Claims Management

It happens. A worker is injured on the job and a claim is filed. When an accident occurs it’s the goal of NYCM's claims management group, under the expert guidance of Cathy Marsden, to minimize your financial exposure by aggressively and accurately handling your workers’ comp claims.

At NYCM, an internal staff of qualified claims adjusters lead a well-trained team through a thorough claims management process specifically tailored to meet your business needs, in conformance with the New York State Compensation Law.

To ensure that each of our claims professionals can spend the time they need to effectively manage each and every claim, we limit their cases to a maximum of 150 - a caseload that’s well below industry average.

Here’s a review of our
Claims Management process:

Investigation
Perhaps the most important aspect of claims management,
the investigation phase begins with a three-point contact
within 24-48 hours of receipt of the claim.

Personal investigations with the claimant, their physician and the employer help us gain a thorough understanding of the claim, first and foremost ensuring its compensability.

Once the investigation is complete, our adjusters work together with our in-house nurse case managers to set up a specific plan of action that will help to accelerate the case towards closure.

Reserves
With the investigation phase complete and a plan of action in place, realistic reserves are established to responsibly manage each claim. Reserves are reviewed and reevaluated each time the adjuster handles the file, or when there is a change in medical condition, to ensure an appropriate level of funding – no more and no less – to support the claim.

Recovery
As part of the investigative phase, NYCM adjusters investigate the potential for shared liability, subrogation and reimbursement by all parties responsible for the   claim and pursue recovery from the workers’ compensation second injury fund. If appropriate, they  take the necessary actions to ensure prompt recovery.

Litigation
Our ultimate goal is to close claims as quickly as possible. Therefore, we take a very aggressive approach to litigating claims. Our in-house case management professionals provide direction as to how the case should be handled to ensure fair and timely closure. Legal counsel handles all board appearances with direction from the adjuster.

Closure
Ideally, every claim is closed without the time and expense of a formal hearing. Complete and accurate case files help to eliminate unnecessary delays in settlement. Decisions are made on a case-by-case basis regarding the most cost-effective disposition of the claim.

Reporting
Documentation for each and every claim managed by NYCM is initiated and monitored using our proprietary Xclaim Internet-based case management program. Our clients can stay up to date on the status of all claims, losses and case management status – 24/7/365 – using Xclaim.