A claims manager needs to open a loss reserve and perform an investigation of an...

Within Health Care Risk Management practice as outlined by ASHRM and the American Hospital Association Certification Center, establishing an accurate loss reserve requires an estimation of the probable financial exposure associated with a claim. A loss reserve represents the anticipated cost to resolve a claim, including indemnity payments and defense expenses.

Comparable verdicts in the county are particularly useful because they reflect jurisdiction-specific jury tendencies, local legal climate, and historical award patterns. Venue significantly influences claim valuation, as jury awards can vary substantially between counties and states. Reviewing similar case outcomes allows the claims manager to benchmark potential settlement or verdict ranges based on injury severity and liability factors.

The surgery center’s claims history may inform overall risk trends but does not directly determine the value of a specific claim. The patient’s total medical bills are relevant but represent only one component of damages and do not account for non-economic damages such as pain and suffering. The insurance limit per occurrence defines maximum exposure but does not guide the realistic reserve estimate unless damages approach policy limits.

Therefore, analysis of comparable local verdicts is most helpful in establishing an appropriate and defensible loss reserve.