Here's a review of our Claims Management process:

Investigation
Perhaps the most important aspect of claims management, the investigation phase begins with a three-point contact within 24-48 hours of receipt of the claim.

Personal investigations with the claimant, their physician and the employer help us gain a thorough understanding of the claim, first and foremost ensuring its compensability.

Once the investigation is complete, our adjusters work together with our in-house nurse case managers to set up a specific plan of action that will help to accelerate the case towards closure.

Reserves
With the investigation phase complete and a plan of action in place, realistic reserves are established to responsibly manage each claim. Reserves are reviewed and reevaluated each time the adjuster handles the file, or when there is a change in medical condition, to ensure an appropriate level of funding - no more and no less - to support the claim.

Recovery
As part of the investigative phase, USA TPA adjusters investigate the potential for shared liability, subrogation and reimbursement by all parties responsible for the   claim and pursue recovery from the workers' compensation second injury fund. If appropriate, they take the necessary actions to ensure prompt recovery.

Return to Work
Our nurse case managers will work with your human resources professionals and the claimants’ physicians to review specific positions, job descriptions, or defined tasks that your injured workers can perform during the injury recovery period. This process helps promote a prompt return to work and help to minimize claim costs.

Litigation
Our ultimate goal is to close claims as quickly as possible. Therefore, we take a very aggressive approach to litigating claims. Our in-house case management professionals provide direction as to how the case should be handled to ensure fair and timely closure. Legal counsel handles all board appearances with direction from the adjuster.

Closure
Ideally, every claim is closed without the time and expense of a formal hearing. Complete and accurate case files help to eliminate unnecessary delays in settlement. Decisions are made on a case-by-case basis regarding the most cost-effective disposition of the claim.

Reporting
Documentation for each and every claim managed by USA TPA is initiated and monitored using Xclaim software, which provides 24/7/365 access to status of all claims, losses and case management files.

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