Claims

The TAEP Trust Delivers Best in Class Claims Management Service

Expert Management

LaMonte Bryant, TAEP Trust Claims Manager, has 16 years of experience in the insurance industy; with 9 years as a Senior Claims Examiner or Supervisor. Prior to joining Montlake, he served as a Longshore Product Manager for a large managed care company.

Lower Caseloads – Increased Personal Involvement & Attention to Details

TAEP Trust maintains average caseloads for claims examiners of less than 100 active time loss claims, a standard far below that found in the industry at large. Lower case loads allow our claims staff to perform field adjusting work that is pivotal in controlling the cost drivers associated with high severity claims, including:

Accident investigations are conducted in the early stages of all serious claims. TAEP Trust provides emergency loss response 7 days a week, 24 hours a day to determine the causal factors of serious accidents and for the purpose of uncovering any potential third party liability that may exist.

Meetings with the insured, the injured worker and the worker’s family are also conducted in the first few days of a serious claim when the uncertainty and fear that often accompanies an on-the-job injury can result in unnecessary litigation if claimants do not understand how the benefit system really works. Our claims personnel visit the hospital to address billing questions and meet with the injured worker and the worker’s family to minimize concerns and uncertainties.

Adjusters meet with physicians in their offices to address complex issues that can have a major impact on the duration and cost of a claim, rather than trying to resolve problems through the mail or over the phone.

Personal visits with claimants in their homes across the life of the claim help to identify and address issues before they become problems.

Aggressive Medical Management

TAEP Trust provides customers with access to a fully integrated medical cost containment program. Medical treatment is closely managed to ensure it is necessary, and consistent with the nature and extent of the injury. To the extent permitted by law and consistent with industry practices, medical bills are reviewed to identify billing irregularities, reduce fees to the appropriate fee schedules, and obtain benefits of contracted provider discounts. Contract nurse specialists and physician experts are also available to support the claims process as needed.

Accurate and Timely Reserving

TAEP Trust establishes adequate reserves for the payment of losses and loss adjustment expenses for claims as early in the life of each claim as possible. The determination of these reserves involves actuarial and statistical projections of the ultimate settlement value of all claims. In determining reserves TAEP Trust considers (1) facts and circumstances currently available; (2) estimates of future trends in claims severity and loss development; (3) legislative changes in benefits or changing judicial theories of liability; and (4) other variable factors which may have a significant effect upon ultimate claim values. TAEP Trust works closely with a consulting actuary to evaluate and monitor the effectiveness of its reserving practices. TAEP Trust will also occasionally use outside consultants with expertise in specific areas for more severe or complicated claims to confirm its estimates of ultimate loss values.

Vigilant Anti-fraud Posture

TAEP Trust will take appropriate steps necessary to detect, investigate, and report suspected acts of insurance fraud and where possible to push for the prosecution of individuals involved in any fraudulent activity.

Comprehensive & Resolute Defense of Litigated Claims

TAEP Trust believes its proactive claims approach significantly reduces the prospects of litigation to facilitate negotiated resolutions of conflicts and problems. However, when these steps are unsuccessful at arriving at terms that are equitable and appropriate under the law, TAEP Trust will aggressively litigate claims disputes using the highest quality of defense counsel. Our case will be built upon a solid foundation of facts and law and TAEP Trust will deliver a quality defense of its position.

TAEP Trust Claims Management Priorities

• Conduct immediate on-site investigations of any loss involving serious injury or any loss where third party subrogation is possible.
• Actively direct claimants to appropriate medical treatment facilities whenever possible.
• Develop working partnerships with claimants by communicating frequently in regard to claim developments and by visiting them whenever possible in their homes to assist with any questions or concerns that may raise.
• Work as closely as possible with each doctor and with the employer to identify opportunities to return qualified injured workers to modified work positions whenever possible.
• Establish adequate reserves for ultimate claim values as early in the life of claim as possible.
• Meet with clients at least quarterly to discuss the current status of each open time loss claim and strategies for the resolution of each one.
• Aggressively pursue all available third party subrogation recoveries through highly qualified legal counsel.
• Manage defense counsel closely to assure all activity is consistent with a clear strategy for claim resolution and to maintain compliance with reporting and billing guidelines. TAEP Trust claims staff will attend important depositions, conferences and trials whenever possible.
• In all things, we seek to settle claims in an efficient, fair and equitable manner. We will pay promptly and efficiently what we owe and we will aggressively resist paying what we do not.