Casualty Risk Consulting eNewsletter

Claim Reviews are Actually Strategy Sessions


The efficient and timely closing of outstanding claims could result in an organization saving thousands of dollars. Claims that don’t receive the proper amount of scrutiny can move on to high profile indemnity claims, costing the organization thousands more than necessary. More worrisome, troublesome claims can linger and become “legacy” claims, monetary albatrosses sitting on the balance sheet for months and even years. Are you getting the best results from your claim review process and your claims provider?

Expedited…but Focused

We differentiate our claim review approach by taking it to the next level. The primary goal of any claim review is to expedite claims closure, appropriately and within the methodology of your claims closure process. The entire review team should evaluate every aspect of the claim and determine the best next steps, resulting in clear and concise action plans.

The following top the list of items that must be addressed or at least considered:

  • Identify disposition, goals, strategies and timelines
  • Assist with investigations
  • Assist with mitigation (i.e., subrogation, tender opportunities, Second Injury Fund, etc)
  • Manage expenses (e.g., defense, nurse, special investigations, vendor)
  • Manage the injury and injured Worker
  • Explore cost effective resolutions
  • Evaluate reserves
  • Strengthen communication and expectation

Every claim should have a disposition plan based on its “known facts” at the time of review. If claim reviews take place every ninety days, the present disposition plan should be the focus over the next ninety days.

If claim reviews take place semi-annually, then the focus of the disposition is to identify objectives and goals for the next 180 days, and so on. The disposition plan for the case is what underpins or frames the goals. The timeline is highlighting or pin pointing milestone dates or time periods in which to achieve the goals. The action plan is to achieve the goals within the timeline. That said, it is important to ensure that reserves are sufficient to accomplish the action plans within the timeline to achieve the goals.

Implementing a Standardized Claim Review Process

It is also important to implement a standardized claim review process which includes descriptive claim processes and identifies objectives and defined action plans that anticipate closure periods.

  • Consultant contacts client and claims administrator to schedule the claim review to allow 30-45 days advance notice to the claim professionals/claim teams.
  • Consultant manages the selection of files appropriate for review with input from client. (Further discussed in a subsequent article)
  • Claim review commences. Consultant captures updated status information, documents agreed action items, updates the disposition and anticipated closure period.
  • Standard deliverable is finalized and distributed to claims administrator with copy to client. Cover e-mail includes instructions to distribute to adjusters so that agreed actions are included in electronic claim file. Also captured are file closures and corresponding savings.

The more standardized the claims review process, the more efficient use of time and resources displayed in our value added deliverable.

Aon’s Casualty Claims consultants advise and deliver industry- and client-specific claims analysis, assessment and direction designed to track and improve claim handling processes. Claim reviews are conducted to reduce casualty cost of risk. The reviews further help to identify post loss initiatives designed to best meet client needs, improve program outcome and management, and provide oversight of the Claim Service Provider (CSP). Providing technical advocacy in a standardized manner demonstrates our strength, especially when engaged in claim strategy sessions traditionally referred to as claim reviews.

Every Aon Casualty Claims consultant is certified to deliver high-quality claim reviews. In order to qualify our consultants, consultants must satisfy an extensive certification process, which requires an educational component followed by colleague mentoring. Once initial certification is complete, subsequent follow up efforts take place in order to communicate updates or process enhancements.

Contact the Author

To learn more about optimizing your casualty claims process, please reach out to
 Wayne Brinkman, Senior Claims Consultant, Aon Casualty Risk Control and Claims.

Thank you to Andrea Vega, Senior Claims Consultant, Aon Casualty Risk Control and Claims, for her contributions to this article.