Claim Management - Open Claims

Question 1

Two questions adjusters should ask themselves every time they review an open claim

Answer 1

What do I need to do to resolve this claim

Are my reserves adequate

Question 2

How many days does the insurer have to reclassify a claim from nondisabling to disabling

Answer 2

14 days from receipt of information the claim is disabling

A request from IW to reclassify

*if more than one year IW must file an Aggravation claim

Question 3

When an IW is represented by an attorney when do you need to provide discoverable documents? How Often and for how long?

Answer 3

14 day from receipt of request for documents, every 30 days for up to 180 days.

Question 4

Which 4 areas is a claims adjuster responsible for setting reserves

Answer 4

Medical

Temporary Disability (Time Loss)

Permanent Partial Disability PPD

Legal Costs (Fees)

Question 5

What information is needed before closing a claim

Answer 5

Med Stationary status

Work Release

Work Status

Permanent impairment information