The Reality of the Biggest Myth Regarding Your Third Party Administrator

The Reality of the Biggest Myth Regarding Your Third Party AdministratorMYTH: The best way to reduce workers’ compensation costs is to change insurance companies or TPAs.

 

REALITY: Wrong! The best way to reduce workers compensation costs is to build a better relationship with your current claims administrator. The major cause of discontent between carriers and the insureds is lack of communication which causes a perception that something is being done improperly.

 

For example, in several situations a company believed nurse case management was too expensive; however, upon audit by our medical advisor, the nurse case management service should be used MORE, HOWEVER should be brought in earlier.

 

It wasn’t effective when it was used (thus seemed expensive and wasteful) because it was used too late in the process.

 

 

3 Ideas to Build a Better TPA Relationship

 

  • Start to build a better relationship by becoming more informed about the services your claims administrator offers. Hold a Vendor Day, and invite your TPA in with every one of their services – leave none out. Ask for samples of reports and deliverables so you can understand the product and will know when to request services. Have them bring brochures prior to Vendor Day, and read the brochures so you can ask knowledgeable questions during about the services.

 

  • Visit one or two claims offices, sit chair-side and observe the process. Learn the categories of desks at your carrier, for example, are there 4 levels of adjusters or 5? Do adjusters have backup and clerical support to get medical files or close files? Sit at the intake desk, then join the lost time and medical adjusters for a few minutes at their desks. Ask to see what happens to medical bills when they enter the system until the time they are paid and filed. This will give you a better understanding of how you can interact more effectively, what information adjusters need from you and what information you can provide about your workplace and employees.

 

  • Invite your adjusters to visit your workplace, so they know what your company does, the types of jobs and skills required of the employees. They can then visualize exactly how an injury occurred easier than if they’d never been to your work place. They can see the possible transitional duty tasks, and perhaps suggest a few more. They can even have coffee in the lunch room and be introduced to a few employees who come in. Make them feel like part of the team.

 

There are times when switching TPAs is the right decision.  However, try working out the problems FIRST, or you may end up with the same grass in a different pasture.

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Maximize Your Third Party Administrator (TPA) Relationship With A Vendor Day

Maximize Your Third Party Administrator (TPA) Relationship With A Vendor DayIf your company is a large organization with many locations and numerous open claims at each location, you may need to consider having several return-to-work (RTW) coordinators. Have one RTW coordinator for each region. For example, one large company has East, Mid-West and Western Region coordinators. The number of coordinators depends on your claims volume, making sure each coordinator has enough claims to justify a full-time position while ensuring they are not overloaded and unable to follow-up on each claim.

 

Coordinators do not do the work of adjusters, but facilitate transitional duty and guide location management.

 

 

Understand What Your Third-party Administrator (TPA) Provides

 

Start your program with a Vendor Day.  Look at the capabilities and services provided by your claims administrator; regardless of whether it is an insurance company or a TPA, you need to know all of their capabilities in detail.

 

Have the claims administrator describe each of their services – a formal presentation; have your TPA come to your office to introduce’ and explain each service. Ask them to bring examples of each report. For instance, ask to see a sample nurse case management report, or an investigators report. Make sure you clearly state your expectations. You want the practice leader or a person who can explain everything about the services to attend.

 

Include all services: medical cost containment, medical management, investigative, recovery, and risk management information systems.

 

  • To prepare for Vendor Day, gather all literature from the claims administrator — have all sales brochures sent to you advance — and review the response to request for proposal (RFP) if the claims administrator was selected through the RFP Process.

 

  • Familiarize yourself with each available service, learn its name and find out how much it costs. For example, is a nurse case manager a telephonic nurse case manager or a field-based case manager who will attend medical visits with the injured employees?

 

  • Ask lots of questions.Is the case manager’ an RN, an LPN, or a non-licensed person with internal medical training? Before you can determine how effectively a service is delivered, learn the specifics of each service.

 

Companies often start the workers’ compensation correction process by selecting a new TPA without even knowing they are not using all of the services of their current TPA. For example, a major carrier has nurses who will go to each unit to help identify transitional duty jobs, yet their client was unaware of this service and its benefits. They didn’t know what they didn’t know.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

11 Ways to Manage Employer, Provider, and Employee Fraud in Workers’ Compensation

11 Ways to Manage Employer, Provider, and Employee Fraud in Workers’ Compensation Workers’ compensation fraud by workers gets the most publicity. But additional fraud is committed by staffing companies, professional employer organizations, medical and ancillary service providers, and brokers.

 

Sometimes multiple parties are involved, as in the case in California involving an alleged $40 million medical billing and kickback operation that involved more than two dozen physicians, pharmacists, and business owners.

 

Here are also some simple preventive measures that could potentially save companies mega dollars.

 

 

11 Ways to Manage Employer, Provider, and Employee Fraud

 

  1. Educate the workforce. Explain to employees that workers’ compensation fraud hurts the whole company and the loss of revenue may threaten upcoming pay raises or even their jobs. They also need to be informed that fraud is a serious crime with penalties. They should have a way to report suspected fraud anonymously.
  2. Teach the higher-ups. Managers and supervisors should understand that every reported injury should be treated as legitimate; however, they should also be taught to recognize some of the red flags that may indicate a fraudulent claim and have a procedure for reporting them. They also need to know how to take statements about an injury — from the worker and any witnesses.
  3. Work with the insurer. Report all suspicious claims immediately.
  4. Investigate ASAP. Make sure all reported injuries and illnesses are immediately and thoroughly investigated.
  5. Pay careful attention throughout the claims process to see if any information changes or doesn’t make sense about the injury. Also, note whether the injured employee was disgruntled prior to the injury.
  6. Drug tests. Require drug testing as a condition of employment. Drug users are statistically more likely to file fraudulent workers’ compensation claims than non-users.
  7. Implement a zero tolerance policy for fraud and take every action possible to expose and prosecute it.
  8. Make examples of cheaters. Whether it is a worker, provider or someone else involved in the process, all participants should see that you will take all steps necessary to fight fraud.
  9. Evidence Based Medicine (EBM). Make sure all treatment follows evidence based treatment guidelines and do not allow claims handlers to authorize treatment unless they have been trained in EBM
  10. Clean the provider network. Vet providers before allowing them into the medical network. Verify their physical location and try to determine if they own the clinic. Where possible, remove from your network any provider who has been accused of fraud.
  11. Involve workers. Regularly send out notices to injured workers with the dates and types of treatment that has been billed and ask them to report discrepancies.

 

 

Conclusion

 

Fraud costs companies billions of dollars. The money lost is passed on — in the form of higher premiums, increased prices for services, or lower money available to pay employees or expand the business.

 

Instead of turning a blind eye to the situation, organizations should adopt a zero-tolerance policy for fraud, educate all involved and enforce rules and regulations to expose the guilty parties and deter it from happening again.

 

See also: Be Aware of Employer, Provider, and Employee Fraud in Workers’ Compensation

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Be Aware of Employer, Provider, and Employee Fraud in Workers’ Compensation

Be aware of Provider, Employer, and Employee Fraud in Workers' CompensationWorkers’ compensation fraud costs the insurance industry an estimated $7 billion per year. Not only is it employee fraud, but employer and provider fraud can be just as, or even more expensive. Recent stories out of California, for example, revealed an alleged $40 million medical billing and kickback operation that involved more than two dozen physicians, pharmacists, and business owners.

 

Often the expense and time involved makes organizations reluctant to pursue fraud charges against offending parties. But being aware of the many ways fraud is perpetuated is key to preventing it. There are also some simple preventive measures that could potentially save companies mega dollars.

 

 

Types of Fraud

 

Employer Fraud 

 

Companies may misrepresent the nature of the business, or misclassify the types of jobs, number of employees or payroll to get lower premiums. They may hide premium scams behind dummy corporations. Or they may not even have workers’ compensation insurance, creating an unfair playing field for their market.

 

Here are some red flags that may indicate fraud by an employer:

 

  • The address. If a post office box is used or the company is located in an area different from its mailing address.
  • Workers are paid in cash with no payroll stub. Or, paid with in-kind services, such as free rent.
  • Too many admins. The number of clerical employees is significantly higher than the number of non-clerical staff for the type of business.
  • The company has not been audited.
  • Multi-businesses. The company has several businesses operating from the same address.
  • The name. The company’s name is inconsistent with the type of work done.
  • Too many independents. There is an excessive number of independent contractor classifications. The employer may require new employees to fill out a 1099 instead of a W-2.
  • Low bids. Estimated prices for projects are substantially lower than the industry standard.

 

 

Provider Fraud

 

Bills for unnecessary or nonexistent medical services have garnered media attention in recent years. In some cases, physicians team up with attorneys to commit workers’ compensation fraud. They may exaggerate the severity of injuries that do occur and bill payers for what would be the ‘appropriate’ type and number of treatments for the conditions.

 

In some scams, clinics and attorneys hire people to lure workers who may or may not even be aware something untoward is happening. In other cases, a ‘clinic’ may exist only on paper, or is just an office with little equipment. Then there are medical providers who game both the workers’ compensation and group health systems by billing both for the same treatment.

 

There are some red flags that may indicate provider fraud is taking place.

 

  • Questionable bills. The payer is billed for a treatment the injured worker does not recall.
  • Weekend bills. Invoices are received for services performed on weekends or holidays.
  • Bad timing. Provider sends bills for treatments after the injured worker has gone to a different provider.
  • Reports too alike. Medical reports appear nearly identical for different patients and conditions.
  • Questionable treatment. The type and length of treatment is not in sync with the type and seriousness of the reported injury.
  • Reporting delays. There are unexplained lags in receiving requested records.
  • Attorney closeness. The provider works with the same lawyer repeatedly on questionable claims.

 

 

Worker Fraud

 

Reporting an injury on a Monday morning or after a holiday are two of the biggest red flags that indicate something may be amiss with a claim. Other indications that an injury may be fraudulent include the following:

  • The worker is new, seasonal or contractual and/or has a history of short-term employment.
  • Early attorney involvement. The worker has a lawyer as soon as the injury is reported.
  • Changing situation. The employee is faced with possible termination or layoff.
  • Funny facts. The description of the accident does not make sense with the reported injury.
  • No witnesses. The worker was alone when the injury occurred.
  • The worker is resentful.

 

 

Conclusion

 

Fraud costs companies billions of dollars. The money lost is passed on — in the form of higher premiums, increased prices for services, or lower money available to pay employees or expand the business.

 

See Also11 Ways to Manage Employer, Provider, and Employee Fraud in Workers’ Compensation

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

You’re Fired! Employment Releases in Work Comp

You’re Fired! Employment Releases in Work CompThere are many challenges to settling a workers’ compensation claim.  One of these challenges includes the possibility the employer may desire to seek a voluntary resignation of employment.  It is important for members of the claims management team and defense attorneys to carefully navigate the complex maze of laws and regulations during this process.  Failure to do so can result in program sanctions or other unwanted legal matters, which negatively impact your program’s bottom line.

 

 

When is Voluntary Resignation Appropriate?

 

Seeking the voluntary resignation of an employee as part of a global workers’ compensation settlement should not be a part of every claim.  There are a number of legal and practical barriers that warrant careful consideration when making this a part of the negotiation and settlement process.

 

When evaluating a claim, it is important to be in contact with trained legal counsel.  Examples of this include several state workers’ compensation acts that explicitly prohibit this practice.  If there is the appearance of even suggesting an employee resign as part of resolving their workers’ compensation claim, the employer and insurer may be subject to additional legal sanction.  This can include paying punitive compensation benefits to the employee and other legal causes of action under a state’s discrimination laws.

 

Even in instances where the practice is allowed, careful legal guidance is required.  Matters to consider include:

 

  • Careful drafting of the legal document being signed by the employee as part of the voluntary resignation;

 

  • Adequate monetary consideration paid to the employee, which is beyond the settlement of the workers’ compensation matters. Attorneys may resist these measures as monies received under an employment release/resignation are considered taxable income;

 

  • Understanding the legal considerations of paying additional funds to the employee. This is an issue regarding employment law and no necessarily a service or protection covered by a workers’ compensation insurance policy.  All monies paid as consideration for a resignation must come from the employer.

 

 

Employer Involvement in Termination Decisions

 

Beyond the legal aspects of including a voluntary resignation, employers play a key role in this process.  In many instances this is a business decision that must take into consideration several factors:

 

  • The physical demands of a position and whether the employee will be able to perform certain job duties upon their return to work;

 

  • Other return to work considerations, including whether modifications can be made to accomplish the goals of a work hardening, vocational rehabilitation or job search efforts; and

 

  • Overall workplace morale. If employees view themselves as being “expendable” following a work injury, efforts to recruit and maintain a diverse talent base may diminish.

 

 

Other Considerations for Attorneys

 

There are also issues workers’ compensation defense attorneys must consider as part of the voluntary resignation process.  These issues are ethical matters and include consideration of the rules of professional conduct.  Matters for the defense attorney to consider include:

 

  • Who is the client and whether adding another distinct legal task changes the nature and scope of whom the client might be in employment related matters;

 

  • Who is responsible for paying for legal services rendered in the negotiating and drafting of an employment release in the global settlement; and

 

  • Whether adding a client to a related case creates even the potential of a conflict of interest.

 

Failure to consider these matters can result in loss of business and one’s professional reputation.  It can even result in an ethical complaint or malpractice exposure.

 

 

 

Conclusions

 

The workers’ compensation claims process is complex and requires interested stakeholders to remain proactive.  One such area includes the consideration of a voluntary resignation and employment release as part of the global settlement.  Everyone involved in the process must be proactive and consider the risks and rewards of this important issue.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Smoking, Depression, and Substance Abuse Wellness Programs in Workers’ Comp

wellness in workers compensationIt has been proven many times that employers can reduce their workers’ compensation costs by investing in a wellness program.  Notwithstanding the imperial data that demonstrates the effectiveness of these programs, many interested stakeholders are resistant to them based on the perceived cost or other imaginary barriers when it comes to improving the health of their workforce.  Instead of focusing on these hurdles, thought leaders within the industry should focus on the bigger picture to reduce costs in their programs.

 

 

Smoking Cessation Programs

 

Notwithstanding nationwide efforts to curb smoking, tobacco use remains a popular habit in millions of Americans.  It is well-documented that smoking and the use of its other forms, including smokeless tobacco have significant negative health consequences.  These include many common issues Americans struggle with such as cancer, heart disease and other respiratory problems.  The use of tobacco also reduces the effectiveness of physical rehabilitation and healing following a work-injury.

 

Access to smoking cessation programs is now more affordable following the passage of the Affordable Care Act (ACA).  Under the ACA, all qualifying individual and group health plans are required to include these programs as an “essential health benefit.”  This means that health plans must allow participants access to programs and services with no copay.

 

Changes in health care have also had a positive impact on people who remain without insurances.  In many instances, employers have taken the initiative to provide their employees, regardless of health instance coverage, access to programs that assist people kick the habit.  This also includes access to patches, gum and other devices that promote smoking cessation.

 

 

Depression and Mental Health Awareness

 

Americans as a who have also become more sensitive to mental health related issues.  This includes greater access to care and parity of coverage when compared to treatment to physical ailments and injuries.  The essence of the awakening and change in attitudes is better resources for employees to receive the care they need.

 

While Americans now have more options when it comes to purchasing health insurance, many remain without.  This has led to opportunities for proactive employers to provide resources when it comes to psychological and psychiatric issues.  This includes:

 

  • Training for employees on how to recognize a coworker suffering from a mental health related issue;

 

  • Greater access to mental health care and services, including treatment by specialists; and

 

  • Easily accessible outreach programs such as supportive and non-judgmental telephonic services for thoughts struggling with mental health needs.

 

 

Substance Abuse Prevention and Treatment

 

Use and abuse of substances, included those that are legal, can have a negative impact on the workplace.  This includes decreased productivity, diminished service of customers and injury.  Failure to address these issues in the context of a workers’ compensation program can only hurt the bottom line and dramatically increase costs.

 

Proactive employers need to take this issue seriously.  This starts with the implementation of a substance abuse policy that is consistently applied.  It must also apply to all employees, regardless of their position within a company.

 

It is also important for employers to assist employees who may use and abuses these substances.  This includes the following methods to implement:

 

  • Reporting of substance abuse issues within the workplace via confidential means;

 

  • Drug testing that is performed in a manner consistent with state and federal laws; and

 

  • Resources such as help lines and other medical/mental health professionals who can assist employees impacted by use/abuse issues.

 

 

Conclusions

 

There are many benefits to any workers’ compensation program when interested stakeholders look for creative and cost-effective measures to improve employee wellness.  They not only cut down on the frequency or injuries within the workplace, but they have many other benefits.  Among these include an increase in morale and reduce turnover.  The bottom line also includes lower workers’ compensation program costs.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Leverage Post-Settlement Professional Administration for Truly Optimal Outcomes

Leverage Post-Settlement Professional Administration for Truly Optimal OutcomesEvery now and then an idea comes along that makes so much sense you wonder why it hasn’t been around all along. In the case of professional administration to handle post-settlement medical fund management, it actually has; but it’s now been perfected so it makes logical and financial sense for injured workers and payers alike.

 

For the injured worker it means they’ll continue to have someone to manage their medical care and assure appropriate compliance with Medicare. For payers, it means finally settling claims that have been on the books for months or even years. For both sides, it means significant dollars saved, it is truly a win-win for all parties involved.

 

 

What Is a Post-Settlement Professional Administrator?

 

Many injured workers get frustrated with the workers’ compensation system, but are nevertheless leery about settling their claims. They are concerned they might not have enough money to handle their future medical and indemnity needs; they may additionally fear they won’t be able to fully comply with Medicare reporting requirements, if a Medicare Set-aside is included. In many cases, as much as they dislike the workers’ compensation system, they are even more fearful of navigating their medical care on their own without someone with expertise to help. This is where professional administration comes in.

 

The level of care the injured worker is used to continues to be provided when a quality professional administrator is involved. In many cases, the care may even be better. The administrator coordinates medical treatment, but without the frustration of utilization review; i.e., providers, treatments and pharmaceuticals are not denied. Deep discounts on treatments and medications are available because of the administrator’s networks. With some companies, there is even a 24-hour support line available. The administrator helps ensure that the money lasts, and the injured worker has an advocate for their medical care and finances.

 

A comparison between the typical services involved in a workers’ compensation claim and those available after settlement through a professional administrator shows they are nearly the same:

 

  • Provider bill review. The discounts provided through the professional administrator’s network can be the same or even better than those available in the workers’ compensation system.
  • Pharmacy benefit manager and durable medical equipment networks: Again, the savings on these can be substantial through the administrator’s network.
  • Phone support.
  • Provider recommendations.
  • Reporting – with a professional administrator all Medicare Set Aside reporting is 100% guaranteed.
  • Bill administration.
  • Utilization review – with a professional administrator, there is none!

 

What makes the idea of a professional administrator even more appealing is that having greater discounts on medical treatments means there is more likelihood the case with settle and the administrator will earn the business. Therefore, it behooves the professional administrator to have a strong network and do the right things for the injured worker, to maintain the relationship and be able to offer further discounted services.

 

 

Benefits to Payers

 

A professional administrator can be brought into the process at any time, and there is no cost unless the case settles. With a solid, experienced group, payers are finding their long-term, seemingly endless claims are settling. But it’s not only the fact that there is a settlement that saves the payer money, it’s also the ultimate dollar amount.

 

Calculations for future medicals can be tricky. There must be accounting for the medical procedures, medical providers and the cost of pharmaceuticals. Add to that the expenses of unexpected complications and inflation, and the amount for the medical portion of the settlement can be staggering.

 

Bringing a professional administrator into the discussions before the settlement is reached can be advantageous to the payer and the injured worker. Because of the network discounts, the future medical costs can be substantially lower than would be typical. Also, the professional administrator can demonstrate real costs to the injured worker, making them more comfortable with the final number.

 

 

Conclusion

 

Many injured workers simply lack the expertise, or interest, to manage the responsibilities of their own medical care, nor do they have access to discounted services and treatments.

 

Professional administration can fill the gap and make a settlement attractive to both parties. A company with solid experience and proficiency in all aspects of workers’ compensation claims can be the right solution for all concerned.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

4 Times When a Workers Comp Claim Should NOT Be Settled

4 times when NOT to settle a workers comp claimIn the workers’ compensation claims world, a common held belief is “the more settled claims, the better”.  However, there are several times when, a claim should NOT be settled — at least not yet:

 

  • When you are not sure the claim is legitimate – if you are still questioning in your own mind whether the claim is legitimate, or whether your company is “being taken for a ride”, hold off settling the claim until you are SURE. There’s nothing wrong with “going with” your gut instinct. This means you should do two things:

 

  • have your own medical advisor review the file and
  • do a thorough sub rosa investigation over an extended period of time (I don’t mean ONE day — I mean “extended”).

 

  • When it sets a bad precedent in the workplace – If you have the type of workplace that one or two settlements could draw in a whole pack of other claims, then I would tend not to settle the claim. Your company may become known as “an easy mark.” You want to pay the exact benefits due, when they are due so the employee receives what he/she is supposed to. Explain this policy in your Employee Brochure.  If employees think the only way they can get their full benefits is to hire an attorney, they are much more likely to do that. When that’s how things transpired for other injured employees in your workplace, it sends the message that is the only way the employer will pay benefits to which employees are entitled.

 

  • When the employee’s condition could still improve – The appropriate time to settle in cases which should be settled is after the employee has reached MMI (Maximum Medical Improvement). Only at this time will it be known how much the employee will be disabled, how much cost he will incur for future medical care, future lost wages, and other expenses such as home-care.

 

  • When the claim is being settled only because it’s a “nuisance” – Your company will want to determine if they want to take a stance in “nuisance cases” and settle them for “nuisance value” (insignificant amounts) or “defense costs” in order to close the matter. Some companies do, some don’t. Although being in litigation is inconvenient at best and a nightmare at worst, that does not mean you want to settle every inconvenient claim.

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Porter Leslie Announced As The President of Ametros

WILMINGTON, Mass. – Ametros, the industry leader in post-settlement medical administration, announced the promotion of Porter Leslie to President of Ametros. The announcement was made by Marques Torbert, CEO of Ametros.

 

“Porter has a track record of executing strategic initiatives with remarkable success,” remarked Marques, “In his new role, he will help the company get closer to achieving its mission of revolutionizing the insurance and healthcare services industry by developing more cutting-edge products and innovative services to benefit our clients and members.”

 

Porter joined Ametros in 2015 and in his previous role as Chief Strategy Officer, had been instrumental in driving growth and change across various disciplines within the company, including IT, marketing, new product development, and strategic partnerships.

 

“We have built a phenomenal team with close to 50 employees, who provide nationwide support for anyone who needs help managing their healthcare after settlement,” commented Porter. “I feel privileged to be asked to lead some of the smartest and dedicated minds in the industry.  There is no limit to what we can accomplish together.”

 

 

About Ametros

 

Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make savvy decisions on how to spend their medical funds. Ametros’ team works closely with patients, insurers, employers, attorneys, medical providers and Medicare to create a seamless experience for their clients. Their depth of expertise in the Medicare Set Aside, property and casualty insurance, healthcare, legal, financial and software industries positions them to offer the best solutions in the marketplace. Their flagship products, CareGuard and Amethyst, are revolutionizing the way funds from insurance claim settlements are administered after settlement, for Medicare Set Aside accounts and any other medical allocation. Ametros is backed by Clarion Capital Partners, LLC, a New York based private equity firm. For more information, visit www.ametroscards.com.

Controlling Work Comp Transportation Expense Is More Than Ordering an Uber

Controlling Work Comp Transportation Expense Is More Than Ordering an UberMonitoring and managing workers’ comp transportation expenses can drastically improve the claim expense cost, especially on larger work comp claims. Unfortunately, claims adjusters and/or nurse case managers often overlook this important expense, thinking to save money by not using a transportation service.

 

Attempting to cut costs in this category is not an option, and here’s why.

 

 

Controlling Work Comp Transportation Expense Is More Than Ordering an Uber

 

Controlling transportation expense is more than ordering an Uber for the employee to get to the doctor or writing the employee a check for personal automobile mileage.

 

When the employee is physically unable to travel unassisted or does not have access to transportation and will have multiple visits to the treating physician or other medical providers, a transportation company specializing in workers’ compensation claims is needed. Services of a transportation company are arranged by the adjuster or nurse case manager, not by the employee.   The selection of a transportation company is based on the company’s ability to provide safe and reliable transport service whenever needed.

 

A full service transportation company saves the claims office a significant amount of time, since the adjuster or the nurse case manager can spend many calls and emails coordinating employee transportation needs. Often employees reschedule doctor appointments for their own convenience and the transportation must be scheduled all over again. Or worse, employees “forget” their medical appointment and are not ready to go when the transportation arrives, knowing the doctor will not see them if they are very late arriving.

 

Experienced work comp adjusters know the more subjective the employee’s injuries are the higher probability they will miss their medical appointments, cancel medical appointments or reschedule them without advising the adjuster.

 

 

The professional transportation company will:

 

  1. Schedule the transportation with the employee as soon as they are notified of the medical appointment.
  2. Contact the employee the day before the medical appointment to confirm the pick-up time and the return home time.
  3. Contact the employee the day of the appointment before they leave their business location to confirm the appointment is still the same.
  4. Notify the claims office if there are any changes in the scheduled medical appointment, or if the medical appointment is missed by the employee.
  5. Provide the adjuster or nurse case manager with a documented trip history as to their departure time from their business location, the time they picked up the employee, the time the employee arrived at the medical location, and the time they delivered the employee back to the employee’s residence.

 

While automobiles are the most common mode of transportation for injured employees, other modes of transportation are occasionally needed for the severely injured. The full service transportation company specializing in workers’ compensation claims is able to provide the work comp adjuster or the nurse case manager with other alternatives including ambulances, wheelchairs and stretchers.

 

 

Employee Has No Incentive To Locate Best Price for Transportation

 

In addition to saving the claims office considerable amounts of time, the professional transportation company also saves the claims office money. The employee has no incentive to locate the best price for transportation, as the employee is not paying for it. Also, the employee is not concerned about the cost for missed appointments. By the claims office controlling the transportation needs of the employee, the transportation cost is properly managed.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, Principal, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

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