Claims Management & Advocacy

When you experience a loss, we are here to advocate on your behalf.  Our team of experienced claims professionals has a proven track record of obtaining the most favorable outcomes for our clients.  We support you by:

• Providing coverage analysis and client/carrier collaboration aimed at maximizing insurance recoveries
• Advocating on your behalf in any coverage denials and/or carrier Reservation of Rights letters
• Coordinating and oversight of managing large claims between multiple insurance carriers, insurance policies, and claim adjusters
• Developing detailed litigation management and claims strategies
• Aggressively pursuing timely closure of all claims
• Conducting claim review action plans targeted at identifying any obstacles and designed to bring the claim to closure
• Insurer/Third Party Administrator (TPA) selection process management

Each year, natural disasters cause billions of dollars in damage and affect millions of people. Some disasters can strike with little or no warning and force people to evacuate their homes and businesses. The damage can be devastating in destroying houses, buildings, and neighborhoods.

Many of these disasters knock out power and present challenges and obstacles and potentially force people to go without basic necessities. It is important to not only be prepared with a disaster emergency plan but also to know the proper steps to take in the event you encounter a property claim.

The interplay of property, business interruption, and extra expense coverage — and the hidden risks in property claims adjusting — makes these claims some of the toughest claims to adjust. We have a number of trained property claim experts who will guide you throughout the claim process, from minor renovations to complex property claims involving a complete rebuild. We carefully review all coverages and the circumstances of the loss, and then aggressively work with the client/carrier to pursue full recoveries.

Using our proprietary Loss Data and Financial Analytic tools and detailed claim review process, our team has the experience to assist in closing your open claims through a variety of claim settlement options. We start by taking a complete inventory of open claims and then ranking each claim based on the opportunity to settle. Each claim is examined separately to identify any unique characteristics or challenges — i.e., whether a Medicare Set-Aside (MSA) is necessary — and then devise a custom strategy to move the claim towards settlement. As we devise a plan of action, we make sure to involve all key partners in the process from the insurance carrier / TPA claims adjuster, nurse case manager, defense counsel, and others.

To augment the primary claims team, Risk Strategies has a Complex Claims Group made up of national coverage experts and coverage attorneys to assist in the review of all coverage disputes or high-profile losses.  This team engages with clients to provide professional guidance on coverage positions, jurisdictional issues, and/or unique coverage queries for severe liability, property, business interruption, management liability, class action lawsuits, and cyber liability/cyber breach (1st and 3rd party) incidents.

Our continuous claim oversight and advocacy includes providing ongoing data analytics to show claim trends.  This helps to ensure new and existing claims are tightly controlled for mitigation purposes and not elevated to Lost Time / Indemnity Claims and to ensure unrepresented injured workers do not turn to counsel for reasons that could be controlled by elevated service from the insurance carrier or third-party administrator (TPA). We also use our data analytics and claims management process to conduct a root cause analysis and loss forecast projection and work in conjunction with our loss control team to help mitigate future losses. 

Insurance is a data-driven industry. At Risk Strategies, we leverage the vast amount of loss data information that we have acquired over time to provide useful insights and game-changing solutions for our clients. Our data-driven capabilities enable our clients to make more informed decisions on their insurance programs by accurately defining, analyzing, and automating a more thoughtful strategic risk management planning process.

• Ongoing claim file audits for reserve adequacy, adherence to claim instructions, and qualitative analysis
• Partnership from us on education about the importance of claim investigation, a robust return-to-work program, and claim mitigation
• Partnership from us on enhancing the value of safety committees and integrating employee safety into the safety committee
• Monitor for data accuracy
• Partnership from us to enhance and strengthen your Return-to-Work program
• Partnership from us for creative solutions to strengthen each component of your workers' compensation program

Risk Strategies uses an interactive analytics platform to drive insights and solutions through client-specific loss data. Risk Strategies leverages this data to create interactive dashboards that outline key risk management performance indicators, financial metrics, and drivers of cost to your program. While using the dynamic dashboard, clients can focus on specific metrics related to their insurance program, including locations, occupations, and causes of loss. Clients can compare these key performance indicators across their entire operation, which results in identifying areas for risk management opportunities and reducing your total cost of risk. 

Risk Strategies uses proprietary predictive modeling that is integrated into the feasibility & marketing of an account to provide optimal efficiency in program design – such as Loss Projections, Collateral Analysis, Captive Feasibility, Retention Analysis, and Accrual Schedules. Risk Strategies leverages these insights to negotiate carrier collateral requirements, risk financing mechanisms, and support marketing efforts. 

Risk Strategies benchmarking capabilities are driven by the vast book of business within our organization – such as Private Equity, Healthcare, Manufacturing, and Higher Education. Risk Strategies exercises our vast book of business in specific industry sectors to benchmark a company’s loss data comparatively to our clients in that industry sector with similar claims experience and exposures. While benchmarking a company’s claims experience, Risk Strategies also benchmarks key financial metrics to ensure that a client has the optimal insurance program in place to best suit their operation.