Self-insured companies already carry the risk. The question is whether you also own the intelligence that drives your claim decisions. When investigations live entirely inside your TPA’s workflow, you may see reports, but not the ties of field facts to reserves, RTW, legal posture, and prevention.
Bringing investigations into your line of sight (while still partnering with your TPA) creates faster cycle times, clearer ROI, and fewer surprises. Unbundling puts you in control of investigative strategy, timing, and deliverables. The payoff: faster cycle times, lower ALAE, targeted indemnity reductions, stronger RTW, and defensible settlements.
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Why “Unbundling” Investigations Pays Off for Self-Insureds
- Control & transparency: Direct alignment on what to investigate, why, and when—not just “run a standard check.” You set hypotheses, timelines, deliverables, and KPIs.
- Proactive decisions: Real-time observations from investigators closest to the claim help you confirm capacity, spot inconsistencies, and support earlier RTW or settlement steps.
- Measurable ROI: When reporting is standardized (timestamps, exhibits, outcome metrics), you can quantify reserve accuracy, ALAE avoided, and investigation spend—every quarter.
- Stewardship reporting: unbundled investigative vendors should provide the self-insured company routine stewardship.
Working Directly with Investigators” in Four Moves
- Define the “why” up front
Tie each referral to a decision: RTW/modified duty, causation clarity, earnings verification, or settlement timing. Make “no findings” an acceptable outcome—neutral, not suspicious. - Standardize deliverables
Require decision-ready packets: objective summary, time-stamped clips/stills, source list, and an investigation report you can hand to an IME or counsel. - Wire in stewardship reporting
Quarterly roll-ups should show activity vs. restrictions, trends (to spot trends, investigative spend, measured impact), and value metrics (time-to-action, reserve deltas, ALAE avoided). - Close the loop with operations
Feed findings to HR/RTW, safety, and finance so lessons reduce future loss, not just this loss.
Choosing the Right Investigative Partners (A Self-Insured’s Checklist)
1. Selection criteria
- Proven domain experience (WC, liability, transportation, etc.) and multi-jurisdiction licensing.
- Modern reporting (secure portals, media handling, metadata) and strong data protection (HIPAA/PII).
- References and case studies relevant to your loss profile.
2. Cost vs. value
- Insist on transparent pricing and steer away from “cheapest wins” dynamics that sacrifice admissibility and quality. Pilot 1–2 vendors on real files before long-term deals.
3. KPIs you can actually use
- Case turnaround, cost per investigation, detection/validation rates, recovery assists, and report quality (decision-readiness). Review monthly/quarterly and adjust scope—not just vendors.
5. Compliance & ethics
- Surveillance and privacy laws vary; require written compliance standards and proof of E&O/cyber coverage.
What “Good” Looks Like (Signals You’re Closing the Loop)
- Decisions accelerate: IME addenda, RTW offers, or settlement moves happen within days of evidence receipt.
- Documentation stands up: Clean chain-of-custody, clear exhibits, and neutral language suitable for court or medical review.
- Finance can trace value: Quarterly view of reserve changes tied to investigations—not anecdotes.
Conclusion
Self-insured companies get the best results when investigations are designed for decisions, not just documentation in a file. Unbundle where it helps, standardize what you expect, and measure the effect on reserves, ALAE, and cycle time. That’s how you truly own the outcome.
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Frasco® Investigative Services delivers ethical and efficient solutions tailored to your needs. Have questions or want to discuss your investigative needs further? Contact one of our experienced experts today to find the answers you’re looking for.
Disclaimer: This blog post is for informational purposes only and should not be considered legal advice. Please consult your general counsel for specific legal guidance. Frasco investigators are licensed, and our operations comply with US industry, federal, state, and local laws.