Should we use a third-party administrator for our senior care claims?

On a guaranteed cost program with a small retention, the carrier handles claims and there is nothing to administer. On a large retention program, most claims resolve entirely inside your money and the carrier involvement is limited to the ones that threaten its layer.

That means the administration question scales with the retention. Somewhere between a modest retention and a large one, claims handling stops being a service you receive and becomes a function you are buying.

Immediate investigation, because senior care claims are documentary and the record degrades. An administrator who obtains the chart, the staffing records and the video within days is preserving the defense.

Reserve accuracy, which matters twice: reserves drive your collateral requirement and they drive how an underwriter reads your loss run. Systematically over-reserved files cost real money at renewal even when they close for nothing.

Defense counsel management, including panel selection, budgets and litigation plans. On an eroding limit or an eroding retention, defense spend control is the single largest lever available.

And senior care experience specifically. An administrator who handles general commercial claims will not know to look for the care plan revision history or to preserve the delayed egress log.

Ask for the caseload per adjuster, because that number predicts service more reliably than anything in a presentation. Ask what proportion of their book is long-term care. Ask who your named adjuster is and what their turnover rate is, since continuity on a file that runs three years is worth more than the fee difference.

Ask how reserves are set and reviewed, how defense counsel is selected and whether you can name your own, and what reporting you receive and at what cadence.

And confirm the carrier will accept them. On a fronted program the carrier has approval rights over the administrator, and that approval should be obtained before the selection is announced internally.

Reporting to the carrier. An administrator handling a claim inside your retention does not relieve you of the obligation to report a claim that could reach the carrier layer, and that reporting obligation is a condition of coverage. Build the escalation trigger into the service agreement explicitly.

And the operational feedback loop. The point of handling your own claims is not only cost control; it is that the person who sees the pattern across fifty files can tell you what to change in the buildings. Require that analysis as a deliverable rather than hoping it emerges.