Question 1

What does claims advocacy mean and why do I need it?

Accepted Answer

Claims advocacy means having an experienced professional represent your interests throughout the claims process — not the carrier's interests. Insurance adjusters work for the insurance company, and their job is to resolve claims efficiently, which does not always mean in your favor. A claims advocate reviews coverage determinations, challenges improper denials, monitors reserve levels, and communicates directly with the adjuster to make sure your claim is handled fairly and your costs are minimized.

Question 2

How do inflated reserves affect my insurance premiums?

Accepted Answer

For workers' compensation and other lines where your loss history affects your premium, inflated reserves directly increase your experience modification rate (EMR). Your EMR is calculated using both paid losses and open reserves — so a claim with a $50,000 reserve hits your mod the same as a $50,000 paid loss, even if the claim ultimately closes for far less. Our reserve analysis service identifies reserves that are not supported by the facts of the claim and works with the carrier to reduce them, which lowers your mod and your future premiums.

Question 3

What is a return-to-work program and how does it reduce costs?

Accepted Answer

A return-to-work program brings injured employees back to work in a modified-duty role while they recover, rather than keeping them on full indemnity benefits at home. Every day an injured worker is on indemnity benefits adds to your claim cost and your experience modification rate. Modified duty reduces indemnity payments, keeps the employee engaged and productive, and signals to the carrier that the claim is being actively managed — all of which reduce the total cost of the claim and protect your workers' compensation premium.

Question 4

What does litigation oversight include?

Accepted Answer

When a claim escalates to litigation, our litigation oversight service keeps you informed and involved throughout the legal process. We review the defense strategy with your assigned defense counsel, monitor legal fees and expenses, evaluate settlement recommendations against the facts of the claim and your long-term risk objectives, and ensure that decisions are being made in your best interest rather than simply to close the file quickly. Unmanaged litigation is one of the fastest ways for a single claim to spiral into a program-defining loss.

Question 5

What is a loss ratio analysis and what does it tell me?

Accepted Answer

A loss ratio analysis compares your total incurred losses to your total premium paid over a defined period, broken down by line of coverage. A loss ratio above 60–70% typically signals that your program is underpriced relative to your actual risk — which means your carrier will either non-renew or significantly increase your premium at the next renewal. Our analysis identifies which lines, departments, or locations are driving your losses, giving you the data you need to target loss control resources where they will have the greatest impact on your program.

Claims Management Capabilities & Services

Frequently Asked Questions