Mistakes happen, but they don’t have to happen often nor should they. Whether it’s a bad judgment call or a simple oversight, mistakes add up to much bigger issues down the line. The following are some of the most common errors that auditors encounter when reviewing claims:
- Failing to perform a thorough investigation. With multiple claims to juggle, it’s possible for a detail or two to slip through the cracks. However, missing important information such as the nature of the claim or the severity of injuries can lead to prolonged claims due to incongruous settlement offers. On the flip side, assuming injuries are extreme based on face value can result in overpayment as well.
- Failing to read medical reports. Not keeping up with medical reports can lead to poor control over medical treatments. Insurers may pay out for unnecessary treatments or erroneously withhold payments for medical care. Reading the medical reports thoroughly can help adjusters stay on top of those claims details.
- Failing to close claims in a timely manner. While some factors are out of adjusters’ hands, auditors have found many mistakes result from adjusters mismanaging their time. This prolongs claims and ultimately costs the insurer more money.
- Failing to keep proper documentation. Not only does this irritate customers, but it also costs time as well as money to re-confirm details multiple times. Taking detailed notes on all incoming documents/information expedites the claims process.
- Failing to maintain good contact with the claimant. Keeping the insured in the loop helps boost customer satisfaction, but it also helps keep insurers up to date on any new developments. Insured customers don’t always think to contact their insurer for every claim related event/situation after the initial incident.
- Failing to maintain claim continuity. Handing claims off from one adjuster to another without a specific reason (i.e. more appropriate field of expertise) can cause errors during the exchange and confusion for the customer.
For every mistake that occurs during a claim, the cost of the claim increases. Insurers can’t afford repeat mistakes, especially when the majority of them are easy to avoid. To that end, implementing a full-cycle claim management system can help dramatically. Contact the experts at Actec to learn more.