Transcript Slide 1

ROOF CONNECT
SAFETY MEETING
ORLANDO
JANUARY 12,13 2006
Standard Lines - Casualty
Services & Capabilities
Service & Capabilities
for ROOF CONNECT
CNA at a Glance
CNA founded in 1897
Industry Presence
• 7th Largest U.S. Commercial Lines Insurance
• 14th Largest U.S. Property/Casualty Insurer
•
6th Largest Workers’ Compensation Insurer
*
*as of 9/15/04
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Service & Capabilities
for ROOF CONNECT
The CNA Service Model
Underwriting
Branch Claim Liaison
Claims
Cost
Management
Case
Management
Subrogation
The
Customer
Risk
Control
Loss Processing
Center
1-800 Reporting
Information
Services
Special Investigations
Unit (SIU)
Internet
Access
Legal
Services
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Service & Capabilities
for ROOF CONNECT
CNA Claim Model
Model is based on two principles:
• Specialization: by line of business and claim complexity, matching the
claim with the experience of the claim handler
• Centralization: of lower exposure claims to gain economies of scale and
improve customer service
Components of the model include:
• CNA Loss Reporting
• Express Center
• Service Centers
• Major Case Unit
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Service & Capabilities
for ROOF CONNECT
Loss Reporting
Single Point of Entry into CNA
• Receives claims via phone, fax, or e-mail - 24/7
• Dedicated toll free number for all customers
(877) CNA-ASAP or (877) 262-2727
• Losses triaged for type and complexity and directed to
– Express Center
– Service Center
– Major Case Unit
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Service & Capabilities
for ROOF CONNECT
Express Center
Handles lower value, less complex claims
• Located in Reading, PA
• Handles Workers’
Compensation Medical Only
Claims
• Lower exposure
Auto/General
Liability/Property Claims
• Ability to dedicate service
teams for ease of
communication and
consistency of handling
• Increased operational hours
provide greater accessibility
and continuity of service
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Service & Capabilities
for ROOF CONNECT
Service Center – Workers’ Compensation
National Claim Coverage for handling mid-size WC claims
• Specialized Workers’ Compensation Teams:
– ICE – Initial Claim Evaluation – Investigates claims to determine compensability and only pay what
we owe; average 20% denial rate and 89% stick rate.
– DMS – Disability Management Specialist – Focuses on reducing lost time and getting people back to
work
– DRS – Disability Resolution Specialist – Works toward final resolution after the injured worker is back
to work.
• Ability to Dedicate Adjusters
• Integrated Team Resources include:
– Nurse Case Manager
– Special Investigation Unit
– Dedicated Central Subrogation
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Service & Capabilities
for ROOF CONNECT
Service Center – Liability
National Claim Coverage for handling mid-size Auto, General Liability and
Property Damage Claims
Specialized Auto and General Liability Teams
• Claims Specialized by type – Bodily Injury, Property damage, Litigation, etc.
• Jurisdictional knowledge
Litigation Management
• CNA Legal Services focus on control of expenses and best outcomes
Units supported by Nurse Case Managers, Centralized
Subrogation Unit and Special Investigations Unit.
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Service & Capabilities
for ROOF CONNECT
Major Case Unit
Major Case Unit direct handles large, more complex Liability & Workers’
Compensation Claims
• Specialization by line of coverage
• Highly experienced claim handlers
controlling the most complex and
high exposure claims
• Reduced caseloads
• Streamlines the decision making
process
• Enhanced communication with client
on high exposure claims
• Catastrophic claim response
• National geographic coverage;
flexible unit driven by adjuster
talent
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Service & Capabilities
for ROOF CONNECT
Case Management
Clinical Intervention
FEATURES – Case Management
• Approximately 200 nationally certified case
managers
• Telephonic, Field, and On-Site Case Mgmt.
• Case Management Desktop
• Vocational Case Managers
• Medical Claims Consultation
• Certified Legal Nurse Consultants
• Certified Life Care Planning
• Home Modification Evaluation
BENEFITS –
In support of Return to Work focus;
assure timely and appropriate treatment
• Ease of access to professional quality and
expertise, effect best outcomes
• Provides latest in clinical/duration
information/electronic transfer of activity
• Alerts adjuster to critical medical issues
providing for early intervention
• Nationally certified expertise in support of
the return to work
• Confirmation of provision of appropriate
service, control of costs
• Assure proper handling of the catastrophic
claim through detailed planning
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Service & Capabilities
for ROOF CONNECT
Medical Provider Networks
• The Largest National PPO Network, Concentra is our partner
• Over 465,000 Providers & Facilities in all 50 states
• Network search via Internet, The FOCUS Premier Network
• Ease of Nomination of Providers
• Ability to direct care via customized panels & provide specialized directories
• National Average PPO penetration of 42.4% (Exceeds 70% in some states)
• Active involvement in directing care at each contact with the injured
worker:
− By the claim specialist
− By the case manager
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Service & Capabilities
for ROOF CONNECT
Cost Management Programs
PPO, Bill Review, Bill re-pricing
• Medical Bill Review & Re-Pricing
• Automated Bill Payment Capabilities
• National Preferred Provider Networks
• Pharmaceutical Management
• Card-less Retail Pharmacy Program
• Concentra Preferred Systems: 3rd level review for negotiated bill
reductions for non–network bills
• Chiropractic, Physical Therapy, Dental and Medical peer review
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Service & Capabilities
for ROOF CONNECT
Medical Cost Containment (December 2004 YTD)
PPO, MCO, Bill Review
40% Savings
Pharmacy Program
$374 million
in overall savings
in 2004
17% Bill Review Savings
29% Pharmacy Retail, Blocked Prescriptions, & Home Delivery Savings
32% Durable Medical Equipment Savings
Imaging (MRI/CT) national discount program
42% Average MRI/CT Savings
Chiro, PT, Dental and Medical peer review
88% Chiro Review Savings
79% PT Review Savings
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Service & Capabilities
for ROOF CONNECT
Legal Services
• Staff Counsel – 36 Offices in 22 states covering major metropolitan
areas
- The average staff counsel legal fee for handling a workers’ compensation
claim is $2,100
- Over 200 trial specialists who average 18 years legal experience
• Panel Counsel – Used to compliment Staff Counsel for specific expertise
and geographic coverage.
• Claims Legal Exposure Management – Experienced attorneys
working in conjunction with CNA Claims and defense counsel to
represent the interests of our insured on high exposure cases.
• Visibillity and Westlaw®–Litigation Management Solution Tool; committed
to state-of-the art case management, time tracking and Internet based.
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Service & Capabilities
for ROOF CONNECT
RMIS Services
• A secure, customizable Portal Site
• Access to Clearview® and Loss Runs
• Links to provider networks, industry and more
Clearview Quickview™ provides real time access to
individual claims information, adjuster notes and
financial activity
Clearview® View Only adds the ability to export your
data to multiple formats
Clearview® adds the ability to run standard and
custom reports, drill down with graphing, plus triangles
and a point in time report package
Tapes, FTP and CD-Rom
Service excellence
An experienced RMIS person answers your call with no wait or
phone prompt
Shadow training on Clearview
Designated Consultant to help you with your information
needs
Design and development of Custom Reports
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Service & Capabilities
for ROOF CONNECT
Clearview®
Search by date of
loss, claimant,
claim number,
social security
number, location
Sort each
column
ascending or
descending
View claim
details,
adjuster notes
and financial
transactions
Clearview Quickview™ provides real time access to individual claims information, adjuster notes and financial activity
Clearview® View Only adds the ability to export your data to multiple formats
Clearview® adds the ability to run standard and custom reports, drill down with graphing, plus triangles and a point in time report package
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