ch 5 care
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Includes any technique for containing injury costs, like HMO and PPO
Technique to evaluate necessity, frequency and costs of treatments. Investigates medical care that has already been given
Investigation of what medical treatment will be received by the claimant using preadmisson testing/certification and fee arrangements
Medical treatments are monitored and recorded as they happen using IMEs, disability management, proactive case management, etc.
Bodily injury claims
Damage elements to consider: medical expense amount, type/extent of injury, wage loss, pain and suffering/loss of enjoyment, disability/disfigurement, preexisting conditions
Individiual case method
Adjusters evaluate the settlement value based on all of the circumstances of the claim and their experience in similar cases. Preferred technique for serious injuries.
Claim file is evaluated by 2 or more claim professionals, each suggesting a settlement range. Consensus should be reached or averaged. Not appropriate for minor claims because how time-consuming it is.
Mathematical formula is used to set reserves. Used widely with soft tissue injuries and other minor to moderate injury claims.
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