Liability
System
A new case may be established in ClaimLink in either of two ways:
1. Electronic Accident Reporting. This module permits new incident information to be entered by non-technical personnel, such as supervisors and managers, who are privy to the facts of the incident. All information about the incident may be entered in this module. However, some additional information must be added by risk management personnel before the case can be actually established. This additional information includes such things as assignment of the adjuster, determining if the case is to remain as an "incident" or is to be a "claim," determining the exposures that apply, and establishing reserves.
2. New Case Entry. An incident may be entered directly by any authorized risk management personnel. If desired, the system will automatically assign a case number to the incident being entered. The individual making the entry determines if it is to be classified as an "incident" (a record of the incident, without any exposure or reserves) or a "claim" (which must include an exposure, although not necessarily any reserves).
Nearly all information in the system may be modified in the Case Maintenance function. This function consists of approximately 17 separate screens of information about the case, claimants, reserves, litigation, subrogation, witnesses, diaries, case notes, reserve history, payment history, indexing and other evaluation issues. Each screen may be reached in sequence or directly so that data may be reviewed or changed. Each field of data may be entered or modified at a single place on a particular screen, even though it may be displayed on other screens for informational purposes (i.e. when looking at information about the claimant’s attorney, the system will show information about the venue and jurisdiction which has been entered on another screen containing defense attorney information).
ClaimLink is capable of issuing either checks or vouchers, as desired by the organization. In addition to requests for computer generated payments, hand-typed payment transactions may be recorded in the system. Ancillary payment-related transactions accommodated by the system include voiding of payments, adjustments, reimbursements and recoveries.
ClaimLink contains an easy-to-use, yet flexible, Diary system that keeps track of tasks scheduled for the future, as well as tasks that have been accomplished in the past. The system permits a variety of users to create diary entries for their own use, as well as for others who may need to perform tasks for the claim (supervisors and claims assistants, for instance). Diary entries can be viewed on a summary screen or on a detail screen, and completed tasks can be viewed on a diary history screen. Entries may be accessed in a number of ways, depending on the cross-section of diaries to be viewed. For instance, diary entries can be viewed for a particular user/adjuster, for a particular period of time, for a particular diary reason, for a single case, or for any combination of the above.
Case Notes may be entered for any case. The system accommodates up to five screens of verbiage for a single note entry. If this is not enough, the note entry may be saved, and an additional note(s) started for the remaining text. Notes are automatically recorded under the date the note is entered. When the note is completed, the system will attach the name of the user to the end of the note, and will record the note permanently. It is not possible to change or delete a note once it has been completed. This insures absolute integrity for the notes for each case, since they may never be altered to suit a later development.
The Evaluation screen is designed to record information pertinent to the settlement of the case, including an assessment of the liability, the amount of any specials to date, and the settlement strategy. This, in conjunction with information on the Negotiation screen which maintains the current status of the settlement (demand, offer, authority, and eventually the settlement amount), provides a capsule of the current status of negotiations, and the strategy to settle the case. This and other pertinent information may be viewed on the Synopsis screens which bring information from several screens together in one spot to facilitate a quick review of the status of the case.
ClaimLink provides a number of ways to communicate information to claimants, providers, attorneys, reinsurers and others involved with the administration of the case.
Case Review. This is an interactive set of screens which permit any authorized user to view all of the information on file for any case, but which prohibits the entry or modification of any data. This capability is frequently offered to a variety of users who have a need to know the details pertaining to individual cases, but who will not be permitted to make any entries.
Reporting to the Reinsurer. Reinsurance agreements are codified in the Reinsurance Profile function, and based on this information, any qualifying case will be automatically reported to the reinsurer. Standard reporting reasons include reaching a percentage of the self-insured retention.
ClaimLink produces several reports which are designed to assist the adjuster, supervisor, and claims manager in controlling overall work load, and in assisting in the administration of each case. Most of the reports described below can be processed at any desired frequency, and may be produced by examiner, or at any of seven organizational levels.
The first of these reports is the Adjuster Diary. Although each adjuster may work the diary entirely from interactive screens, some individuals prefer to utilize a hard copy report upon which they can make notations as they proceed. Typically, the hard copy diary report, which is produced by adjuster, and by day, is prepared at the end of each week, and includes all diaried actions in the past for which action has not yet been taken, as well as the next two to four weeks of scheduled future activity. Upon occasion it may be desirable to just list the diaried entries for a particular reason, such as trials, which can then be used as a trial calendar.
The Caseload report summarizes a number of statistics for each adjuster, unit, and adjusting office. It contains information such as the number of new cases established for the adjuster in the last period, the number of cases reopened in the same period, and the number of cases closed in the same period. It breaks down the number of cases for these categories into subcategories for Litigated Cases and Total Cases, and shows the Total Paid and the Incurred Cost for each category. Additionally, the report shows the total open Cases at the end of the reporting period, and the number of new incidents reported during the same period. This report permits a quick determination of the distribution of the caseload, the closing ratio for each adjuster, and other tools of measurement. For each unit and each office, the system computes per-adjuster averages for all of the categories above.
ClaimLink contains a number of reports which are designed to provide management with information to analyze the financial performance of the Liability claims program, to control costs for the program, and to provide other information that will help to keep the program running properly. Like most other reports, these reports may be produced at all organizational levels, and may be produced at any desired frequency. A few of these reports are described below:The Liability Loss Summary by Date of Loss report includes totals for all claims, whether open or closed (but not including incidents), and presents this information by loss year. It has two basic sections, with the first showing the number of exposures, and the second showing the financial figures. Each exposure (line) is shown separately for each loss year with the following case counts offered: 1) open cases, 2) closed cases, 3) total cases, 4) open litigated cases, and 5) open subrogated cases. To the right of this are shown cost figures as follows: 1) paid to date losses, 2) paid to date expenses, 3) total paid to date, 4) future reserves, and 5) total incurred cost. The information on this report is all valued at the close of the period end listed at the top right of the report.
The Analysis of Liability Litigation Expenses by Attorney report is designed to present information about each legal firm, and the caseload which has been referred to it. All cases assigned to each firm are listed if they have had payments to the firm during the past year. The report identifies the firm by name, identifies each case by number and claimant name, shows total incurred cost for each case, and breaks down fees paid to the attorney both for the current period as well as from inception to date. For information, a column is presented showing the percentage that the attorney fees bear to the total incurred cost for the case. Additionally, any other legal expenses paid for each case are listed (and to whom the payments were made), and a column is presented showing the percentage that all legal costs for the case bear to the total incurred cost. A total line for each firm aggregates the figures just described to give an overall view of the actual and relative costs for legal expenses.
The loss prevention reporting generated by ClaimLink is perhaps one of the most important features of the system. Clearly, an injury that is prevented saves a lot more money that an actual injury that it administered even in the most cost effective manner. The reports available attempt to highlight problem areas, identify situations with worsening experience, and help spot other opportunities for prevention. The Loss Control Management Summary report has 11 different breakdowns that will help identify problem areas, and like other reports, can be processed at any desired organizational level. These reports show both the frequency of accidents, the severity (incurred cost) of the same accidents by a variety of categories and depict this information in bar graph form so that unusually bad experiences can be readily spotted. The list below identifies the 11 separate reports that are currently available in this reporting format:
Site of Loss
Period (Month) of Year
Day of Week
Age of Claimant
Time of Day
Type of Loss
Part of Body
Nature of Loss
Agent of Loss
Cause of Loss
Department
Another valuable report is the Liability Experience by Date of Loss report, which compares various claim figures on a month-by-month basis for the past three years. Separate pages are shown for each Case Type (Auto Liability, General Liability, Product Liability, etc.). There are three separate comparisons on this basis, including frequency, paid-to-date and incurred cost. A percentage column for each month-to-month comparison indicates if the figure for the month of the lateryear is less than or greater than the corresponding figure for the earlier year. The report also shows year-to-date totals and comparisons, and average monthly figures and comparisons. This report can also be produced at any organizational level to provide meaningful comparative figures for each responsibility center.
Many of the reports prepared by ClaimLink are utilized in one way or another for accounting and record keeping purposes. However, there are some special reports that are worthy of mention, and which are described below:
A basic report that is necessary for accounting purposes is the Check Register. This report shows all of the payments issued, including vouchers, along with any of those payments that have been voided. These disbursements are broken down into two sections, the first for computer generated checks, and the second for hand-typed checks. In another section of this report, other disbursement related transactions are shown including adjustments which normally reflect a debit/credit correction of some original mis-coding. In the last section of the report, receipts are shown, and include both reimbursements and recoveries.
For additional information on the ClaimLink workers' compensation system, contact John Johnson at (626) 440-1676 or e-mail to j_johnson@ sucaba.com
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