PGCS Online Claims Questions & Answers

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Submitted by Public Risk Underwriters of Florida, Inc. – Loss Control Department

We recently had the pleasure of speaking with Cheryl Riley, Director of Worker Compensation Claims, for Preferred Governmental Claims Solutions (PGCS) regarding the PGCS claims database. Cheryl provided answers to some of the common questions regarding the claims database that include how to register for access as well as features/benefits.

Q: Can you tell us how a member would register for access to the claims database?

A: To register, a user must first complete the registration process by accessing the PGCS website located at – www.pgcs-tpa.com; Once there select the hypertext word “Register” in the upper right-hand portion of the home page. Complete the form and select the “Register” button to complete the registration process. Within 48 hrs. you will receive your Password/ID so you can begin accessing the claims database.

Q: How easy is it to report claims through the program?

A: Members can report claims on-line 24/7 with templates available to assist with the reporting process for all lines of coverage.

Q: What reports are available?

A: The PGCS claims database provides multiple report options to assist with claims management and provides for the following:

CLAIMS LOOKUP
The Claims Look Up feature allows the user to search for individual claims or claims within a specific date range. The search results will allow the user to view the claim that includes claim notes, payment history, reserve history and financial summary. There is also a direct email link to the Claims Adjuster should the user have any questions regarding the claim.

LOSS RUNS
The Loss Run feature allows the user to generate variety of reports. More specifically, it provides the user the ability to compile a comprehensive loss run report, loss run report by a specific policy year, loss run report by claim status as well as a loss run report by specific coverage type. With the comprehensive loss run report details are provided that include employee name, the injury description, date the claim happened, date reported, total incurred, paid for medical, indemnity, legal and expense as well as claim reserves.

CHARTS
The following charts are available:

  • Total Incurred by Top 7 Cause Groups
  • Claims by Day of the Week
  • Total Incurred by Day of Week
  • Claims by Current Status & Year Opened
  • Claims by Body Part
  • Total Incurred by Body Part
  • Claim Count by Age
  • Total Incurred by Age
  • WC Claim Type
  • WC Incurred by Claim Type
  • WC Claim Count by Claim Type – Fund Year
  • WC Total Incurred by Claim Type – Fund year

 

REPORTS
The Reports feature allows the user to create reports based on criteria pertaining to claimant, cause, body parts, nature of injury, employee classes, etc. The user is also able to create reports by claim count, paid, reserve, incurred and claimant.

LOSS CONTROL
This report can be run for all years, last three/five-year timeframes as well as a particular year. Members see the amount of premium paid for the policy year and the amount used to pay claims. There is a column for reserves, and incurred, the number of claims for that year, the average cost of the claims, loss/frequency ratio, and the experience modifier on Workers Comp claims. On the lower portion of the report the member will see the break down for each policy by year and the claims. This report is great for identifying the frequency/severity of claims which can be used to establish trends and recommend corrective action to mitigate claims.

RECOVERY
The Recovery feature provides a list of vendors as well as a direct link to each vendor website for services for mold remediation, recovery management and water extraction.

HURRICANE WATCH
The Hurricane Watch feature is a link to NOAA, allowing our members to track named storms and hurricanes.

INFORMATION
Provides a brief Power Point Presentation about PGCS Mission Statement, history and staff, as well as means to contact PGCS.

Q: Are members able to create their own reports with the information that is provided through the on-line claims?

A: Yes, the member can export to excel the raw data to create their own reports. The database has an option listed on the report to make this easier.

Q: Can you tell us the ways you have found that members use this service to best assist them with claims handling?

A: Members have found the information provided on the claim database keeps them updated on their claim activity to assist with claims management. The charts and reports provide valuable information to initiate discussions with the safety committee and departments on claims prevention. This may lead to policy updates, procedure changes, equipment changes as well as training.

The PGCS claims database is available to Preferred Members at no additional cost and is an invaluable tool which can be utilized to assist with risk/claims management. More specifically, it can be utilized to review claims status, provide tracking/trending of claims, conduct accident investigations, conduct safety inspections, provide agenda items for safety committee meetings as well as identify safety training topics.

Should you have any questions regarding the PGCS claims database please feel free to reach out to Cheryl Riley or your Preferred Loss Control Consultant. Also, your Preferred Loss Control Consultant can assist you with scheduling Claims Review meetings and/or Claims 101 Training, both of which are integral to an effective claims management program.