Is Your Workflow Working? The First Steps…

In my last newsletter I shared questions to help claims and claims legal departments get a better understanding of their internal processes for how requests and subpoenas are being handled. You can read it here.

I said in subsequent newsletters I would share more about the crucial steps in the process to be successful in fulfilling requests for copies of claim files. Below is an overview of how to get started.

A subpoena is a request for the production of documents, or a request to appear in court or other legal proceeding. It is a court-ordered command that essentially requires you to do something. These requests require you to produce documents, materials, or other tangible evidence. Request letters or medical authorizations that don’t come in subpoena form are still requests for the reproduction of documents. I’ll use the word Requests in this article to cover all forms of these document requests.

The very first action is to create a step-by-step workflow for receiving requests for copies of claim files. Define all the elements that determine if the request is valid.

Ask questions like:

• Is the claimant identifiable?
• Is the Date of Accident accurate?
• Does the authorization meet compliance guidelines?
• Have a single system for tracking the status of each request which should include important dates, claimant and requester information, and notes. Sticky notes and spreadsheets are not an acceptable solution.
• ?Establish standards for validating the request and authorization that may be included.

I’m not a lawyer and I don’t play one on TV, but many times I speak with the general counsel at Insurance Carriers and they tell me they don’t have a good grasp on their monthly or annual volume of requests. They are often separated between the claims and claims legal departments so it’s hard to track when they aren’t all filtered into the same workflow. It’s easy to miss deadlines or priority requests when they are being moved in between departments.

The deadline for a response is determined by the civil procedure laws of the jurisdiction in which the subpoena was issued, so subpoenas (except those from federal courts) are handled strictly on a state-by-state basis.?Having a proper tracking system in place helps to prioritize requests, organize them by state, and ensure they are handled at the right time. If carriers do not comply they can also be held in contempt of court.

What I outlined above is only the first part of a streamlined workflow to successfully fulfill requests for copies of claim files.

Some claims organizations have the bandwidth to do this in house on their own. Some do not and can rely on us. Our clients tell us that when they partner with us it allows them to put time and resources back into their day and that are even able to free up time for managers oversight of the process. They feel the value of this entire process being handled for them with expertise. ?

“It didn't just create capacity as far as the work went. It created capacity for my management team.”

Check out these 2021 results from two of our clients.

I'm happy to provide an estimate on how much you could save by partnering with ClaimFox.

In future newsletters I’ll share information about the next steps in the process. Stay tuned to read on, and let me know if you have any questions.

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About ClaimFox:

ClaimFox fulfills requests for copies of claim files so that you don’t have to—freeing you from inefficient processes and labor-intensive tasks. Insurers receive requests every day for copies of their claim files. These can be simple request letters, medical authorizations, and subpoenas from claimant attorneys, defense attorneys, adverse carriers, third-party record retrieval companies, workers’ compensation boards, and other sources. Fulfilling these requests is something you don’t always have the time or streamlined process to complete. ClaimFox manages this entire function on your behalf. Is it secure? Yes! In fact, we pride ourselves on our commitment to our clients’ data security and privacy. We are ISO 27001-compliant to ensure that you are fully protected with legal, physical, and technical controls to manage your information risk.