Workers’ Comp // Claims Management

The CIC claims management team has many years of workers’ compensation claim handling experience. They provide prompt loss investigation, benefit review, and prompt payment turn-around time better than that required by state statute. Our philosophy is simple; we evaluate the exposure of a claim and promptly pay benefits that are due, whether they are temporary or of a permanent nature.

Compensability is determined by immediate investigation, with the ability to do a field investigation of the loss as necessary. Non-compensable or questionable claims are thoroughly investigated and resisted or denied coverage as necessary. We will use private investigators to help us evaluate questionable claims. Frequent, ongoing communication with the employee, employer and physician is the key to our insureds and your customer’s success and is openly maintained during the claims management process.

Initial medical only reserves are defaulted to a nominal amount that is normally closed in a short time period. These reserves may be increased or decreased based on subsequent review of the loss and any medical records.

The claim handler reserves all lost time claims within 24 hours. Again, our philosophy is to proactively handle all claims. This requires ongoing claims handling, review and communication with all parties involved. All cases should be reserved to the ultimate value of the loss within 30 days of receipt, on average, unless there are unusual circumstances involved, such as a catastrophic result of surgery, change in employment status, litigation, etc. Reserves are determined by standard industry reserving practices. After the reserves are determined, they are entered into an automated claims handling system. This helps ensure that the injured employee receives benefits in a timely manner. Reserves are constantly reviewed by experienced claims adjusters to make sure they are as accurate as possible.

All medical bills are reviewed for accuracy and price by an outside review firm. This firm works with an extensive system of doctors, hospitals and other medical facilities to ensure that the best price is acquired for treatment. Quality will never be sacrificed for price. Any treatment outside of the usual network of medical facilities will be reviewed against specifications of standard, reasonable and customary care and cost guidelines. Prompt pay discounts are negotiated with all facilities and services providers utilized.

Our claims team is very proactive in the injured employee rehabilitation process. Initially this activity is performed by our own claims handlers. Some states have mandated statutes for the initiation of Case Management Procedures. We follow the statutes as required and in many cases exceed these requirements. Case management initiation provides our insured and us a cost beneficial avenue when an employee injury involves extensive medical procedures, hospitalization and/or lost time.

Another plus with the CIC claims team is that they are located locally in Charlotte, NC. This allows our claims adjusters to not only know but also truly understand both North and South Carolina state law regarding Workers’ Compensation benefits. Our claim adjusters are not paid by the number of claims that they can close each month. With CIC you receive personal service. Ongoing communication is essential in our claims handling process. Additionally, our adjusters handle an average caseload of 130 claims per adjuster, instead of the typical industry standard of 175 to 250.