© 2023 by Triad Group, LLC

400 Jordan Road
Troy, NY 12180

Headquarters:

1-800-337-7419

Phone:

Email:

Claims Management

Early Intervention

Our claims management professionals provide immediate review of all referred workers’ compensation claims in 24 to 48 hours. A three-point contact to employer, physician and injured worker allows us to obtain crucial baseline information, which is imperative when formulating a proactive treatment plan.

 

Through client collaboration, we achieve tremendous cost savings by addressing initial and ongoing concerns before claims escalate. By addressing initial injuries from the onset and remaining in constant communication with our client, we can identify and prevent the potential for a simple claim to escalate into a complicated issue. Our nurses can “red flag” a concern such as low back strain, and carefully review all medicals and diagnostic outcomes, as well as pre-existing and non-related medical issues.


Claim Investigations

Claims are thoroughly investigated to achieve accurate and prompt compensability determinations.  Our clients are informed of compensability recommendations along with potential mitigating factors, such as subrogation opportunities.

Claims Administration

As a result of our more than thirty years of experience in servicing the needs of our clients, our professional management staff, workers’ compensation claim staff and our in-house legal counsel are uniquely experienced to provide a comprehensive claims administration program.
 

Reserving

Triad takes a practical approach to reserving. While the initial claim reserve is based on industry standards, our reserves are reviewed to verify accuracy at specific intervals and as new information, documentation, or investigative developments are received by the claim administration staff. The reserve reflects a realistic outcome based upon our knowledge and experience of the claim and we avoid the practice of step reserving. We develop a reserving practice in consultation with our client to ensure the financial requirements are understood on every individual claim.

 

Action Plans

Action plans are formulated for every claim in collaboration between our claim administration staff, nurses and internal legal counsel. Action plans are established thirty days from the onset of the claim, are reviewed on a regular basis, and are revised for any material changes to the claim thereafter. Action Plans are designed to move injured workers toward timely post-injury recovery and return to gainful employment, as well as provide timely claim resolution with favorable outcomes for our clients. Clients have full on-line access to review an action plan on any given claims.

 

Independent Medical Examinations (IMEs)

IMEs provide an unbiased assessment of a claimant’s injuries and potential action plans. Triad utilizes IMEs to clarify and resolve medical, return to work and treatment issues relating to the claim. Triad contracts with IME scheduling companies that have physicians familiar with the Workers’ Compensation process and can provide the appropriate and required reporting, documentation, and, if necessary, testimony.

 

Recoveries

Triad is focused on recoveries and subrogation for our clients. Triad has a dedicated Excess Workers’ Compensation Manager that oversees all Excess WC reimbursements, Second Injury Fund reimbursements as well as a third-party subrogation. The Excess Manager works alongside our claims administration staff and legal counsel to ensure reimbursements are timely and are accurately captured in our database.

 

Claim Resolution and Settlements

Triad manages all claims with the goal of claim resolution. Creative strategies are developed to bring claims to full and final resolution, taking into consideration the unique circumstances associated with each claim. Our settlement authority is always dictated by our clients and we maintain an open and active dialogue on potential and ongoing settlement procedures. Additionally, our in-house staff attorneys can provide settlement documentation that is competitive and cost effective, which in turn, delivers additional savings to our clients.

 

Fraud Monitoring

Triad is focused on reducing fraud for our clients and constantly monitors early warnings for short-term claims developing into long-term claims. As part of our initial and ongoing monitoring, Triad claims administration staff are trained on various methods to detect potential malingering and fraud. Examples include history of multiple claim fillings, lack of progress or inconsistent reported progress, and subjective complaints outweigh objective medical findings, among others. Any potential fraudulent activity is communicated to our clients to determine next steps, which can include additional examinations or even private investigation services.

 

FileHandler™: Triad’s central and mission-critical technology solution in partnership with JW Software

Current and accurate information is an essential tool for any risk management professional. Triad’s claim professionals are supported by a state-of-the-art claims management system called FileHandler™, a multi-line claims reporting and control system with elaborate checks and balances to ensure a high degree of data integrity. FileHandler™ is provided by our technology partner, JW Software, while Triad claims management staff control all data that is managed within the system. Therefore, Triad personnel are always available to answer any questions or requests from our clients.

 

Customized Reporting and Dashboards for Risk Management Programs

We are able to capture data fields to generate customized and real-time reports based on client’s departmental needs. Clients have access to our full claims database and are able to run reports and retrieve any information pertaining to an injured worker’s claim. We also provide Medicare, Medicaid and SCHIP Reporting (MMSEA) at no additional cost to our clients.