Claims Audit Verification

Claims Reserve/Paid Loss Management

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.

Benefits of Claim Verification

Reduce Premiums by Reducing Reserves and Losses Paid

  • Demonstrate an improved loss history & facilitates underwriting history.
  • Produce higher dividends & lower retrospective rated premiums.
  • Results in lower earned premium audit bills.
  • Produces underwriting profits.

Verify Claim Files Handled, Adjusted and Maintained by:

  • Commercial Insurance Carriers
  • Independent Third Party Administrators
  • Group Trusts
  • State Insurance Funds
  • Safety Groups 
  • Captive TPA's
  • In-House Administration of Self-Insurers

Claims Verification management reduces the cost of:

Claim Verification costs an average of $7.50 per claim per week*. We will provide a detailed, confidential proposal.

  • Large Deductible plans (Self-Insured Plans)
  • Retrospective rated Plans
  • Scheduled Dividend Plans
  • Retention Plans
  • Cost-Plus Plans
  • Average claim is open 208 weeks.

Verification Reviews For:

  • Insured
  • Brokers
  • Agents
  • Consultants
  • Accountants
  • Attourneys
  • Benchmark Reviews for Carriers/TPA's

Additional Verification Applications:

  • Premium Adjustment Reviews
  • Dividend Statements
  • Litigation Support
  • Due Diligence for Merger/Acquisitions
  • Claims Auditing Documentation Verification