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Managed Care
Includes any technique for containing injury costs, like HMO and PPO
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Retrospective Management
Technique to evaluate necessity, frequency and costs of treatments. Investigates medical care that has already been given
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Prospective Management
Investigation of what medical treatment will be received by the claimant using preadmisson testing/certification and fee arrangements
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Direct Intervention
Medical treatments are monitored and recorded as they happen using IMEs, disability management, proactive case management, etc.
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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
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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.
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Roundtable technique
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.
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Formula Method
Mathematical formula is used to set reserves. Used widely with soft tissue injuries and other minor to moderate injury claims.
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