Workers’ Compensation
Claims Advocacy

 

Only ESM provides the tech-enabled tools and training for employers to manage their injured employees while navigating through the complexities of their Workers’ Compensation claims. ESM’s Claim Advocates provide our customers with expert advice and data supported reports to help employers make the most ethical, legal and financial decision when managing their claims. ESM’s Advocates facilitate strategic action plans with all parties and timelines for case resolution with reserve accuracy. All of which is tracked in real time and made available to the employer and broker within ESM’s INSITE claims portal.

With over 40,000 claims managed, ESM is the industry leader in claims management.

Client Track Record

 
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Click HERE for a one-page overveiw.

 

Claims Advocacy powered by INSITE

INSITE customers have access to their Workers’ Compensation claims updates in their INSITE portal. Key features include:

  • Access to company’s claims data via our secure, cloud-based portal (web and mobile friendly)

  • Client and insurance broker access to claims information, follow-up tasks, and updates

  • Automatic email notifications on claims updates

  • Reports printed on-demand

  • Report new claims via INSITE

  • Loss trending summary and claims data analytics

 
 

Why Claims Advocacy

Aligning all of the Workers' Compensation stakeholders ensures maximum benefit. Here are just a few ways ESM has an impact on our client's Worker’s Compensation claims management:

  • Provide Workers’ Compensation technical expertise to employers

  • Facilitate ongoing communication between employer and insurance carriers/TPA

  • Interpret loss runs and other loss data

  • Establish action plans for the resolution of claims

  • Analyze claim statuses and critique carrier action plans

  • Analyze reserves for accuracy

  • Provide reports to employers regarding action plans and reserve recommendations

  • Analyze experience modification worksheets and complete X-mod projections

  • Strategize litigated claims for optimum resolution

  • Verify employer compliance with Workers’ Compensation requirements

  • Resource for Workers’ Compensation claims issues

  • Audit of Third Party Administrator

  • Supervisor Training

  • Evaluate Medical Provider Network (MPN)

 

Critical Time Lines in Claims Management

Unit Stat Valuation

  • 18 months after inception of the policy

  • Annually thereafter

  • All claims are valued for use in the next year’s X-mod calculation

  • Open claims include paid and outstanding

  • The outstanding balance is negotiable

Renewal

  • Are the outstanding reserves accurate?

  • Is there any subrogation potential?

  • Any other pertinent underwriting information?

  • Are Safety issues addressed?

  • Is the Return-To-Work program implemented?

  • Has the Medical Provider relationship changed?

 
 

ESM's Claims Management Goals

  • Provide valuable oversight and direction with the claims administrator to ensure that the employer has the information and resources to make the best financial, legal and ethical business decision for the management of their Workers’ Compensation claims.

  • Empower the employer with assistance in best practices that will provide ownership and internal management of their Workers’ Compensation claims.

  • Act as an advocate for employer and liaison with the claims administrator to ensure that the claims are positioned for cost effective resolution and are accurately reserved.

 

                                                  

 
 

Get control of your Work Comp claims today. Schedule a time with an ESM advocate to learn more.

Initial consultation is free. Complete this form to get started.