Winston Churchill once said, “True genius resides in the capacity for evaluation of uncertain, hazardous, and conflicting information.”
There is no better time than the present to stop and ask yourself these five questions to ensure you’re doing everything you can to evaluate the uncertain, hazardous, and conflicting information to resolve claims and settle litigation cost effectively.
- Are you using quantifiable data and medical facts to support the decision to deny or approve a claim or support a settlement? Are the case-specific allegations or claims at issue evaluated on the basis of information obtained from the medical records, pertinent medical research, and evaluation of other relevant case facts?
- Are you investigating claims at the appropriate time? Investigate, don’t wait. The Unfair Claims Settlement Practices Act of 1997, created by the National Association of Insurance Commissioners, provides guidance to ensure insurers and the self-insured acknowledge and act promptly regarding communication of claims.
- Are you using the most cost-effective resource for the job? Served with a subpoena or a summons and complaint? Give it to your lawyers. Reviewing medical claims, medical records, and medical information? Give it to a legal nurse consultant.
- Do the resources you are using fit your internal staffing? Were your claim managers promoted from within? Do they have a health sciences background or access to resources with a health sciences background on staff? MRN is available to your staff as a resource whether it’s by attending your monthly staff meeting in-person or online, or providing your team unlimited access to our nurse consultant toll-free hotline. We’re here for you.
- Does your claims management process line up with your company’s organizational mission statement or claims’ philosophy? Mission based health systems – mission based claims resolution.