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Passive approach to TPAs invites problems, risk managers say

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VANCOUVER, British Columbia—Third-party administrators need active employer oversight to keep their workers compensation claims adjusters motivated, several risk managers said.

“I don't care what kind of program you have—guaranteed-cost, large-deductible or self-insured—you have to actively manage your TPA because your TPA is only as good as you manage them,” said Carla Wynn, Philadelphia-based assistant vp of strategic claims management for ARAMARK Corp.

“If you actively manage the process, you are going to get good results,” Ms. Wynn said during a panel presentation at the Risk & Insurance Management Society's Annual Conference & Exhibition moderated by Mark W. Walls, assistant vp of claims for Safety National Casualty Corp. in St. Louis.

Obtaining good results also requires coaxing, they said.

When Hilton Hotels Corp. held quarterly telephone calls with its TPA's adjusters, the adjusters often failed to share information such as their observations on adverse claims trends, said Peggy Crook, Hilton's director of global claims in McLean, Va.

“It sounds basic, but we were not getting the feedback we needed,” Ms. Crook said.

So Hilton sponsored webinars to teach the adjusters to communicate with Hilton's claims staff, hotel managers and defense counsel, she said.

To encourage the adjusters to better contain attorney costs, Hilton last year began tracking each adjuster's management of attorneys to how well each attorney they work with adheres to a budget, Ms. Crook said.

“They will never say to the attorney, "Why are you doing that? We don't need that,'” Ms. Crook said. “And that is what I expect them to do.”

For optimal attorney management, employers should develop their own litigation protocols that fit their claims needs rather than passively accept the TPA's protocols, said Becky Robinson, assistant vp of risk management for Hobby Lobby International Inc. in Oklahoma City.

Many companies “rely on their TPA's protocols and litigation guidelines and they don't provide input,” Ms. Robinson said.

Ms. Robinson said her firm's TPA also is helping the employer track litigation expenses and settlement records by attorney.

TPA's “can do just about anything if you ask them,” she said.

Hobby Lobby and ARAMARK purchase TPA services from Sedgwick Claims Management Services Inc. Hilton also is a Sedgwick customer through its April purchase of Specialty Risk Services L.L.C..

Sedgwick does a good job, but adjusting claims is tedious work, so ARAMARK motivates adjusters by offering incentives, such as lunch and a handwritten thank-you note, if they meet set closure rates, Ms. Wynn said.

Ahold USA Inc., a unit of Amsterdam-based international retailer Royal Ahold N.V., owns a subsidiary whose internal adjusters manage the company's claims, said Libby Christman, Ahold USA's senior director of risk management in Carlisle, Pa.

Even though the adjusters are Ahold employees, she still cultivates their engagement in and adherence to return-to-work policies, safety practices and guidelines on interacting with operations managers, she said.

To that end, she said she encourages the adjusters to visit Ahold's retail stores and warehouses so they understand how the operations work. That helps them ask the right questions when investigating claims.