risk management is the process of identifying, assessing and controlling threats to an organization's capital and earnings. These threats, or risks, could stem from a wide variety of sources, including financial uncertainty, legal liabilities, strategic management errors, accidents and natural disasters
Risks which are not capable of avoidance, prevention, reduction to a large extent or assumption may be transferred from one party to the other party. The basic objective of insurance is to transfer the risk of a person to the insurance company which has easily spread it over a large number of persons insuring similar risks. As such, for handling risks which involve large financial losses or which are dangerous, insurance is a means of shifting such risks in consideration of a nominal cost called premium.
Created an insurance claim management pitch deck. The problem, Solution, competitive analysis, marketing analysis, Financial analysis, roadmap, and GTM.
Caseless Mediclaim is the best insurance policy as it has number of benefits. This policy offers insured person all the charges of the hospitalization and treatment. The most important point is we recharge the entire claim if you ever exhaust your health cover.
Understand the relevant contractual provisions and different types of claims. Identify the major causes of construction claims and disputes. Learn how to handle your claims effectively using strategies and different solutions. Understand delay cost procedure and process. In depth review on the SOP Act. How to prevent disputes leading to litigation/arbitration/adjudication
Claims Management - Edge through Efficiencyneetamundra
The objective of this paper is to talk about the current state of the claims process and how an efficient and ideal claims system should be. This document is most relevant for the Indian insurance industry.
Training Slides of Claims and Counterclaims Preparation, Analysis, Assessment and Successful Settlement of Disputes , discussing the importance of Claims and Counterclaims.
Some Key-Points:
- The Framework of Compliance
- Corporate Governance
- Compliance Program
For further information regarding the course, please contact:
info@asia-masters.com
www.asia-masters.com
On February 16, construction law attorney, Mike Madigan hosted an in-house seminar discussing construction claim management + project documentation. The seminar focused on the steps to make a claim, key project documentation considerations, and dealing with a claim from the perspectives of the owner, the CM, and the subcontractor.
A panel of top industry professionals provide their expert opinions on current hot-button legal topics and their impact on your operations. Topics include:
• OSHA investigations
• The borrowed servant doctrine and its impact on the relationship between crane companies and their customers
• How you should respond to accidents
• Recovering from at-fault parties and employees for damage to your crane and other property
Moderator: Fred Marcinak, Attorney-At-Law, Smith Moore Leatherwood LLP
Panelists:
Bill Smith, Executive Vice President, Nations Builders Insurance Services, Inc. (NBIS)
Matt Stone, Attorney-at-Law, Smith Moore Leatherwood LLP
Jim Wiethorn, Principal Engineer/Chairman, Haag Engineering
Ethical dilemmas and overlooked issues in private practice ppKate McNulty
Presentation to NASW 2015 conference on social work ethics; includes little-known aspects of ethical responsibilities in independent clinical practice.
Take a proactive position to reduce claim costs and secure optimum benefits. This presentation will help you know the best practices for handling the complex liability claims.
Lessons learned from the Aged Care Royal Commission Interim Report JFM LAW
The Disability Royal Commission is a response to evidence that people with disability are more likely to experience violence, abuse, neglect and exploitation than people without disability
Watch the video above to understand:
Why lawsuits happen
How you can avoid them
How you can properly manage accidents and incidents
Incidents will happen.
How well you are prepared and how you respond are critically important to the manner in which your facility will be impacted financially, legally and beyond.
William Moorehead, President, All Clear Emergency Management Group
Using situational analysis, participants will learn to identify common legal issues in emergency
management and how to enhance response through agreements. This session will examine common
legal issues encountered within emergency management and emergency response including liability and
the formation of mutual aid agreements. The audience will analyze hypothetical scenarios and news
stories to identify potential liability issues. The session will highlight the challenges and barriers to
implementing agreements, benefits of prepositioned contracts, and the importance of putting agreement
in place now before they are needed. The goals of the session are to review the fundamentals of
liability, examine common legal issues, discuss best practices, and analyze situations common in
emergency management.
Chapter 9 A Primer on Medical MalpracticeMalpracti.docxmccormicknadine86
Chapter 9: A Primer on
Medical Malpractice
Malpractice – What is it?
• Error - behavioral matter
• Misperception
• Mistake
• Omission
• Substitution
• Accident - unplanned event
• Malpractice - negligence
Negligence
• An act that a prudent person would not
have done or the omission of a duty that a
prudent person would have fulfilled,
resulting in injury or harm to another
person.
– A civil wrong and part of the law of torts.
– Founded on the relationship between the
actor and the victim
Requirements of an Act of Negligence
• Legally recognized relationship between the
health care worker and patient
• Health care worker has a duty of care to the
patient
• Health care worker breached the duty of care
by failing to conform to the required
standards of care
• The breach of duty was the direct cause of
harm, resulting in the patient suffering
damages as a result of the harm
Malpractice
• Negligence that is the proximate cause of
injury or harm to a patient resulting from
– A lack of professional knowledge, experience
or skill that can be expected in others in the
profession.
OR
– From failure to exercise reasonable care or
judgment in the application of professional
knowledge, experience or skill.
Medical Malpractice
• The commission or omission of an action
causing an injury is shown to arise from
the exercise of professional medical
judgment
• There must be:
– A Physician-Patient Relationship
– A Duty to Perform Professionally
Sources of Professional Standards
• Government statutes and regulations
• Professional society standards
• Voluntary accrediting agency standards
• Administrative policies and rule of the
facility
Theories of Liability
• Informed consent
• Strict liability
• Vicarious liability
• Res ipsa loquitur
Re ipsa loquitur
The thing speaks for itself
– Injury would not ordinarily occur in the
absence of negligence
– Injury was caused by the actions was within
the control of the defendant
– Injury is not due to any action on the part of
the plaintiff
– Evidence surrounding the circumstances is
mostly within the control of the defendant
Hospital Liability for Malpractice
• Respondeat superior
• Ostensible agency
• Staff Privileges
– Corporate Negligence
– Contributory Negligence
Other Liability Theories
• Intentional tort
• Assault and battery
• Libel
• Slander
• Invasion of Privacy
Types of Damages
• Compensatory damage
• Awards for pain and suffering
• Punitive damages
Statute of Limitations
• The maximum period of time after the
patient’s injury during which a lawsuit may be
commenced.
• Most state have a statutory period between
one and three years.
• Typically the statutory period is deferred
(tolled) during infancy and starts to run only
on the patient’s 18th birthday.
Common Malpractice Allegations
• Surgery/post-op complications
• Failure to diagnose cancer
• Surgery/inadvertent act ...
10 Tips for Reducing Wokers' Compensation CostsEPAY Systems
Rising workers’ compensation costs are among many employers’ greatest concerns, as large-dollar claims against companies—especially those who employ hourly, blue collar workers—continue to rise.
While the laws regarding workers’ compensation benefits vary from state to state, all but one state requires mandatory coverage for private employees. Generally, these mandatory benefits include medical bills, compensation for lost time from work, and permanency benefits for the residual effects of a work related injury. Interestingly, medical services provided on a workers’ compensation case are typically billed at a much higher rate than Medicare, state provided health coverage such as Medicaid, and even private group health insurance. Because of this and other factors, the cost of doing business has taken a significant toll on both the traditional “mom and pop” small employer and large corporations in certain states.
While workers’ compensation coverage is a necessary expense for businesses, there are also many indirect costs of on-the-job injuries and accidents, which go beyond your insurance costs. This may include training replacement employees, investigating claims, repairing damaged equipment and property, and implementing corrective measures. Plus, your business may lose productivity and be forced to deal with lower employee morale.
LawSense Conference 2015 - DUTY OF CARE FOR MENTAL HEALTH PRACTITIONERS Kerry O'Brien
The objective of this presentation is to provide an understanding of:
- Your ‘Duty of Care’, how it arises;
- The standard of your ‘Duty of Care’;
- Recent Case Study – ‘Duty of Care’ to third parties;
- ‘Duty of Care’ and the Mental Health Act 2007; and
- Your exposure.
The Impact of FMLA and ADA Compliance on EmployersSedgwick
Presentation at DMEC 2013
Denise Fleury Sedgwick
Barbara LaRocque Pepsico
Letitia gallman Delta Airlines
Ellen Shelnutt SunTrust Banks Inc.
Deborah Jacobs Southern California Edison
Midlevel Operations: Exploring New Expsoures with Allied Health ProvidersSedgwick
Jayme T. Vaccaro, J.D.
Director, Professional Liability Claims
Sedgwick Claims Management Services, Inc.
Jayme.Vaccaro@sedgwickcms.com
www.sedgwick.com
Actuaries and Examiners Talk Numbers: Go Figure!Sedgwick
When actuaries and claims examiners discuss and compare numbers, the resulting conversation can be fascinating. It is the claims examiner that reviews individual claim files and estimates the ultimate cost or reserve associated with each file. It is then the actuary who takes the aggregate claims data and estimates the cost of losses for the historical policy periods and coming year. The expertise and resulting analyses of both can have a tremendous impact on an employer’s program and the organization’s budgeting process. Learn more about both the reserving and actuarial forecasting process and become better prepared to ask questions and contribute to future financial discussions. Panelists will describe the reserving process from the point of view of the claims examiner, review the data and process used to complete an actuarial loss forecast, and talk about the impact these numbers have on the risk management program.
Order in the Court: Litigation Management StrategiesSedgwick
With continued pressure on businesses to reduce their cost of risk, risk managers are focusing increasing attention on managing legal expenses. Given the current economy, there is a tremendous financial pressure for claimants to turn to attorneys for perceived justice and claim resolution. Attorney involvement has been shown to increase claim costs significantly. Resulting outcomes are seldom ideal for employers or employees. The claims process becomes extended, costs increase, and frustrations mount for both sides. This session is designed to provide risk managers with a broader view of how to manage both expenses as well as the process. Participants will learn the benefits of establishing a well-defined legal philosophy, how to select and direct a legal and claim management team, when to consider the use of alternative dispute resolution techniques, and how to effectively employ these techniques to improve the legal outcomes for their own organizations.
Event Report - SAP Sapphire 2024 Orlando - lots of innovation and old challengesHolger Mueller
Holger Mueller of Constellation Research shares his key takeaways from SAP's Sapphire confernece, held in Orlando, June 3rd till 5th 2024, in the Orange Convention Center.
The world of search engine optimization (SEO) is buzzing with discussions after Google confirmed that around 2,500 leaked internal documents related to its Search feature are indeed authentic. The revelation has sparked significant concerns within the SEO community. The leaked documents were initially reported by SEO experts Rand Fishkin and Mike King, igniting widespread analysis and discourse. For More Info:- https://news.arihantwebtech.com/search-disrupted-googles-leaked-documents-rock-the-seo-world/
3.0 Project 2_ Developing My Brand Identity Kit.pptxtanyjahb
A personal brand exploration presentation summarizes an individual's unique qualities and goals, covering strengths, values, passions, and target audience. It helps individuals understand what makes them stand out, their desired image, and how they aim to achieve it.
Putting the SPARK into Virtual Training.pptxCynthia Clay
This 60-minute webinar, sponsored by Adobe, was delivered for the Training Mag Network. It explored the five elements of SPARK: Storytelling, Purpose, Action, Relationships, and Kudos. Knowing how to tell a well-structured story is key to building long-term memory. Stating a clear purpose that doesn't take away from the discovery learning process is critical. Ensuring that people move from theory to practical application is imperative. Creating strong social learning is the key to commitment and engagement. Validating and affirming participants' comments is the way to create a positive learning environment.
VAT Registration Outlined In UAE: Benefits and Requirementsuae taxgpt
Vat Registration is a legal obligation for businesses meeting the threshold requirement, helping companies avoid fines and ramifications. Contact now!
https://viralsocialtrends.com/vat-registration-outlined-in-uae/
LA HUG - Video Testimonials with Chynna Morgan - June 2024Lital Barkan
Have you ever heard that user-generated content or video testimonials can take your brand to the next level? We will explore how you can effectively use video testimonials to leverage and boost your sales, content strategy, and increase your CRM data.🤯
We will dig deeper into:
1. How to capture video testimonials that convert from your audience 🎥
2. How to leverage your testimonials to boost your sales 💲
3. How you can capture more CRM data to understand your audience better through video testimonials. 📊
Understanding User Needs and Satisfying ThemAggregage
https://www.productmanagementtoday.com/frs/26903918/understanding-user-needs-and-satisfying-them
We know we want to create products which our customers find to be valuable. Whether we label it as customer-centric or product-led depends on how long we've been doing product management. There are three challenges we face when doing this. The obvious challenge is figuring out what our users need; the non-obvious challenges are in creating a shared understanding of those needs and in sensing if what we're doing is meeting those needs.
In this webinar, we won't focus on the research methods for discovering user-needs. We will focus on synthesis of the needs we discover, communication and alignment tools, and how we operationalize addressing those needs.
Industry expert Scott Sehlhorst will:
• Introduce a taxonomy for user goals with real world examples
• Present the Onion Diagram, a tool for contextualizing task-level goals
• Illustrate how customer journey maps capture activity-level and task-level goals
• Demonstrate the best approach to selection and prioritization of user-goals to address
• Highlight the crucial benchmarks, observable changes, in ensuring fulfillment of customer needs
Personal Brand Statement:
As an Army veteran dedicated to lifelong learning, I bring a disciplined, strategic mindset to my pursuits. I am constantly expanding my knowledge to innovate and lead effectively. My journey is driven by a commitment to excellence, and to make a meaningful impact in the world.
1. Jeff Brody
Divisional Safety Director, Pepsi Cola Bottling Company of New York
Kathy Tazic
Senior Vice President, Client Services, Sedgwick
Vicki Telford
Director, Global Insurance and Risk Management, Hanesbrands Inc.
Tuesday, April 23, 2013
Session Time: 2:15 to 3:30 p.m.
4. Workers’ compensation
• What are the most important aspects of
the claims investigation process?
• Timely witness interviews
• Detailed written report
• Recorded statements where appropriate
• Evidence
• Why investigate a claim?
5. Workers’ compensation
• Questions revolve around these
four basic elements and their
relationship to one another
• Develop a good checklist that
helps identify the pieces of the
accident “puzzle” and how they
fit together
• Job safety analyses (JSAs) can
be very helpful by providing the
foundation of the investigation
6. Workers’ compensation
• Once the information is gathered, it’s time to
get it off to your TPA or insurance adjuster
• Ask 5 “W” questions: who, what, where, when
and, most importantly, why
• Team approach usually works best
• Take pictures and get prompt interviews
• Root causes sometimes are elusive,
but without them, it’s Groundhog Day!
7. Workers’ compensation cost of reporting lag
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
< 3 Days 3 to 7 Days 8 to 13 Days 14 - 30 Days > 30 Days
WC Average Cost
WC Average Cost
8. General liability
• Work from a checklist
• Develop/ personalize your form
• Team effort with insured is critical
• Always keep fraud in your process
• Get a statement from claimant, written or recorded very
early on before they lawyer-up
9. General liability
Try to secure
information from
multiple sources
Look at the scene, take
photos, is there a defect,
was there notice? - get
internal report
Anyone working in the
area? - canvas for
witnesses
Did claimant contribute
to the event?
Was it a product that
caused the accident -
who made it?
Cameras are
everywhere these days!
10. Auto liability
• Paperwork – where is the form
• Pedestrians, bicyclists, skateboarders
• On-scene pix are essential
• Fraud – huge issue in auto liability
• By the way, whose fault is it – witnesses
• Drivers and other occupants
11. Auto liability
• Responders
• Police, fire, EMS
• Accident reconstruction
• Property damage experts
• Distracted driving -
telematics (technology to
capture real-time info)
• Comparative negligence
• Arbitration - we need
another set of eyes and ears
14. Workers’ compensation
• Roles and responsibilities
• Adjuster
• Nurse case manager
• Utilization review
• Pharmacy benefit management
• What is it and why is it critical?
• Examples of medical management tools
15. General liability
• Sometimes we will get a second medical opinion
on necessity of all treatment, issue of tangential
injuries, soft tissue claims and maximum
medical improvement or future care but this is
usually later in the claim
• Check for priors - do an ISO search - never know
what will turn up - there are way too many
‘professionals’ out there!
• Seldom do we get to manage medical treatment
16. Auto liability
• Medical management of your employees will be
pursuant to workers’ compensation
• No fault - an opportunity for medical mills to do
their $$$ thing
• Not much opportunity to manage driver/other
occupants
• HIPPA laws prevent prying eyes
• Use activity checks – know who your claimant is and
what type of lifestyle they are leading
19. General liability
• May require second medical opinion,
life care plan, modifications to home
or vehicle
• Ongoing physical therapy, prosthesis,
home care may be warranted
• Settlement may need Medicare
approval
• Disability does not mean the end
20. Auto liability
• For your employees refer
to workers’ compensation
• For other driver and
occupants
• Carefully scrutinize injury,
treatment and recovery in light
of severity of collision
• Pay special attention to psych
claims
• Often unable to control third
party Where else? Queens, NY!
23. General liability
• Work with counsel, share all information available, statements, photos,
claim, previous history of claims from claimant, problems with the site
• Defend or negotiate a settlement - take a position
• Attend settlement/mediation hearings, have pre-arranged range of
agreed upon values
• Let the attorney do the talking - but make sure you understand what he is
saying and why
• Stay away from jury trials in unfriendly venues bent on giving away your
client’s money
• Be ready for day of haggling - it’s an art - learn it!
• 90% of claims can resolve prior to court
24. Auto liability
Ability of adjuster to
resolve matter prior
to litigation
• Settle non-disputed
portions of the claim
Settle v. litigate -
what is your
preference
Work with a team of
trained legal
professionals familiar
with your business
• Clear understanding of
your legal strategies
26. Workers’ compensation
Some settlement strategies
and considerations:
• Adjuster negotiations
• Mediations
• Use of annuities
When is it a good idea to
settle a claim?
What constitutes an
acceptable result?
Other tools, including
surveillance
27. General & auto liability
• Goal should be to resolve prior to attorney on board - negotiate fair settlement
with pro se claimant
• If the claim is multi-part, settle what you can where liability is clear
• You can still negotiate with attorney prior to S&C – don’t be intimidated - use
mediation or arbitration if far apart
• Review defenses and immunities early on, if counsel agrees, seek a motion for
summary judgment (MSJ)…if not:
• Fact find from involved parties, witnesses and experts
• If unfavorable – negotiate settlement
• Don’t be intimidated by a huge med file
• Use settlement or mediation when possible - if you can’t settle within range of
comfort, get ready to defend
A Job Safety / Hazard Analysis helps in this aspect:Task – Was an unsafe work procedure used?Change in normal work conditions? Appropriate tools and materials available and used?Safety devices working? Lockout/tagout used, if applicable.Material – Was there equipment failure, and if so, what caused it to fail? Was material badly designed?Were hazardous substances present, and were they clearly identified?Was correct PPE used? Were users of PPE property trained?Was there regular maintenance of equipment?People – need to stress that you are not trying to assign blame, but you do need to explore the human factors involved, such as :Was the worker properly trained and experienced ?Physically able to perform tasks?Tired? Stressed? Health issues?What about substance abuse? – post accident testing – in many states, if EE was under the influence and it was sole cause of event, employer has a remedyIn looking at management, need to ask: were safety rules adequately communicated & understood by all? Written procedures enforced? Was there adequate training and supervision?Were unsafe conditions corrected? Adequate on-boarding / OJT program if new employee?Environment – What were the weather conditions? Was poor housekeeping an issue? Was it too hot or too cold? Was excess noise a problem? Was there adequate lighting? Were hazardous gases, dust , smoke or fumes present?
You are seeking to find the root cause(s) of the incident, and thus develop a plan to minimize the possibility of a re-occurrence. Who should be on the team? Safety managerSafety committee member(s)Injured worker’s supervisorOther supervisor familiar with the job
Critical to get claims investigated and reported promptly. The longer you wait, the fuzzier the details become and the likelihood of attorney involvement increases.This is for med-only (first aid) and incident only, not just lost time