Tag Archives: Documentation

3 Ways to Make Your Claim Notes Better

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Writing Shouldn’t Be a Chore

Recently I have been spending a lot of time auditing claim files.  It’s really a great exercise to review files, and an important part of well-run claims organization.  One thing that continues to amaze me is the number of files that have poor documentation.  Writing good claim file notes are an important part of handling a claim file. Claim notes record the history of what is going on in addition to the reasoning behind claims decisions.  Good claim notes tell a story.

For some reason, putting notes in a file has turned into a painful exercise for many claims professionals. I am not sure why this has happened, but maybe it’s because of added pressure to document files – the dotting of the “i” mentality – or maybe it’s increasing file loads. Either way, good claim notations have suffered.

I am a big advocate that claim notes do not need to be treatises on what has taken place.  There should be no reason to write paragraphs and paragraphs to explain events when a sentence or two will do. You are a claims PROFESSIONAL and are being paid for your professional abilities to summarize and analyze the facts.  Be brief and get to the point and you will find notes will be easier to write and certainly easier to read.

Write Better Notes with These 3 Suggestions

  • Reserve Notes: When reviewing a reserve, and certainly when changing a reserve, a brief note should be put in the file explaining the reasoning behind the reserve. There is no need to write a book, rather simply state “I have changed the reserve to $10,000 because we received new information about medical treatment that had not been considered.”  A good note will explain the action taken in 2 to 3 sentences.
  • Speak English: I know this seems like a silly statement, but I have often read claim notes that are so full of abbreviations that it would be impossible for anyone to know what was being said except for the author.  Does this type of note make sense?

49 year old Private Bar Attendant who sustained injury to her RUE subsequent to her U&C duties on a CT basis.Rcv’d ltr from DA re EE dcsn 2 c new MD. Have been advised that clmnt no longer has TPD but is now a PPD.

  • Plans of Action: Before you get into your car I am fairly certain you know where you are going to go and how you are going to get there.  When you look at a claim file the same should be true. Every file should have a direction, a plan, a way to get from point “a” to point “b”.  A concise plan of action describing the next steps and plans to bring the claim to a conclusion should be a regular part of your note taking habits.

There are certainly more ways to improve notes. Regardless, these three establish a foundation to improving your ability to properly document all that great work you do.

Are There Any Other Suggestions To Improve File Notes?

5 Claims issues cited for non-compliance on market conduct exams & 3 tools to avoid them

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Insurance Market Conduct examinations are a regular part of the insurance business. Besides the stress of the exam itself, being cited for violations can result in costly fines. Regardless, many citations can be avoided.

Every year, insurance compliance solutions provider Walters Kluwer releases its annual study of top ten reasons insurance companies are found to be out of compliance in state market conduct examinations. In the most recent 2008 study, five of the ten issues of non-compliance were claims related.

If you look at the Walters Kluwer studies performed in 2007 and 2006, you will see similar results around claims. As in the past, documentation and customer service issues are the primary culprit for claims non-compliance.

5 Claims issues found as non-compliant

  1. Failure to acknowledge, pay or deny claims within specified time frames
  2. Failure to pay claims properly (sales, tax, loss of use)
  3. Improper documentation of claim files
  4. Failure to communicate a delay in the settlement of claims in writing
  5. Use of unlicensed claims adjusters or appraisers

All of these findings could have been avoided with enforcement of best practices and an internal review process. With some basic actions, a company can  minimize or eliminate their risk of being out of compliance.

3 Simple tools to avoid costly fines

There are very simple tools that should be employed to help prevent negative claims findings on market conduct reviews. Here are some basic preventative steps to eliminate or mitigate against being cited in a review:

  1. Manage to best practices – Establish and manage claims departments to meet industry best practice standards. Set guidelines and educate staff as to the importance of proper file documentation and notification requirements.
  2. Self audit –  Regularly reinforce good handling practices and customer service expectations through internal audits. A self-audit program should be designed to look for deficiencies and establish plans of action to correct any issues promptly. These compliance audits of staff should be done at least annually.
  3. Vendor management program – Set up a standard vetting process to make sure vendors are appropriately licensed and will comply with company guidelines. Where appropriate, audit these vendors as well to ensure information originally supplied during the application process remains current.

So many of the 5 issues cited above are avoidable. Setting standards and monitoring for compliance will minimize your risks in a market conduct examination. As an added benefit your files will be in better shape and your customers will be happier for it.