A lack of historical claims databases is the most likely reason for US insurers making incorrect claim payments, said Insurance Services Office (ISO).
ISO said 46% of US insurers had identified the lack of historical databases as a major cause of poor claims management, with 20% identifying lack of medical knowledge as the second most probable reason for incorrect claim payments.
Of the respondents, 16% said inadequate negotiation skills led to incorrect claim payments, while 13% blamed claims handlers' inexperience.
“Empowering claims handlers with more information about similar claims and injuries is the most important step insurers can take to achieve accurate claims assessments,” said ISO vice president of claims services Lee Fogle.
“A powerful relational database that incorporates a medical encyclopaedia, based on the International Classification of Diseases, provides claims handlers and managers with a complete claims history audit trail at their fingertips.
“Such a tool also provides more efficient management reporting practices, improves claims handlers' medical knowledge and increases their negotiating skills.
“Combining best practices with professional knowledge is critical to establishing high claims-handling standards,” concluded Fogle.
