Run Workers Compensation Claim Review and Reserve Audit Checklist — Free

Review Scope and Claim Inventory

Review period and claim population are defined critical (required)

The review period, open-claim population, and inclusion criteria are documented before the audit begins.

Yes No N/A

All open workers' compensation claims are listed with claim number, injury date, and adjuster critical (required)

The inventory includes each open claim with enough detail to identify the file and responsible handler.

Yes No N/A

Claims are segmented by severity, age, and litigation status

Claims are grouped to highlight high-severity, long-duration, or litigated files that need management attention.

Yes No N/A

Prior action items from the last review are tracked to closure

Open items from the previous roundtable are documented with current status and owner.

Yes No N/A

Claim File Completeness and Documentation

First report of injury and employer incident documentation are present critical (required)

The file contains the initial injury report, incident details, and employer notice documentation.

Yes No N/A

Medical reports and work status notes are current critical (required)

Current medical documentation supports the claim status, restrictions, and treatment plan.

Yes No N/A

Recorded statements, witness statements, and investigation notes are complete when applicable

The file contains investigation materials appropriate to the claim facts and jurisdictional requirements.

Yes No N/A

Correspondence, notices, and key diary entries are documented

Material communications and follow-up dates are recorded in the claim file.

Yes No N/A

Coverage and compensability decisions are supported by the file critical (required)

The file includes the basis for acceptance, denial, or reservation of rights, where applicable.

Yes No N/A

Reserve Adequacy and Financial Controls

Indemnity reserve reflects current wage loss exposure critical (required)

The indemnity reserve is aligned to current disability status, wage information, and expected duration of benefits.

Yes No N/A

Medical reserve reflects current treatment plan and projected care critical (required)

The medical reserve is supported by current treatment, anticipated procedures, and likely future care.

Yes No N/A

Reserve changes since the last review are explained and documented

Material reserve increases or decreases include a clear rationale tied to claim developments.

Yes No N/A

Large or aged reserves have management review and approval critical (required)

Claims above internal authority levels or aging thresholds show documented supervisory approval.

Yes No N/A

Reserve adequacy is reviewed against settlement and closure strategy

Reserve levels are consistent with the current plan for return to work, settlement, or ongoing litigation.

Yes No N/A

Medical Management and Return-to-Work Path

Treatment plan and next medical milestone are identified

The file identifies the current treatment plan, next appointment, and expected decision point.

Yes No N/A

Work restrictions are current and communicated to the employer critical (required)

Current restrictions are documented and have been shared with the employer or return-to-work coordinator.

Yes No N/A

Modified duty or return-to-work opportunities are being pursued

The claim file shows active efforts to identify suitable modified duty or transitional work.

Yes No N/A

Independent medical exam, peer review, or utilization review is considered when appropriate

Escalation tools are used when the medical picture is unclear, prolonged, or inconsistent with expected recovery.

Yes No N/A

Barriers to return to work are documented with an action owner critical (required)

Any barrier to closure has a named owner and a dated follow-up plan.

Yes No N/A

Resolution Path, Litigation, and Closure Readiness

Primary resolution path is documented critical (required)

The file identifies the most likely path to closure, such as return to work, settlement, denial finalization, or ongoing care management.

Litigation status and defense strategy are current when applicable

If counsel is involved, the file reflects current litigation posture, key deadlines, and defense strategy.

Yes No N/A

Settlement authority and negotiation posture are documented when appropriate

Settlement opportunities are reviewed with current authority, valuation, and negotiation plan.

Yes No N/A

Stalled claims have a documented escalation plan critical (required)

Claims with no meaningful movement have a dated escalation path, owner, and next action.

Yes No N/A

Expected closure date is realistic and supported

The projected closure date is based on current facts, not a placeholder date.

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Run: Workers Compensation Claim Review and Reserve Audit Checklist

Review Scope and Claim Inventory

Claim File Completeness and Documentation

Reserve Adequacy and Financial Controls

Medical Management and Return-to-Work Path

Resolution Path, Litigation, and Closure Readiness

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