By producing Best Practices Guidelines for the type of claims handled by your carrier, third party administrator (TPA), or independent agency, you set forth standards and procedures that will guide your organization through a process that is sound, consistent, and fair.
The following tips help guide you in planning and writing these documents:
1. Decide which Best Practices Guidelines need to be written. Even small TPAs and carriers may find that they want a Best Practices Guideline in place for a number of situations or claims. These could include production of loss runs, anti-fraud, audits, auto claims, construction defects, homeowners claims, occupational accidents, and subrogation.
2. Decide on an attractive format for your Guidelines.Regardless of subject matter, the Guidelines should be well spaced, have headings and subheads, have wide margins, and avoid long paragraphs and sentences. Avoiding long paragraphs is especially important if you plan to have text that is both left- and right-justified, since right justification tends to emphasize a paragraph’s length.
3. Indent bulleted lists. By doing so, you help readers differentiate meanings quickly and retain more of what they read.
4. Use Plain English.Although the Best Practices Guidelines are often written by house attorneys, they should be free of most jargon and easily understood by most claims professionals.
5. Read the Best Practices Guidelines aloud.Your ear may catch what your eye doesn’t. The Guielines should have the warmth and color of human speech. By reading them aloud, you’ll catch phrasing problems, punctuation problems, make sure bullets are parallel, and eliminate unnecessarily legalistic phrases.
6. Choose Headings that are logical.For a Guideline on Subrogation, one TPA chose the following subheads:
INTRODUCTION, INVESTIGATION, EVALUATION, DISPOSITION, REPORTING, DOCUMENTATION, and SUPERVISION.
The Guideline’s only subhead, “Mitigation” was placed within the heading “INVESTIGATION.” By bolding and capitalizing the headings while upper- and lower-casing the subheads, the Guideline immediately tells the reader which topics are subordinate to larger topics.
7. Using passive language to describe procedures within a Guideline is fine. While active language (e.g., “Generate a Risk …,” “Draft and submit a denial …”) can be helpful if a practice is written for a single employee, most insurance carriers favor passive language to tell what should be done, instead of naming the doer of the action.
So, instead of “Generate a Risk,” a procedure within a Guideline might read, “If a claim is reported late, a risk alert should be generated.” Also, “Where declination of coverage is indicated, a denial in compliance with state-specific form and time requirements should be drafted and submitted to the Unit Manager to obtain carrier approval before publication.”
8. Use Subheads that Are Simple and Descriptive. For a Best Practices Guideline on Statements, one company used just five concise subheads:
INTRODUCTION, STATEMENT SUBJECTS, GENERAL PREPARATION, THE INTERVIEW and POST INTERVIEW.
9. Keep Best Practices Guidelines to a reasonable length. A Best Practices Guideline for Occupational Accidents may run four to five pages, while a Homeowners’ Claims Guideline could run 10 pages or more. The shortest Guideline I’ve seen is one that runs only one page (Production of Loss Runs).
10. Revise, update and amend Best Practices Guidelines regularly.When a claims vice president or a manager of quality assurance at a TPA or carrier discuss the revising of Best Practice Guidelines or claim form letters with me, I advise them to send me one or two samples and then I review them FREE. If I catch more than six writing issues on a single page of text, I suggest that they consider an overhaul of their documents; otherwise, I congratulate them!
When was the last time your claims form letters or Best Practices Guideless were reviewed and updated?
Blake is director of The Communication Workshop, offering writing seminars and webinars to insurers across North America. Phone: 516-767-9590. E-mail: firstname.lastname@example.org. Web site: www.writingworkshop.com.
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