Reporting the Claim
What is gathering information?
Collecting the date, time, location, and parties involved is part of this first step.
Failing to meet these reporting requirements may jeopardize the claim.
What are deadlines set by the insurance company or government agency?
These benefits include lost wages and medical payments when a client is injured while in the course of employment.
What are Worker’s Comp benefits?
This role must obtain pictures and confirm the client is treating within 7 days.
Who is the Liability Case Manager?
These documents often need to be requested in both MVA and NON-MVA cases to confirm policy limits.
What is the Dec Page?
When describing the incident, you should only state information that meets this certainty level.
What is 100% certain?
All emails, letters, and phone conversations should be documented with names, dates, and times as part of this practice is called?
What is keeping records of communication?
Because a third party is at fault, the Worker’s Comp carrier can do this against the personal injury case.
What is submit a lien?
This role handles the question, “Is investigation needed?”
Who is the Attorney?
This database is used in Massachusetts to verify Employer's insurance coverage.
What is MAPOC (MA Proof of Coverage) (Worker’s Comp)?
Who handles key information about the claim, the claim number, and contact details and works for the insurance company?
Who is the adjuster?
This type of letter is sent early in a NON-MVA case to the defendant or their insurance.
What is a letter of representation (LOR) / threat letter of representation?
This party is responsible for reporting the Worker’s Comp claim to the WC carrier.
Who is the employer?
In an MVA, this role reports claims, uses the Incident tab, and notes that all claims were reported.
Who is the Legal Assistant?
When checking Worker’s Comp coverage, you must confirm this detail matches the date of incident.
What is the policy term (date policy is active)?
These must be completed accurately and sent along with our ROT form at the beginning of the case.
What are Initial Liens and Ledgers
In a NON-MVA case, a new task appears 14 days after sending the defendant letter of representation. It asks if we have this type of information.
What is the defendant’s insurance information?
When you obtain the WC carrier information, you must add it here in SmartAdvocate and update this financial section.
What are the All Insurance tab and the Lien Tracking section?
This conversation type (found in the Client Communication tab) is specifically called out as a Case Manager responsibility and occurs when our client still has lingering pain that is unresolved.
What is the MRI conversation?
This check is part of the “Preservation of Evidence” tasks and verifies license and vehicle information.
What is a DMV/RMV check?
Who all so you contact to open a claim when you first receive a case?
Liability Ins., UM/UIM Ins., Erisa Ins., Medicaid/Medicare, VA, Tri-Care,
What are the Presentment & Presentation deadlines for all three states?
MA- 30days
RI- 60Days
CT- 90Days
Who has Liens and who has Ledgers
Liens- Ins.
Ledgers- PIP & WC
This occurs when we are unable to identify the defendants insurance company after we have sent out the Defendant LOR & Threat Letter.
Conversation with the Attorney to send a Courtesy Complaint.
In NON-MVA cases, this must be added to the file before sending Document #58 (Defendant LOR).
What is the Defendant?