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Large Claim Management

for Traditional Products

  1. WHAT IS A LARGE CLAIM MANAGEMENT AND WHY SHOULD IT BE USED?
    • Catastrophic or chronic illness often required expensive medical care. But high cost and quality care are not necessarily synonymous.
    • In many cases, a more economical alternative may also be a better medical solution. Better for the patient because its fits his or her needs; better for the Employer and insurance provider because it combines concern for the patient and cost containment. Therefore, early intervention is crucial.
    • When ever you encounter a circumstance that suggest a large claim may be building or alternate medial care may decrease paid claims, please contact TPAC Underwriters, Inc. immediately.
  2. GOALS OF CASE MANAGEMENT
    • To provide cost containment as a tool in successful Risk Management.
    • To provide the most appropriate and compassionate care to all patients diagnosed with catastrophic injury or illness in the most cost-effective setting available, whether it be the hospital, skilled nursing facility, hospice or the patient’s residence.
    • To facilitate the timely transition of the patient to a lower cost, but equally competent health care provider environment.
    • To encourage flexibility in the allocation of benefits providing for maximum care at a cost effective level.
    • To assure consistent, high quality care.
    • To promote maximum efficiency and sensitivity in the co-ordination of health care services.
  3. WHEN SHOULD NOTIFICATION OCCUR?
    • When information is received that applies to the “Trigger Diagnosis List.”
    • When total paid claims exceed $50,000.00.
    • Anytime, in the opinion of the administrator, a claim suggest is will develop sufficient loss to reach the Specific Attachment Point.
  4. HOW DO I NOTIFY TPAC UNDERWRITERS, INC. OF A LARGE CLAIM MANAGEMENT CANDIDATE?
    • A phone call to TPAC Underwriters, Inc. (763-231-8800), a fax (763-231-8801) or a handwritten note on the TPAC Underwriters, Inc. Specific Claim Form.
  5. WHO WILL PAY FOR LARGE CLAIM MANAGEMENT COSTS?
    • When TPAC Underwriters, Inc. is contacted prior to implementation of Large Claim Management and Large Claim Management is approved by TPAC Underwriters, Inc., Large Claim Management fees will be paid by TPAC Underwriters, Inc. regardless of whether or not the individual exceeds their specific deductible.
    • When the fees are part of a specific claim.
    • There are instances when TPAC Underwriters, Inc. may request termination of Large Claim Management services if it appears that there is no further cost savings potential. The Employer may continue Large Claim Management services but the fees will not be considered as eligible under the specific claim.