Claims Services

Our long history of focusing exclusively on workers' compensation insurance has resulted in a carefully conceived, well-tested set of claims services, each designed to improve results for policyholders. Services include:

Claims Management: To ensure prompt, personal, and focused attention, each policyholder is assigned a lead claims examiner. Case managers work in teams with claims examiners and a national network of health care providers to coordinate all aspects of a claim. The high quality of our claims management processes are further supported by:

• Case loads that are well below the industry average
• A one-to-two ratio of claim assistants to examiners
• 24x7 availability of claims professionals through an emergency call-back system

Physician-Guided Care: SeaBright pioneered the practice of giving physicians direct, ongoing oversight of the care received by injured workers. Through our Physician-Guided Care (PGC) program, we now assign a physician to any claim that could potentially involve six weeks or more of lost work time, as determined by predictive modeling. PGC physicians have full authority to oversee the claim during its entire lifecycle, including the medical treatment received by injured workers. The program also makes physicians available, as needed, for oversight of less complex claims, and assigns pharmacists or physicians to review all prescriptions for narcotics.

USL&H Center of Excellence: U.S. Longshore & Harbor Workers' Compensation and Jones Act/Maritime Employers' Liability claims are handled in a central location, making it possible for claims examiners to tap one another's knowledge and experience. We've handled more than 45,000 USL&H claims since 1985, and our staff averages 24 years' experience with maritime claims, as well as with the ever-changing judicial interpretations of the state and federal regulations that govern them.

Easy Access, Online Claims Systems: To encourage policyholders to report accidents the minute they occur, our BrightNotice™ telephone and web-based Claim Reporting system is available around the clock. (Policyholders also have the option of mailing or faxing accident reports.) In addition, larger customers can track the status of claims in two ways: through our web-based BrightView™ Loss Information System or our PC-based Compass system, which records each step of a claim's progress, complete with our claim examiner's notes and comments.

Pharmacy Benefit Program: To lower prescription costs and avoid out-of-pocket expenses, injured workers can obtain injury-related medications at discounted prices from a nationwide network of over 64,000 pharmacies. Affiliate pharmacies also review prescriptions prior to their being filled, and cross-check patient information to help identify any potential adverse effects. In addition, health care providers receive SeaBright's experience-based formulary of effective drugs for various worker-related injuries, with an emphasis on lower-cost generic equivalents, as appropriate. Beyond this, staff pharmacists provide an added level of expertise by reviewing requests for narcotics, guiding treating physicians in weaning recovering workers off chronic narcotics use, and serving as an ongoing resource for our claims examiners.

ReadyReturn™: Our ReadyReturn program helps employers adopt effective strategies for transitioning recovering workers to temporary, alternative employment to promote full recovery, re-capture productivity, and ultimately lower the claim cost. When alternative work is unavailable, temporary assignments are usually available through our national network of charities.

Fraud Detection: Our claims examiners are trained to detect indicators of fraud. If they spot a red flag, they refer the suspicious activity to an independent investigator to pursue the case.

Subrogation Services: Our in-house subrogation unit and liability attorney are expert at identifying recovery opportunities where third-party liability exists.

Our Performance Record

• SeaBright's claims closing rate of 96 percent within five years tops that of the 10 largest workers compensation insurers, according to a study by the California Worker's Compensation Institute for the state of California, which represents 20 percent of U.S. workers compensation claims.1
• SeaBright's average medical cost per indemnity claim in California is 38 percent lower than the industry average for the state.2

SeaBright Claims Kit
SeaBright ReadyReturn Brochure

1 Claims-closing performance data comes from Schedule P, Part V, from the annual statements of the top 10 private workers compensation insurance underwriters, as measured by premiums written. For subsidiaries of holding companies, the aggregate data for all held companies was used.
2 Industry data comes from the Workers' Compensation Insurance Rating Board, as of December 31, 2010. SeaBright data is valued as of May 31, 2011.