Managing Evidence-Based Self-Insurance Plans

Instead of contracting with a traditional health insurer to provide group health insurance, many organizations are turning to self-funded insurance plans that are managed by third-party administrators or an outside health management company. According to the Employee Benefit Research Institute (EBRI), about 50 million workers are covered with self-insured group health plans. To help reduce costs and errors associated with these plans, many of these entities are now evolving into “evidence-based” self-insurance plans.

Because self-insured plans are subject to the Employee Retirement Income Security Act (ERISA)–the federal law that protects employees’ retirement income and benefits–the same rights that are available to insureds with traditional healthcare plans are available to individuals on a self-insured corporate plan. This means that when treatments are denied, for whatever reason, the patient has a right to appeal the decision and have it reviewed by a like specialist not involved in the original claims decision. When such a dispute arises, TPAs and self-funded insurance managers are required, by ERISA and state laws, to have questionable cases reviewed by non-biased specialists within specific timeframes.

The primary issue here is how do the management companies, without a full medical panel on staff, decide that treatment decisions are based on proven medical evidence each and every time? How do these companies ensure that they are staying up-to-date with the latest medically approved treatment options?

While some cases are obvious, partnering with an Independent Review Organization (IRO), such as AllMed Healthcare Management, may be just the answer to this issue. An IRO can provide access to the broadest panel of specialists that can make sure decisions are based on proven medical evidence. And, an IRO can also help guarantee state and federal deadlines are met by turning around review decisions within 48 hours or less. For more information on how an IRO can help your organization, please contact AllMed at 800-400-9916.

Why You Need To Hire A Public Insurance Adjuster

There is an old saying among the practitioners of the legal profession, “anyone who represents themselves in a court of law has a fool for a client.” This is frequently also true when it comes to negotiating a property damage claim with an insurance company as well.

When the average insurance consumer has an insured property damage loss, they frequently have no idea how to prepare, adjust or submit their claim. Most of the insurance buying public must rely on their “Insurance Company’s” “insurance adjuster” to do that for them. That is a huge mistake. What the average consumer does not understand is that it is the insurance adjuster’s job to present “reasonable” settlements to policyholders and claimants. The average consumer lacks the basic skills and necessary information to build the foundation upon which a claim is made. A licensed and bonded Public Insurance Adjuster or PA can pour the footings and build the walls to make that happen. Do you want the house of straw, sticks or brick?

Knowledge is power, power is leverage. The more you or your personal representative know, the more power and control you have in the claims process. Depending on the company, insurance adjusters receive two to four months of intensive training in claims settlement procedures and then continuous dollar saving training over the rest of their career. All of this training is to save the insurance company money. How do you compete with it?

Company Adjusters are trained to cut corners and save their company money. With the recent news about delay, deny and defend tactics being implemented by some of the larger insurance companies it is obvious many companies are looking for even more ways to limit claim payments or avoid making any claim payments altogether.

When filing an insurance claim you need someone in your corner looking out for your interests. The objective in adjusting should be to get as good a result as possible, as quickly as possible with as little trouble free as possible.

An insurance policy is a legal contract. An insurance claim is a request for performance under a legal contract. The problem most property owners face is not one of intelligence or determination but rather a lack of training, ability, information and understanding. Would you hire your gardener to remove your appendix? Then why would you represent yourself in a contract negotiation.

If the insurance company gets their way, only the person representing the insurance company is considered the adjuster. When this is the case the policyholder receives his or her adjustment from a loyal company employed, company paid, company inspired and company motivated adjuster.

In order to arrive at a fair adjusted settlement, each side needs to satisfy their own needs. The less information you have, the more likely you are to accept the needs of the insurance company as your own. To get a fair settlement you must determine and access your claim damage recovery needs. To get a fair settlement you must know your rights. A Public Adjuster can help you achieve both of these goals. If you don’t know what you need or how to ask for it you may be overwhelmed by the sheer volume of information provided or requested and surrender your needs much too easily.

No one, not even the Public Adjuster knows the outcome of a claims settlement before the adjustment begins. As such no one can anticipate to what extent either party will give in to the needs of the other. Knowledge and experience usually become the bargaining power which leads to a closed claim file. The facts usually rise to the surface as the claim is investigated. Claims adjusting should always be approached from the position of strength and knowledge that only a Public Adjuster can offer. Negotiating from a position of weakness is not an option.

Insurance adjusters facing a knowledgeable public adjuster usually enter claim negotiations on a more cooperative give and take basis. With this being the case there is a strong likelihood that each will strive to attain the common goals and achieve a settlement that is fair to all parties.

The average policyholder ends up dealing with a claim at a time following a disaster such as a fire or theft. The psychological stress leaves most people in a state of confusion. This means they are not up to the task under these circumstances. It is very common to see people in a state of shock, confusion and helplessness after a loss, especially after the death of a family member or cherished pet. A professional public adjuster should be emotionally detached from the situation and enter the claim with a level head and competent ability.

The time of a personal disaster is not the time to be thinking about all of this for the first time. Think about it now and take comfort in the knowledge that a Public Adjuster can be there to protect your interest if indeed the unthinkable happens to you.

A Public Adjuster is not an attorney or lawyer, although an attorney may be a Public Adjuster. The PA is a negotiator trained in the insurance contract and how to evaluate a property damage claim. Since they are not lawyers their fees are substantially lower. Depending on the state, Louisiana being a notable exception, the average public adjuster charges a fee equal to ten percent (10%) of the total claim settlement. Even if you have proudly handled the first half of the claim yourself, they still get their fee based upon the entire claim settlement. The biggest reason for this is they have to go back and fix all the problems the unskilled self declared claim experts have left them.

This article is for informational purposes only and is not to be considered as legal or profession­al advice. This article can be reprinted only in its entirety and used by permission only with proper citation. It can be divided in to one or more news letter articles as long as printed in its entirety overall.

Incident Reporting Enhances Personnel Management

In many lines of business, personnel are a company’s most valuable and expensive asset. Protecting employees and protecting a company’s finances from them are a crucial and double-edged sword. There are several steps that can and should be taken to reduce risk for employee and liability for employers. These include proper FROI (first report of injury), detailed attendance reporting, regulatory compliance, incident reporting, and potentially the outsourcing of these services.

FROI, or first report of injury, is a critical component to compliance with workers comp guidelines. Whether or not an employer agrees with an employee, the FROI must be filed. Typically reports are required when an injury causes an employee to miss 5 or more paid workdays, and must be submitted within seven business days of the fifth missed day of work. Each state has its own FROI form, available online, which should be completed in quadruplicate. One copy must go to the state, one must go to the employee, one to the insurer, and it is recommended to keep one for business records. If a doctor sees the employee, and the employee complains of work-related injury, he or she is also compelled to file a report. Neither report exists to comment on the veracity of the employee or employer, but solely to begin a paper trail to ensure that dates, times, and places can be known to as great a specificity as possible when ascertaining the proper course of action. Like FNOL (first notice of loss), the more promptly and accurately FROI forms are completed, the more likely a positive outcome.

In addition to workers compensation claims and FROI, employee absences can slow down an organization. As soon as an employee reports an absence, there are many steps to be taken. Automatic notification of all affected parties, activation of procedures to find a replacement, and beginning the intake process for absences related to short-term disability, long-term disability, or Family Medical Leave Act (FMLA) incidents are all crucial elements. Beyond this, an absence reporting system should record when absences will begin and when employees will return so a team or company can plan accordingly.

It is equally critical to stay connected with feedback from employees regarding fraud, theft, sexual harassment, ethical concerns, equipment breakdowns, and safety matters to eliminate potential problems before they evolve into serious liability issues and lawsuits. Proactively soliciting feedback from employees not only reduces your liability, but also increases retention rates. Furthermore, it improves the work environment for all employees while staying in compliance with the Sarbanes-Oxley Act of 2002, which mandates that companies provide a way for employees to submit anonymous reports about financial irregularities without fear of retaliation. Outsourcing FROI, absence reporting, and employee feedback systems can substantially increase employee satisfaction while decreasing costs.

Role of Insurance Lawyers in Your Legal Battle

Accidents can happen to anybody, anytime. In case of personal injury or disability, the plaintiff may require immediate medical intervention. He or she may not afford to wait for a settlement or judgment to pay medical bills. In such a situation, competent insurance lawyers can come to the rescue. They possess the tact and the tools to deal with such cases.

Why do you need a lawyer?

Personal injury cases are different from those of property damage. In case your house is damaged, you can always stay in a hotel until it is repaired, but what would you do when you are hurt or disabled and out of work? In such a case, you need an immediate resolution. Moreover, there is a time limit until which you can file a claim for compensation.

This means, you cannot wait until your physical and mental trauma gets over. You have to make your move amidst trauma and confusion. There are times when your mind gets blurred, making it difficult to think and decide properly. That’s why experts advise to hire a lawyer, so that he or she can handle things for you.

Perhaps, this is the reason it is often said that when you meet with an accident, two people to call first are the cops and the lawyer. Others can come later.

Insurance claims process

When you file a claim for insurance, you are actually making a formal request to the insurer to give you the compensation as promised in the policy.

Sounds simple, right? However, it is not so.

To be precise, insurers have contributed to making things complicated. The process features several stages, such as submission of claim, review, and approval or denial, which is based on the examined validity of your situation.

When your claim gets denied, it implies that the insurer does not see your injury or disability to be severe enough to meet the requirements of compensation. In case you feel that your claim denial is unjust, you must contact insurance lawyers. They will assess your case and give you the true picture.

Remember that insurance companies are here to make money. They have no mood for social service. So, they usually put up a fight or create a scenario that helps them to deny claims or settle the case for a lesser amount. They have become infamous for this actually.

Don’t let their ambitions of earning profits come in your way of getting justice. According to experts, you must keep copies of every interaction with your insurer. This helps to build a strong case. Your lawyer can use this while preparing an aggressive defense in case you decide to sue your insurer for wrongful denial of your insurance claim.

Qualified insurance lawyers are equipped with the right legal knowledge, resources, skills, and experience to help people get their due compensation. Why not take the benefit of such a rich legal aid? Why suffer in silence? You are not obliged by any law or policy to silently accept the verdict passed by an insurance company. It’s your turn to put up a fight.

How to Pursue an Appeal Properly for Denied Claims?

Resolving medical claim denials at the right time is critical when it comes to obtaining timely and accurate reimbursement. Unresolved claims can adversely affect the cash flow of healthcare practices. The opportunity to file appeals for rejected claims is a great relief for medical service providers.

Five levels of appeals are allowed in the case of Medicare claims.

  • Re-determination of Claims with Medicare Contractor
  • Re-consideration with Qualified Independent Contractor
  • Office of Medicare Hearings and Appeals (OHMA) Claim Review
  • Medicare Appeals Council Review
  • Review under Federal Court

Healthcare entities can try each level if they disagree with the outcome of the previous level. Revoking the denials through appeal process is not an easy task. Appeals should be genuine with strong reasons to move on to the next level and argue against the rejection. Also, the appeals need to reach the relevant authority before the deadline. Hence, if an organization decides to pursue an appeal, they need a good appeal letter and an efficient appeal management system to make the most of the opportunity.

Requirements of a Good Appeal Letter

Before writing the appeal letter, it is imperative to find out the exact reason for the claim denial and include the documentation of what happened actually for denying claims, along with the clinical outcome. The aim of this documentation is to show the authority that you have followed all the required procedures. Call the payer directly and/or collect all relevant documentation so far to find out the real reason behind the denial.

Precisely, a good appeal letter requires background information about the denial, actual issue, request for Medicare-severity diagnosis-related group (MS-DRG) and detailed explanation of the request. The letter should also include all documents that support the request, such as Coding Guidelines, Coding Clinics and more. In the case of an outpatient appeal letter, it is required to include relevant CPT Assistants, Medical transmittals and Coverage determinations (both local and national).

The Right Approach to Write an Appeal Letter

The approach may differ according to the type of appeal letter. Let us see what the right approach in each case is.

Medical Necessity Appeal

Medical necessity appeal can be filed if the claim is denied due to the absence of medically necessary services. In this case, denials are focused on short stays. The right format for this appeal letter is as follows.

  • Begin with a summary of rejection and then include a paragraph which makes clear and comprehensive arguments about the relevant process of the hospital to assess the admissions for level of care decisions to provide services.

  • An appeal letter should keep the reader engaged by providing all details of the patient such as age, sex, and medical history. Talk about all the circumstances that ultimately led to the admission.

  • Scrimping on the details is not a good practice. Instead, include information such as patient’s condition at the time of diagnosis, treatment received in the emergency department, symptoms after treatment, treatment for which the patient was admitted and daily status during the stay wherever necessary.

  • Finish the story with the discharge information and details of treatments and/or services advised after discharge.

  • Once the detailing is over, add references to standards of care and/or community norms. For example, clarify whether the patient meets the guidelines laid down by hospital management. It is better to reference Medicare Benefit Policy Manual and add a paragraph about physician’s intent.

  • Finally, write a summary on how the arguments in the letter support Medicare’s definition of an inpatient.

Administrative Appeal

Administrative Appeal is filed when the claim is rejected due to non-medical or technical reasons such as not meeting deadlines, not following important guidelines and so on. The format of this appeal letter is discussed below by considering the example of a weak clinical argument as denial reason.

  • Focus the letter on the factor which acts as the basis of medical necessity determination. In the example, medical necessity determination depends on whether the services meet the requirements of Medicare’s definition of inpatient admission. Hence, the letter should focus on the intention of the physician to admit the patient as inpatient.

  • Add relevant references from Medicare Benefit Policy Manual. Medicare’s definition of inpatient can be added in the example.

  • Submit support documentation regarding the argument made in the letter. Here, the argument is that the treating physician intended that the patient needs to be admitted into hospital for inpatient services.

Coding Appeal

Coding appeal is forwarded if a claim is denied due to coding error. The appeal letter in this case should be clear and well-organized with documentation which supports the DRG (Diagnosis Related Group) billed. Thorough research on coding rules and coding updates is necessary to ensure accuracy. In addition to this, include any rules or definitions that are pertinent.

Proper Management of Appeals

An efficient appeal management system involves the following procedures.

  • Tracking and Review – Maintain a system which can track and monitor both denials and appeals so that you can ensure appeal letters are sent in a timely manner. Check the queue in that system and distinguish partial denial low-balance claims (not good to pursue for an appeal) and large balance claims. Review each appeal and decide whether it is worthwhile to pursue.

  • Prioritizing and Grouping – Assess the dollar value of claims and prioritize them to determine whether it can go through at least one round of appeal. Then, check the age of the denial, whether it belongs to clinical or non-clinical category, and the type of insurance for grouping them into similar denials. It will help to carry out the appeal writing process in batches, which is quite efficient.

  • Organizing in Proper Order – Organizing appeal letters will help to send them before the deadline. Create a template which contains pertinent information such as patient name, account number, medical record number and other details. Use a database for arranging appeal letters according to their due date so that it will be easier to select the most crucial letter.

  • Selecting an Appropriate Author – Choosing a knowledgeable person to write the appeal letter is very crucial. Consider the type of appeal before looking for an author. A person who has a strong clinical background, distinguished analytical skills and thorough knowledge in Medicare rules and regulations, and billing and legal formalities is best for writing medical necessity and administrative appeal letters. For coding appeals, a professional well versed in medical coding rules and regulations is needed. In both cases, speed is very important as the appeal letter has a deadline.

It is very difficult for a provider to pursue appeal letters as it is an arduous task which needs time and dedication. A professional medical billing company providing revenue cycle management services will be a great support in this regard.

Car Insurance Is Not Required in All States, Despite What Some Insurance Companies Claim

Car insurance is set in place to protect both you and others from the high price of car repairs. This is the reason that almost every state makes it mandatory that a person has car insurance when they register a vehicle. If a person who does not have insurance hits you, they will be fined but you will have to pay for the repairs if they are unable to. If you are driving without insurance, a person could take you to court to recover the cost to repair their property damage and medical bills.

A few states will allow you to register a vehicle without car insurance with conditions. In New Hampshire, if you can show that you can cover the cost of damages immediately, then you do not need to be insured. However, many argue that if you can show that you can quickly cover the damaged, then you can also afford car insurance.

In addition to New Hampshire, other states have other options to car insurance. Virginia and South Carolina will allow a person to drive legally without vehicle insurance if they pay $500 to the state. You will receive a receipt that must be shown if you are pulled over by a law enforcement officer. If you do not have the receipt with you, then you can be ticketed for driving without insurance. This finding will also make you responsible for any court cost that is required. It is important to note that you will still be liable for the damages you cause in the accident.

South Carolina also has an uninsured motorist fee, and it is $50 more at $550 each year. The driver is still liable for damage, and it is due every year. Many car insurance plans that offer just the bare minimums for the state cost less than $550 a year. You are also taking a huge gamble by not having insurance to protect your vehicle and people inside from damages.

If you want nothing more than liability if there is an accident, then this fee is for you. Most people who opt for this method do not have any assets to lose and want to drive in a legal manner. Unfortunately, they rarely own much, which makes it difficult to get the money for repairs.

There are many who do not understand why insurance is so necessary. Some companies would tell you it has to do with the covering the possibilities. A handful of people that opt to take the optional fee are gambling that they will not get into a wreck. If they do hit someone, they could look at the property damage of several thousand dollars. However, there are also the medical bills that can quickly accumulate with the price of chiropractic care and x-rays.

Compensation Claims – The Pringle Poppers

Typically accidents occur and there are many reasons why hundreds of people everyday file compensation claims. Questionably it can be for the money, but realistically it’s for the loss, pain and suffering.

Sadly you could be unfortunate to have met with an accident injury and someone else was responsible for it then you have the right to make a compensation claim. The first thing that perhaps anybody would do will be to go to a personal injury solicitor.

There are also many   claims   management  firms popping up every day, unethically trying to help injured people. With the meaning of popping up, there is also an increasing trend of  claim   management  firms popping over. As in closing down!

The faster they pop up, the quicker they close down. So the technique is simple, look for the benchmark firms. The ones that create and innovate and last years, rather than ones that are famously quoted, here today, gone tomorrow.

Types of Accident Compensation Claims

Mainly any type of accident compensation claim gives you the right to make a legal claim for compensation. The most common compensation claims made are for:

· Accidents at Work

· Slip and fall accident.

· Bike or car accidents

· Injury using a defective product

· Injury or death caused due to medical accidents

· Shoddy work by a dentist

Compensation According To The Damages Incurred

If the defendant agrees to take responsibility for the injury then he will compensate for the damages you sustained. Your compensation claim solicitor will be able to advice you on the amount you can claim and receive for your injury. Depending on the damages you will get compensation regardless it being large or small. Damages are of two types: General damages and Special damages.

Personal Injury General Damages

General damages, is the compensation amount that you would get for the pain, suffering and loss of amenity you had to go through because of the accident injury. For you to make this claim a solicitor would have to obtain a medical report confirming your medical history in connection for what you are claiming for.

The circumstances of the accident, the injuries you received and further treatment you have to undergo have to be explained. Your injury solicitor would then be able to give you an estimate as to how much money you should be awarded.

Given below is a list of different types of body injuries for what you can claim for. Only after going through past records of the amount awarded to similar victims in similar cases, your solicitor would be able to advise you on the amount you can expect to receive.

· Head Injuries

· Eyes Injuries

· Hearing Injuries

· Dental injuries

· Neck Injuries

· Shoulder Injuries

· Back Injuries

· Arm Injuries

· Elbow Injuries

· Wrist Injuries

· Hand Injuries

· Pelvic or Hip Injuries

· Leg Injuries

· Knee Injuries

· Ankle Injuries

· Psychiatric Injuries

· Post Traumatic Stress Disorder

Personal Injury Special Damages

Special damages would cover all expenses and losses, which you directly incurred because of the accident. A claim for compensation would include prescription charges, over the counter medicine, loss of earnings, loss of overtime and also for the time and care of any assistant, even if it’s by a family member.

You can also claim compensation for any future losses such as loss of earnings if your ability to work in the future has been affected because of the accident. Your medical report will support this. You should also produce all receipts for any expenses incurred if you want to recover them back as well.

So, before pursuing with a claim, make sure you have all supporting papers or reports to help with your case. By getting a solicitor involved with only make life easier. Also see to it that you get an experienced and licensed solicitor who can help you with all the proceedings.

4 Tips to Help You Claim Insurance Benefits

Chris was involved in an accident and couldn’t go to work for a few weeks. He wasn’t worried since he had accident insurance which entitled him to claim insurance benefits for that period. However, when Chris’ claim was processed, the claim amount he received was much lower than what he asked for.

Why did this happen? In Chris’ case, he made a few mistakes while filing his claim. You can prevent the same thing from happening to you by following these simple tips while claiming insurance benefits.

Tip 1: Submit valid documentation

The most common reason for reduced insurance benefits from claims is insufficient documentation. Insurance companies rely on the claimant’s lack of legal knowledge to drive down claim amounts. You can avoid this by carefully reading the fine print in your policy and providing complete and up-to-date documentation as required. A better option would be to engage the services of an injury claims lawyer who can help you with the required claim procedure.

Tip 2: Back up your claim with evidence

Ensure that you provide all necessary evidence to substantiate your claim for insurance benefits. This includes medical reports, doctor’s bills, recent paychecks (to calculate income lost), police statements, etc. Excluding any relevant bit of evidence may make a big difference to your claim.

Tip 3: Prepare for routine checks

Remember, the insurance company is not your friend. When an insurance agent calls you, it is his job to get you to settle for a lower claim. Your accident lawyer can help you prepare for these calls by guiding you on how much information you can divulge and trick questions to avoid.

Tip 4: Be honest with your claim

This may seem obvious, but it is actually one of the most important factors in claiming insurance benefits. If the insurance company’s enquiries fail to verify the information you have presented, you could wind up with little or no insurance benefits at all. In addition, you may even be in trouble for filing a fraudulent claim.

The Top 6 Workers Comp Insider Secrets

For most organizations, employee related costs are one of the biggest drains on the bottom line. And workers compensation insurance is often the main drain. Unlike the price of gas, however, understanding these six workers compensation insurance industry secrets can help owners and managers aggressively control these costs. So what are they?

1. Insurance companies don’t pay for your employee injuries – they just finance them for you.

Do you realize that oftentimes you pay $2 to $3 back to your insurance company for every dollar they pay out for your employee injuries? Each claim results in an extremely expensive financing contract. You pay your premiums. Then you have to pay for almost all of your claims. You pay:

– For employee injuries through lost dividends and return of premium

– Increased costs because your Experience Modification skyrockets

– Lost productivity

– Reduced morale for the unhurt employees who fill in for the injured employee

– Increased stress for management and staff

Workers Comp does not pay for employee injuries. You do!

2. Insurance Company Claims Management Services are usually horrendous.

Now that you know you write the checks for your employee’s injuries you should realize how critical it is for you to demand aggressive claims management. Claims adjusters are snowed under with too many cases. Your injured employee doesn’t get the attention he or she deserves. In spite of this, insurance companies continue to downsize as they strive to increase profits. Add Managed Care to the mix and your employee’s claim is often outsourced to a case management company. The adjuster doesn’t even know what is happening or how your injured employee is being treated. You just can’t notify the insurance company your employee was injured and expect them to “do their job.” You must have a proven process in place to minimize the cost of the injury and expedite your injured employee’s return to work.

3. You are penalized and overpay when the “Audit Police” make a mistake on an audit

Because your real insurance cost is determined after your policy expires, it is essential the audit is correct. You’re at a disadvantage from the start. The insurance company auditor knows the rules, you don’t. The auditor is not compelled by law to explain the rules, even if applying a rule would cause you to pay a lower premium. Here’s how the auditor works against you:

– Your entire payroll is put into the highest classification

– Then, the “standard class exceptions” are put into the correct cost classification. When someone is not properly moved to the lower cost classification, you pay at the highest rate. Misclassifications are common and the system is designed for you to pay for all mistakes. Would you allow an IRS agent to conduct an audit without an expert on your side? Of course not. Then, why allow an insurance company auditor to conduct an audit without an expert at your side? A workers comp audit may actually cost you more money than an IRS audit. A workers comp audit is every year. You may go years without an IRS audit.

4. Experience modification factors are often wrong or mismanaged

Most insurance buyers accept on “good faith” that their experience modification factor is correct? Why? It’s just easier that way. I go into great detail about this in my article Why Assuming Your Workers Comp Experience Mod is Correct Could be a Dangerous Calculation. However, for our purposes here, you need to learn how to double check your mod because oftentimes it may be wrong. Your insurance company then collects an unfairly high premium.

5. Your dividend may not be what it appears to be

If you were placed into a dividend program with the promise of future savings, at least be aware that these promises are often illusory. Did you just buy your workers comp policy based on that fancy proposal your agent presented or did you really read the contract that states the terms of your program? Realize that you pay a bigger premium upfront to finance the possibility that you will not have any claims. And if you do have a few claims, your dividend will magically evaporate.

6. Your money will fly away unless your agent pays closer attention to your Workers Comp than any other insurance buy.

Here’s what your agent must do to insure you have the best value for your workers comp insurance:

– Claims need to be monitored

– Premium audits must be managed and verified

– Experience modifications must be double checked for accuracy

– Contract must be analyzed

– Sub-contractor’s insurance must be controlled Many actions are time sensitive.

If you don’t know why 6 months after your policy expires is such a critical date, you may be overpaying your insurance. If you need a specialist in any one area of your insurance program, it is in the management of your insurance that affects your employees the most- workers compensations, medical and disability benefits.

How to Boost Your Insurance Payout on Property Damage Claims

Filing property damage claims is a complex process that often results in the property owner being shortchanged. First and foremost, insurance companies are for-profit businesses. They aren’t in the business for fun; they’re in the business to make money. Insurance companies have two ways to make money: collecting premiums and minimizing payouts.

It doesn’t matter if you have a homeowners insurance claim or a commercial property insurance claim, the process is the same. You pay premiums to the insurance company for coverage. If you suffer a covered loss, you file a claim and the insurance company pays you a settlement, less any applicable deductible. However, this settlement may not be enough to fully reimburse you for your losses.

In order to boost your insurance payout, you must not sit back and let the insurance adjuster tell you what they will pay. Instead, you need to take an active role or hire someone to act on your behalf. Remember that the insurance adjuster, no matter how nice he is, serves the insurance company whose goal is to make a profit by minimizing losses – including YOUR losses.

On the other hand, a public insurance adjuster is one that you can hire to represent you. These adjusters document everything and negotiate higher payouts directly with your insurance company. They are licensed and are often former insurance industry employees who know how the insurance claim game is played. They can counter any tactics the insurance company throws your way and aggressively pursue maximum settlement offers. These professionals earn a percentage of the payout, so it’s in their best interest to maximize it.

If you want to boost your property damage payout on your own, find a reputable contractor who will be doing the repairs and ask the contractor to be present during the insurance adjuster’s visit. The contractor will have the expertise to point out all structural and cosmetic damage – damage that the insurance adjuster may have overlooked on his own. In addition, the contractor will ensure that estimates reflect actual rebuilding and material costs. The insurance adjuster relies on books and software for making estimates while a real contractor has working knowledge of real world costs.

One of the most important tasks when boosting an insurance payout takes a bit of work on your part. You must thoroughly document EVERYTHING. Invest in a digital camera with a huge storage card and take hundreds of pictures. For example, if you have water damage, take pictures showing the standing water and water level as well as pictures of every single damaged item, especially those that you must throw out due to safety concerns.

Next, use a notebook or your computer to write down a complete inventory of damaged items along with their original cost and estimated replacement cost. Include everything, even small items. You’d be surprised at how your small losses soon add up to significant amounts. For example, if the contents of your refrigerator must be replaced due to the power being out for several days during a flood, make a thorough inventory of all items, even condiments. At $2 to $4 a bottle for salad dressing, mayonnaise, ketchup, and olives, it doesn’t take long before you have a huge grocery bill just to restock the basics.

Don’t forget to keep receipts for any emergency repairs, temporary lodging, and other related expenses and include them on your claim. When filing the claim, be as thorough as possible and make sure that the claim form is complete and legible. Insurance companies love to delay payouts due to “missing or incomplete” information.

By taking a proactive approach to filing a property damage claim, you will definitely boost your payout.