Arizona State Fund Excels at Claims Management

A recent review of the State Compensation Fund of Arizona’s “Claims Performance Standards” by an external industry auditor resulted in the highest possible score obtainable, according to the workers’ compensation insurer.

“This audit confirms that the claims management at SCF is sound, responsible and meets best practices guidelines, which ensures that our policyholders and injured workers, as well as medical providers, can count on us to provide them with quality customer service at all times,” said Paula Koroso, senior vice president, Claims Services.

The audit evaluated SCF for claims performance standards as well as claims related reporting, processing procedures and controls. These areas include:

• Compensability and coverage determination
• Pursuit of recovery
• Reserving
• Medical care and cost control
• Indemnity and disability management

SCF achieved the maximum possible score in the claims performance standard of the review and received the highest rating.

Among some of the conclusions in the report were that SCF:

• Plans for future claims handling
• Is timely in reporting claims decisions
• Utilizes integrated medical management and cost containment program
• Screens medical bills properly
• Pays medical bills in a timely manner

In a second part of the audit, which focused on claims reporting, processing and controls, SCF received the maximum possible score and the highest rating. The audit report stated that SCF’s claim processing procedures and controls are in compliance with all established guidelines for processing workers’ compensation and employers’ liability assigned risk claims.

SCF Arizona, headquartered in Phoenix, is the state’s largest workers’ compensation insurer, providing coverage to more than 35,000 policyholders and some 500,000 employees statewide. SCF has operated in Arizona for 85 years, holds $3.4 billion in assets and employs more than 500 people.