Work Comp Claims and Risk Management Services

  • Workers’ Compensation Claims Management

The primary focus of the claims management department is to monitor any workers’ compensation claims that affect the current experience modification as well as to serve as a liaison between you and the insurance company. The service provided includes but is not limited to:

1 – Providing your company on a regular basis with updated paid/reserve/incurred amounts on (open/closed) claims affecting the current experience modification.

2 – Reviewing, in detail, the most currently valued loss runs provided by the insurance carrier on a regular basis to ensure proper paid & reserved amounts.

3 – Coordinating unit-stat meetings between carrier, insured, & PDI to discuss claims activity & paid/reserve amounts affecting the unit stat filing.

4 – Assisting/Guiding your company with questions and/or concerns regarding workers’ compensation claims, reporting procedures, etc…

5 – Working closely w/ your company with respects to any questionable or red flag claims.

In order to commence monitoring of any new “reportable” claims, we request that your company fax a copy of the Employer’s First Report of Injury or Occupational Illness to our office. Please note that you must still report the injury to your carrier within 5 days of the claim being reported to your company.

Work Comp Claims Manager: Karina Hernandez.  Karina currently holds a certificate in Health Claims Examiner/Medical Records Coder, Fire & Casualty Broker-Agent License with a CISR designation, and Workers’ Compensation Claims Professional Designation.

             Risk Management

PDI offers an online database services to help control your claims costs, loss control services and employee/employer type services. 

             Other valuable loss control & risk management links.

Coso/Enterprise Risk Management – http://coso.org/default.htm 

Cal Osha – http://www.dir.ca.gov/DOSH/

Workers’ Compensation Insurance Rating Bureau – https://wcirbonline.org/wcirb/ 

Insurance Journal – http://www.insurancejournal.com/      

Insurance Information Institute – http://www.iii.org



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