In 1991, the Colorado workers’ compensation
system underwent significant legislative reform. As part of an
effort to increase efficiencies, contain cost and reduce
litigation, the General Assembly declared that active management
of workers’ compensation claims should be practiced by Claims
Managers at the Division of Workers’ Compensation. Their job
would be to educate, review, audit and close cases, “to promote
speedy and uncomplicated problem resolution...and to otherwise
manage claims.”
Anticipating the need for strong
administrative oversight, a computer system was developed to
identify discrepancies and calculation errors on Admissions of
Liability (admissions). The purpose was to provide a “first
cut” automated review of admissions which could then be
forwarded to Division Claims Managers for further review. This
process has come to be known as the “error letter process.”
When a discrepancy or calculation error is
identified, an error letter is generated to the insurance
company as the primary recipient with copies to the injured
worker or claimant and attorneys for both sides. The error is
described in the text of the letter as well as any action that
is required to be taken. All letters are reviewed by a Claims
Manager prior to mailing. Some will be discarded due to a
document entry error or receipt of supporting documentation. In
the alternative, a letter may be mailed without any changes, or
additional errors may be noted following the Claims Manager’s
review. The insurance adjuster is required to respond within 15
days. The file will then be reviewed by a Claims Manager to
ensure compliance.
The purpose of
the error letter process is to alleviate unnecessary litigation
and costs that can be resolved simply and efficiently through
administrative intervention. The role of a state agency is to
provide enforcement and administration of the laws it oversees.
Claims Managers have a duty to educate. Timely review and
feedback on errors provides instruction as to required
performance and is a mechanism for productive communication
between the administrative agency and those it serves. For more
information, click on
How to avoid an error letter
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