8 Ways Public Entities Can Improve Claims Management

Public entities have unique insurance needs, particularly in how their property and casualty insurance is structured, managed, and regulated. When it comes to general liability, public entities face a broad spectrum of exposures due to their diverse operations. These can include liabilities arising from the maintenance of public property, law enforcement activities, public events, and educational services. General liability insurance for public entities must address potential claims related to bodily injury, property damage, personal injury, and advertising injury. This insurance is crucial in protecting public funds and ensuring that the entity can continue to provide essential services even in the face of significant claims.

The unique aspects of public entity insurance are even more pronounced in workers’ compensation. The scope and coverage between public and private entities differ significantly. Public entities often need to cover high-risk public safety employees such as police officers, firefighters, and emergency medical personnel, who face unique and higher risks. There might be special provisions and benefits to consider as well, such as extended benefits for public safety workers injured or killed in the line of duty. Additionally, public entities are often faced with a wide range of coverages, including employees from various departments like education, public works, transportation, and administration.

Moreover, there is the regulatory environment, where there could be sovereign immunity protections, state, and local regulations to navigate that often include additional rules for public sector employees. You are often subject to collective bargaining agreements that can influence workers’ compensation benefits and claims processes. 

There are also unique claims management and handling concerns. Many government entities use self-insurance programs or participate in risk pools to manage workers’ compensation claims, often having in-house claims administration or working with specialized third-party administrators experienced in public sector claims. Due to the visibility of the employees being covered, claims processes and outcomes may be subject to higher levels of public scrutiny and transparency requirements. 

Public entities often have extensive risk management and safety programs to address the diverse and high-risk nature of public sector jobs, and frequently must provide specialized safety training tailored to the unique risks of public sector roles, such as law enforcement and firefighting. 

There are also enhanced benefits and specialized compensation factors to consider. Public sector workers, particularly in hazardous roles, may receive enhanced benefits, including higher wage replacement rates and extended medical benefits.  

Employee relations and union involvement are other factors to consider. There is a much higher likelihood of a unionized workforce, influencing workers’ compensation policies, benefits, and claims processes through collective bargaining. There may also be formal grievance procedures in place for disputes related to workers’ compensation claims. 

Modern core technology can significantly help public entities and risk pools manage their unique workers’ compensation needs by providing advanced tools, streamlined processes, and enhanced capabilities tailored to the public sector’s specific requirements. Here are eight ways in which modern core technology can assist with workers’ compensation claims: 

1. Enhanced Claims Management 

• Automated Workflows: Automate repetitive tasks such as claim intake, certificate of insurance requests, documentation, and communication, reducing administrative burden and speeding up the claims process. 
• Integrated Systems: Integrate with other government systems such as payroll, HR, and public safety databases to ensure seamless data flow and comprehensive case management. 
• Real-Time Data Access: Provide adjusters and managers with real-time access to claims data, enabling faster decision-making and more accurate claims processing. 

2. Advanced Analytics and Reporting 

• Predictive Analytics: Use predictive analytics to identify high-risk areas and potential claims before they occur, allowing for proactive risk management and prevention strategies. 
• Detailed Reporting: Generate detailed reports and dashboards that provide insights into claims trends, costs, and outcomes, helping in strategic planning and resource allocation. 
• Regulatory Compliance: Ensure compliance with local, state, and federal regulations by providing tools that track and report necessary data to regulatory bodies. 

3. Improved Communication and Collaboration 

• Unified Communication Platforms: Utilize communication platforms that allow for easy interaction between claimants, adjusters, medical providers, and other stakeholders, improving transparency and coordination. 
• Mobile Access: Enable field adjusters and public safety officials to access and update claims information on-the-go using mobile devices, ensuring timely updates and efficient claims handling.

4. Specialized Risk Management 

• Tailored Safety Programs: Develop and manage customized safety programs for different departments (e.g., law enforcement, fire services, public works) based on specific risk profiles. 
• Incident Tracking: Implement incident tracking systems that monitor workplace injuries and near-misses, facilitating prompt interventions and safety improvements. 
• Training and Education: Track training and education for employees on safety practices and workers’ compensation procedures.

5. Enhanced Employee Experience 

• Self-Service Portals: Provide employees with self-service portals where they can report incidents, track the status of their claims, and access relevant information and resources. 
• Transparent Processes: Increase transparency by keeping employees informed throughout the claims process, reducing frustration, and improving trust in the system. 
• Personalized Support: Use AI-driven chatbots and virtual assistants to offer personalized support and answer common queries, improving employee satisfaction. 

6. Efficient Financial Management 

• Cost Tracking: Track all costs associated with claims, including medical expenses, lost wages, and administrative costs, to manage budgets effectively. 
• Fraud Detection: Implement advanced fraud detection algorithms to identify suspicious claims and prevent fraudulent activities, safeguarding public funds. 
• Budgeting Tools: Use budgeting and forecasting tools to predict future workers’ compensation costs and allocate resources accordingly. 

7. Compliance and Legal Support 

• Regulatory Updates: Stay updated with the latest regulatory changes and ensure that all processes and documentation comply with current laws. 
• Documentation Management: Maintain a secure and organized repository for all claims-related documents, making it easier to retrieve and review files during audits or legal proceedings.
•  Legal Case Management: Integrate legal case management tools to handle disputes, appeals, and litigation effectively, minimizing legal risks and costs. 

8. Scalability and Flexibility 

• Modular Solutions: Implement modular software solutions that can be customized and scaled according to the size and needs of the government entity. 
• Cloud-Based Systems: Leverage cloud-based systems to ensure data security, accessibility, and scalability, allowing for easy upgrades and integration with new technologies. 
• Interoperability: Ensure interoperability with other public sector systems and platforms, facilitating comprehensive management across different departments and functions. 

Summary

Modern core technology can help public entities manage their unique workers’ compensation needs by enhancing claims management, leveraging advanced analytics, improving communication, and offering specialized risk management tools. These technologies also improve the employee experience, ensure efficient financial management, support regulatory compliance, and provide scalability and flexibility. By adopting these advanced solutions, these organizations can achieve greater efficiency, transparency, and effectiveness in their workers’ compensation programs. 

To see first-hand how your organization can achieve greater efficiency, transparency, and effectiveness with SpearClaims^TM, our award-winning multi-line claims management system built by industry experts on a modern low code platform that delivers the power of built-in AI and Analytics while lowering your total cost of ownership, Schedule a Demo.   

To discover how Spear’s solutions are accessible to insurers of all sizes, Request Pricing.