A healthcare plan audit program
to safeguard your plan assets
is a Best Practice

Subrogation and Coordination of Benefits Claim Audit




In essence, subrogation is when a third party is determined to be responsible to some degree for an insurance claim and then reimburses the injured parties, or insurance companies, for all or part of the damages.

In the context of workers’ compensation, when an employee is injured, the employers may pursue subrogation if the injury was the fault of another party, such as the manufacturer of a faulty piece of equipment or material.

Most subrogation issues, especially in business enterprises, are not so simple and clear-cut. The time and effort required to work through the complexities of some claims may deter adjusters from pursuing subrogation fully.

In other cases, adjusters may be knowledgeable about subrogation for one area, property or automobile claims for example, but lack experience or expertise in dealing with subrogation relating to workers’ comp. The result may be significant recoveries unclaimed and possible revenue unrealized.
MedReview supplements the administrative and legal functions of your Plan Claims Administrator. We coordinate and enhance your Plan’s subrogation recovery efforts.

MedReview has committed itself to serving the coordination of benefit and subrogation needs of self-insured clients. We recognize that subrogation is but a small portion of the health benefit administration. Our staff is trained to clearly explain subrogation principles to your members and not to upset subscribers through heavy-handed collection tactics. Our focus is not exclusively the recovery of subrogation funds in any particular case, but rather insuring that the Plan systematically pursues and identifies all possible subrogation claims in a documented, effective revenue-producing manner. This will maximize the dollar value of your subrogation recoveries. It is important for you to have detailed supporting documentation regarding overall and specific subrogation activities in order to demonstrate to management that the Plan Administration is cost efficient and that the Plan does care about the health care dollars that it administers.

The reporting information from this program will further show management that you are diligently performing your Fiduciary Duties to the Plan, and subrogation funds recovered will dramatically increase.

All closed cases are reported with the reason why each case was closed. You will then be able to run reports not only to show how many cases you have investigated and closed, but why, in each particular case, a recovery could not be secured.