Background: Equian entered into a subrogation agreement with a high profile, national workers’ compensation carrier with $1 billion in annual premium.
Finding Missed Opportunities: The client’s recovery model prior to our relationship with them was a decentralized approach with claim examiners handling the identification and recovery process of subrogation files. With this model in place, they were losing ground in the battle to maximize their recoveries. They recognized that their adjusters were being stretched and may not have all of the tools necessary to properly identify all subrogation potential.
Our client needed specialized resources that were solely dedicated to the subrogation process from end-to-end in order for them to maximize recovery opportunities. With the start of our relationship in place, we quickly went to work on a solution that would enable this client to enhance their subrogation recovery efforts and improve their accuracy by inserting our expertise into the areas where it was most needed; enabling their examiners to become more focused on their policy holders and getting injured employees back to work.
Implementing a Best in Class Solution: The starting point for this client was performing a retrospective review on claims closed without recovery from the two years prior to our contract with them. With the objective of identifying any missed subrogation opportunities that hadn’t exceeded the statute of limitations, we went on to complete investigations on over 8,000 cases. We developed theories of liability based on available evidence and supporting documentation. The review uncovered a leakage rate equivalent to 1% in paid claims.
Equian customized a more centralized program specific to the client’s need of dedicated resources to achieve top quartile performance. By providing us with access to their online claims and imaging system and sending us files electronically, we were able to screen claims for potential third party liability using a proprietary, client-specific cause of loss and financial protocol. Through use of this process, we were able to provide tailored, data mining alongside of a thorough investigative process to ensure a complete end-to-end recovery process.
The Result: Through a benchmark study using key indicators specific for this client, Equian compared them to others in the industry and uncovered significant results. Since inception of the program, Equian has increased the client’s gross recoveries by 130%. Equian’s outsource program has enabled this client to become “best in class” with their subrogation recoveries.
