Connecting the Dots in Restaurant Claims

Have you ever played Connect the Dots? At first it might seem like a bunch of dots and numbers. But as the dots begin to connect, the image magically appears. Restaurant claims are similar. At first it might seem like a bunch of events and numbers. But eventually general liability, personal injury, liquor liability, product liability (food poisoning, allergic reactions, hepatitis), and fire can all come together and magically reveal the whole picture.

It’s obvious enough that insurers have an obligation to fulfill the promises they make to protect against losses when they sell policies. But who protects your risk managers? How can they ensure they’re properly identifying all of the risks they’re paid to mitigate? How can they do so efficiently and coherently? And how can they connect the dots between claims to identify patterns, to improve their risk selections, and to maximize guest satisfaction?

The Whole Picture

They can start by tracking incidents, rather than claims. Here’s a scenario: One evening, Gladys, a waitress at Ernie’s Chop Joint, trips on her way across the dining room and drops a tray containing a carafe full of water and eight water glasses. The glasses shatter. As the carafe rolls across the floor, water runs into some electric sockets in the floor, causing a fire. (Claim #1, property damage.)

On its way to the floor, the carafe full of water, ricochets off the right foot of Herb, a gentleman having dinner with his wife, fracturing three metatarsals. (Claim #2, bodily injury). Herb’s wife, Grenadine, believing Gladys dumped the tray on purpose, convinces Herb to sue Ernie’s. (Claim #3, general liability.)

The risk manager now has three claims to contend with, all stemming from Gladys’s stumble, but that may be unrelated in terms of coverage. For that matter, it’s possible for the claims to be managed by different people who may have no way and no reason to connect the dots. If, on the other hand, the claims had been tracked by incident (poor Gladys), then all the dots would have been connected.

If the claims system the risk manager used tracked incidents — used tag-based organization for documents to eliminate network folders and files; attached image files, videos, PDFs, and other documentation to each incident and anchored every claim to an incident — dots would connect themselves. As a result, claims would be managed more efficiently, patterns would be more readily identified, risks would be assessed more effectively, and conditions and circumstances could be adjusted to mitigate those risks.

We can’t promise to protect Gladys. But we can definitely help the risk manager who’s trying to.

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TPA: Total Processing Adaptability

Especially for workers comp claims — and especially for companies that use TPAs (third-party administrators) — it’s crucial to have Total Processing Adaptability.

What we mean is that your claims system should let you manage everything you want to manage and to have an optimally flexible relationship with your TPA(s). And it entails the ability of that system to give you the reports you need to enable you to spot trends in your claims experience. Are claims being reported properly? What kinds of claims are prevalent? What types of injuries are most common? What body parts are most likely to be injured? What are the most common complications? What are typical recuperation or rehabilitation times for particular types of injuries?

Beyond that, Total Processing Adaptability means your claims system lets you control the flow of information. We’ve seen setups in which accident reporting goes straight to the TPA because the organization in question doesn’t have the technology to capture accidents. If you’ve got Total Processing Adaptability, you have first-report capability and can route accident reports to TPAs automatically, based on your business rules. The right choice of unbundled software — with no reliance on software provided by a TPA — means your data is yours. If you have multiple TPAs or want to switch TPAs, having your own claims software gives you a layer of protection; that is, an element of risk management that helps normalize your reporting and operations. That ensures one view of your data, regardless of TPA, insulating you from the negative effects of changing TPAs.

When we created Cloud Claims, we knew we wanted to give our customers Total Processing Adaptability. We wanted to ensure a first-class claims experience for claims managed in-house and those managed by a TPA. We wanted to automate workflows to eliminate manual processes. We wanted sending files to TPAs to be as easy as clicking a button. By freeing adjusters from administrative tasks, we wanted to let them concentrate on critical decision-making — and we wanted to supercharge every risk management department’s productivity.

You can’t completely manage the safety of your workers. But you can manage your workers comp claims. With the right TPA and Total Processing Adaptability, you can effectively manage those claims and reduce the costs of the claims that occur.

With the right claims system, you’ll be on your way to more efficiency, better outcomes, and fewer headaches.

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