Our Services > Home Visiting Services
Home Visiting Services
Claim Form VisitOn receipt of instructions our inspector will contact and visit the claimant on the insurer’s behalf to assist with the completion of the claim form. The Inspector can inspect documentary evidence of age and financial information on behalf of the insurer or collect the information for the insurer. The claim form is then sent to the insurer and the inspector provides a report on the visit, including any additional information not requested in the claim form and will identify any significant perceptions or misconceptions. The inspector will ensure that the claimant understands the terms and conditions of the insurance. Some insurers ask the inspector to leave details of the terms and conditions or notes on claiming benefit with the claimant so that the claimant has written information to refer to.
A Claim Form Visit adds value by
• making direct contact with the claimant at the earliest possible opportunity;
• providing help in completing the claim form and the production of documentary evidence, particularly financial evidence;
• ensuring that the Claims Manager has all the available facts and evidence;
• providing the claimant with an opportunity to ask questions about the insurance;
• providing the claimant with details of the claims procedure;
• making the claimant aware that the claim will be actively managed and that help will be provided with rehabilitation;
• providing the opportunity to identify cases where the provision of funds for investigations or treatment might expedite recovery.
The majority of claimants appreciate help at a difficult time and the visit is usually seen as part of the insurer’s service to its policyholders.
Pre Admission Visit
Some insurers prefer to wait until the claim form has been received before deciding whether to visit a claimant. The inspector can then follow up any information given in the claim form that is incomplete, inconsistent or confusing. The inspector will ensure that the claimant understands the terms and conditions of the insurance and will identify any significant perceptions or misconceptions. Some insurers ask the inspector to leave details of the terms and conditions or notes on claiming benefit with the claimant so that the claimant has written information to refer to.
A Pre Admission Visit adds value by
• making direct contact with the claimant at an early stage in the claim;
• checking any incomplete, inconsistent or confusing information given in the claim form;
• ensuring that the Claims Manager has all the available facts and evidence;
• providing the claimant with an opportunity to ask questions about the insurance;
• providing the claimant with details of the claims procedure;
• making the claimant aware that the claim will be actively managed and that help will be provided with rehabilitation.
Here again, the majority of claimants appreciate help with what is perceived by some as a daunting task and the visit is usually seen as part of the insurer’s service to its policyholder.
Full Visit
These visits are designed for established claims. The inspector will review the claimant’s illness or injury and establish why the claimant believes that he or she is not able to return to work. The inspector will ensure that the claimant is aware of the help that the insurer and the State will provide to help the claimant to resume some work. The inspector is also able to deal with any questions the claimant might have about the terms and conditions of the insurance and will identify any significant perceptions or misconceptions. If the inspector does not have the answer to a question or the question covers a matter of policy the inspector will ensure that the insurer is asked to respond to the question(s).
Service Standards
In all cases we will provide you with a written report within ten working days of receiving instructions for cases within the British Mainland and Northern Ireland, provided we are able to make contact with the claimant and agree a mutually convenient appointment within a reasonable period. If there is a problem in making an appointment that will cause delay we will ensure that you are kept fully informed.
We are able to offer a visiting service in areas outside the British Mainland for which there is a special tariff. While we are not able to guarantee turnaround times we are able to ensure that visits are completed within a reasonable time. The Bureau has a subsidiary company in the Republic of Ireland that can service your needs there.
Reports
Reports can be tailored to meet your requirements. Our inspectors are happy to express an opinion about a claim, based on the information gained at the visit, if required but it must be borne in mind that the claimant has the right to demand a sight of the report.
Health Claims Consultant Visiting Service
The Health Claims Consultant Visiting service has now been in operation since December 1999 and during that time we have seen a substantial increase in business. Our main objectives are to:
• provide Health Claims Consultants with a nursing or occupational therapy background to help Claims Managers with the assessment of continuing claims to ensure that they remain valid; and
• identify those claimants whose motivation and circumstances enhance the probability of returning to employment given proactive rehabilitation and case management.
Our specialist Health Claims Consultants have a variety of specific skills and are experienced in dealing with:
• the medical, psychiatric and technical aspects of disability claims
• rehabilitation, occupational health issues, work place assessments, careers counselling and employer liaison.
Services Available.
We offer two services: -
Pro-Claim Immediate Needs
Assessment.
· Inspect picture ID on arrival to confirm the identity of the claimant.
· Inspect evidence of age and complete a verification form for your records.
· Assist the claimant with the completion of the Claim Form.
· Ask supplementary and additional questions to ensure that all of the claimant’s
circumstances are fully understood.
· Make specific enquiries to assess the validity and probable duration of incapacity.
· Using an evidence-based process assess the claimant’s engagement and
motivation to return to work.
· Assess if the claimant’s recovery and return to work will benefit from immediate
help or if the claimant is likely to need assistance with rehabilitation following
treatment.
Our Health Claims Consultants use the evidence based Medical Disability Guidelines (MDGuidelines), published by the Reed Group, to assess probable disability duration from the commencement of treatment or completion of surgical procedures. Our consultants are trained to look for the biopsychosocial pointers to non-medical factors that might be barriers to a return to work.
Our consultants undertake: -
· an Engagement/Motivation to Return to Work analysis – a diagnostic process
which generates an immediate initial assessment of the claimant’s declared
engagement with their employment, presented graphically and compared with
normative data; and
· A Field Force Framework – a comprehensive graphical analysis of the key driving
and hindering factors of the situation, perceived to be the most influential in terms
of outcome.
Our consultants prepare a report: including –
· Executive Summary of Key Drivers
· Personal Details of the Claimant
· Occupational Details
· Medical Details
· Personal Financial Issues
· Policy Conditions and the claimants perception of the insurers
· Plans for the future
· Conclusion
· MD Guidelines guidance on disability duration
· Assessment of engagement and motivation
· Recommendations – if required
When dealing with Individual Income Protection there will be an additional section dealing with the claimant’s earned income for Limitation of Benefit purposes.
Where appropriate our Health Claims Consultant will also, separately from the report, prepare two copies of a Priority Intervention Plan detailing: -
· the actions they see as Immediate Priorities; and
· the actions they see as Secondary Priorities; and
· who they suggest should take the action.
An estimate of the cost will be included if the Plan suggests further action by our Health Claims Consultant or recommends a Rehabilitation Case Management Plan. The Priority Intervention Plan will enable the assessor to sign, date and return the one copy by Fax if they require the Health Claims Consultant to proceed with the proposed actions.
Our Health Claims Consultant will case manage the rehabilitation process providing the assessor with regular reports on progress. When the claimant is ready to commence work our Health Claims Consultant will be available to work with the employer to arrange a graduated return to work and will monitor the claimant’s return to work to ensure that it is sustained.
Our Health Claims Consultants will also identify those claimant’s who are not making the progress expected and where they are satisfied that the claimant will not manage a return to work will bring the rehabilitation process to a close in a non-confrontational manner.
We appreciate that where the deferred period is less than four weeks and early notification is received a claim form visit might not be appropriate in every case. We are happy to undertake an immediate needs assessment visit at any time in the first 12 months of incapacity after the claim form has been completed and the initial assessment of the claim has been undertaken
Claim Review Visits.
We appreciate that a claimants circumstances can and will change during a claim. Our Health Claims Consultants are able to visit claimants during a claim to help the assessor gather additional information to assist in the review of claims.
Visits can either be announced or unannounced depending on the insurer’s preference. The Health Claims Consultant will arrange a mutually convenient date and time for the visit by telephone or letter. If we encounter any difficulties we will inform you as soon as possible.
One of the Health Claims Consultants’ main objectives is to try and establish the true physical functioning levels and psychological status. It is particularly important that these are carried out in an unobtrusive and non-invasive way. This is done by observation and discreetly encouraging the claimant to carry out various simple tasks which will involve mobilising, bending, lifting, sitting, manual dexterity, the use of relevant questionnaires if appropriate, assessing cognitive functioning and the use of non-direct and direct questioning.
Health Claims Consultant visits can be particularly effective for self-reported disabilities such as anxiety state, depression, chronic fatigue and where the disability is said to be stress related.
As part of our overall service the Health Claims Consultant will make one further contact with the claimant by telephone at an agreed time after the visit to review the claimant’s progress since the visit and will provide an additional brief report. There is no additional charge for the single extra contact by telephone. Further follow-ups or additional telephone enquiries can be arranged for an additional fee.
Our prices are all inclusive with no extra charges for travel or accommodation except for: -
· Visits in Northern Ireland; and
· When a specific Consultant or discipline is requested to make a visit out of
their normal geographic area;
when an additional charge will apply.
Health Claims Consultant fees are zero rated for VAT.
Group Scheme Business – Employer Visits.
For Group Scheme business our Health Claims Consultants will also visit a claimant’s employer to discuss the opportunities for rehabilitation to the claimant’s original occupation or to an alternative occupation. Our Health Claims Consultants will ensure that the employer is aware of his or her responsibilities under the Disability Discrimination Act and of the State help that is available to retain a disabled person in employment.
Critical Illness and Total Permanent Disability Claims.
Claims for Total Permanent Disability are frequently difficult to assess and a number of claimants do not properly understand the criteria for a valid claim which can lead to disputes and complaints. An early Health Claims Consultant visit can help the insurer to make an initial assessment of whether the claim warrants full examination and provides the opportunity to explain to the claimant the criteria for a valid claim