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Given
the nature of workers' compensation and P&C
claims, it is critically important that clients
know the experience level and capabilities of
their service provider. Our licensed multi-line
adjusters have a minimum of 10 years experience
and in several cases over 20 years experience.
We also have an in house General Adjuster, as
well as bi-lingual adjusters, providing our clients
additional capabilities.
At EMI, we believe a proactive approach is an
important part of delivering the intended results
to our clients. That is our mission. Handling
over 4,000 workers' compensation and P&C claims
annually, our team manages every phase of the
claims administration process. With a maximum
lost-time caseload of 150 files per adjuster and
a target of 125, EMI is able to provide aggressive
claims management services that are second to
none. Experienced adjusters review claim files
frequently during the month to ensure the best
possible outcome. Additionally, EMI's Claims Committee
reviews all complex cases, including mediations
and proposed settlements.
Beginning with a notice of injury, which EMI can
accept through our toll-free line, electronically
or via fax, adjusters begin actively working each
claim and make initial contact with the claimant
within 24 hours. EMI's adjusters perform their
own field adjusting and attend all depositions,
mediations, hearings and trials, where reasonably
possible.
Adjusters work closely with assigned attorneys
to develop the appropriate strategy and to control
legal costs. Litigation is part of the workers'
compensation and P&C landscape, and your service
provider must have a strong litigation management
process in place in order to control these costs.
At EMI, subrogation is not an after-thought. Our
adjusters review the facts and circumstances of
each case for possible subrogation. EMI prepares
all necessary documentation, subrogates against
the adverse party and vigorously pursues collections.
Litigation and subrogation are both a core part
of our claims administration services.
To ensure the appropriate level of expertise,
EMI also utilizes outside vendors for services
such as legal, surveillance, physical damage appraisals,
hospital bill audits and outside case management.
We have access to several vendors of such services,
and make assignments based on the specific facts
and circumstances of each individual case.
Reserves are established based on factors such
as the type of injury, claimant age/status, medical
treatment, community, etc. The standard life expectancy
charts are also utilized in Permanent Total cases
or for use in preparing settlement reports. Our
adjusters review reserve adequacy frequently and
make adjustments as deemed necessary. An outside
actuary familiar with our claims process is also
available to analyze and calculate Incurred But
Not Reported ("IBNR") reserves, if required
by the client. EMI also has other industry-accepted
formulas that can be utilized internally. We do,
however, strongly encourage periodic review by
an outside actuary to ensure that adequate claim
reserves are established and maintained by our
clients.
EMI encourages frequent communication and close
coordination with our clients, including direct
contact with our adjusters. On at least a quarterly
basis, adjusters assigned to your account will
meet with you in a more formal setting to discuss
your claims and any settlement authority requests.
We also assign emergency contacts that are available
via cell phone or beeper to ensure that urgent
needs are addressed in a timely manner.
If needed, EMI will handle all aspects of policy
administration, including policy issuance, endorsements,
renewals and terminations. Premium billing and
collection services are also offered.
EMI has incorporated internal policy and procedures
for our claims administration. These procedures
provide a uniform process throughout our claims
department for all adjusters. This program enables
our client to feel comfortable in knowing that
our procedures are uniform regardless of who handles
their claims.
Examples
of these policies include:
Claim Processing
Initial and Continuing Contact
Investigations
Indemnity Benefit Payments
File Documentation
Medical Treatment and Control
Medical Cost Containment
Disability management
Individual Case Reserves
Litigation Management
Settlements
Potential Recoveries
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