Always bear in mind the expected outcome of seeking further evidence. Is more information going to alter the decision? If not, there is really no reasonable basis for requesting further information.
Don't get information just for the sake of it. With each case being dealt with on its merits, there are no cut and dried 'rules'. It only wastes time both for claims staff and the person information is being sought from.
Existing evidence must be weighed up and risks associated with the decision making process managed. Some questions to consider include:
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what are the likely implications of saying 'yes' or 'no'?
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is it more practical to say 'yes' to a claim that is low cost and straightforward?
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is there sufficient evidence to say 'yes'?
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Example |
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A claim is lodged for an infected cut finger. Total claim costs are for $50.00, for medical treatment and an hour of incapacity. |
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Is the infection related to the cut finger? Probably. Is the cut finger related to the employee's employment? Probably. Is a medical report required? No. The cost of the report could be up to $200.00. Balancing that cost against the claim hardly makes the report worth it. Investigate later if the finger and infection become an issue. |
Also, saying 'no' is not always prudent. Remember that claim management is all about looking at the implications of decisions; looking at the wider picture.