What ARE "account handling instructions," you ask? Account service instructions (ASIs) also called "account handling instructions" or "special account instructions" are the instructions your insurance adjusters live by.
They tell the adjusters what must be done when handling your claims. So, make sure you have input into the preparation of these instructions. Every insurance company or third-party administrator has them although the names vary. Items you want in your ASIs will vary depending on the carrier or TPAs best practices; ASIs will be developed "around" what they are already providing.
This is a very abbreviated list from Workers Comp Kit's Improvement Plan. The complete list is 10 times this length…
A 16 Point Account Servicing Instruction Checklist:
1. Settlement Authority Who has settlement authority — the company or the adjuster? A "consult" is totally different than "authority." How much authority you get depends on the type of insurance program you have.
2. Selection of Counsel Do you select your own legal counsel? What type of legal counsel does your company utilize – panel counsel or outside counsel?
3. Reporting How often do you receive status reports for open claims from your insurer? Over 30, 60 or 90 days? Even though you may have been provided access to run reports, if you'd prefer to have them run for you, ask for that.
4. Reserves Does the insurer provide a written explanation each time reserves are raised over $10,000 or more? Do reserves set take into consideration the company's aggressive return-to-work program, probably resulting in lower wage loss?
5. Dedicated Adjuster How many adjusters are dedicated to processing claims for your account? One adjuster with a full-time admin can handle more than an adjuster without an admin.
6. Payment/Review of Legal Bills Do you receive copies of bills for legal services?
7. Investigations How do you request investigations? Will you receive copies of the investigation reports and video for review? Are emergency room records/notes obtained for every worker who is treated in the ER? Are drug test required at the clinic after an Emergency Department visit?
8. Structured Settlements & MSA Set-asides Do you consider structured settlements for all cases over $10,000? Are MSA settlements structured? Who handles compliance?
9. Subrogation Are all cases reviewed for subrogation potential? Who closes a file and waives subrogation recovery? Do you want to be consulted before a lien is waived or compromised?
10. Workers Compensation Do you see copies of payments being made on each open file? Do you review checks or a list of all payments made for accuracy? Are statements tape recorded on all claims where compensability is questionable such as heart-attacks, stress claims, unusual injuries, claims where liability is not clear?
11. Referral to Physician Consultant/Medical Advisor How are outside vendor services activated and coordinated? Are all medical records sent to the Medical Advisor before an independent medical examination is conducted? Does the MD write the IME cover letter and make sure timing is appropriate for an IME?
12. Medical Bill Review How and when are medical bills audited? Who will audit the hospital bills? What level of hospital bills are audited? Do you decide if medical case management is warranted? Is there immediate and automatic referral of complex lost-time cases to medical case management?
13. Utilization Review How do you decide which bills and services will be reviewed? Who provides this service?
14. Referral to Vocational Rehabilitation Who decides if vocational rehabilitation is warranted? Do you automatically refer complex lost-time cases to vocational rehabilitation? Will reports be sent to your company?
15. Alternative Dispute Resolution/Mediation Is alternative dispute resolution considered on all claims for all lines? Are you or are subrogating insurance carriers members of the Center for Public Resources (a non-profit organization whose members agree to avoid litigation and try to pursue alternative means of dispute resolution)? If so, is this noted?
16. Miscellaneous Do you have the option to change your account instructions? Do you have the right to review the complete original claim file? Dont be afraid to negotiate for what you want in your account handling instructions. Remember, if you have a large deductible insurance program, its YOUR money!
If you have a guaranteed cost program, you will not have as much leverage as if you are self-insured or in a large deductible program, but don't let that stop you from asking for what you want. Much of the above information applies to litigation managment for product liability claims, etc.
Read the 7 Biggest Mistakes Employers Make when Working with their TPA or insurance company: http://www.reduceyourworkerscomp.com/results-from-your-insurance-company.php
For more cost savings tips go to WC Cost Reduction Tips. I hope this is helpful, and would appreciate your feedback if you have specific examples of where you have been able to use this information. If you need help with your account instructions, I can help you or refer to to another consultant that can.
Author: Rebecca Shafer, J.D. Rebecca is a national expert on workers compensation cost containment and has helped many companies reduce their workers compensation. She is the author of: Manage Your Workers Compensation Program: Reduce Costs 20-50% at www.WCManual.com
RShafer@ReduceYourWorkersComp.com
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment program initiatives.
© Copyrights strictly enforced. 2008-2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
One of the most important decisions a company makes is selecting their insurance broker. Smaller companies generally have insurance agents and larger companies have insurance brokers. Most large companies have brokers rather than agents because they have many "lines" of coverage. This is obtained from many different insurance companies — not just one. An agent normally represents only one insurance company (or a handful if they are a multi-line agent); a broker represents many different insurance companies. Some key questions to ask prospective brokers are:
- How will they structure your company's insurance program?
- How will they market your company to the insurance carriers?
- How creative are the individuals on the team — can they provideexamples ofhow they have enhanced another company's insurance coverage and reduced the insurance costs to make the program more cost effective?
- Who is the team that will service your account?
- Do they have experience in your industry?
- Does the firm have global capabilities (necessary if your company has operations outside the US)?
- Do they have a timeline of all activities they propose?
- What are the firms capabilities in the following areas:
- Claim Advocacy - claim specialists to help difficult claim situations
- Claim Reviews - reserve, claim closureand best practice reviews
- Loss Control - specialists to help developstrategic plans in: Ergonomics specialists, Repetitive Motion Injuries specialist, Loss Trend Analysis, Slip & Fall Prevention, Air Quality Programs, Lock-out/ Tag-out Expertise, Safety Consulting on key OSHA Requirements, Safety Culture Consulting
- Post-Loss Cost Containment - systems to reduce WC costs such as described http://www.reduceyourworkerscomp.com/employees-back-to-work-sooner.php
- Insurance Policy Review
- Coverage Analysis
- Certificate of Insurance Distribution
- RIMS Capabilities (Risk Management Information Systems)?
- Do they have experience withyour existing carrier?
- Fees and remuneration– are incentive-based optionspossible?
- Do they have captive affiliates?
- Do they have industry groups for your industry?
- Are there other services that differentiate their firm?
- Is the broker tied into the net — how user-friendly and complete is their website? Do they have lots of educational resources available for clients?
- Are they easily accessible via email?
- How easy is it to reach your team by phone?
These are some of the things you will evaluate when selecting the best broker for your needs. The biggest broker isn't necessarily the most qualified for YOUR situation, so meet with several to make sure their capabilities meet your needs. For more cost savings tips go to WC Cost Reduction Tips.
When employees can make more when NOT working than when working, there's very little incentive to return to work, right? It's time to examine all the possible sources of "collateral source benefits" (a term I invented almost 20 years ago), to make sure you are not inadvertently making your problem worse than it needs to be. I saw one example recently where an employee stayed out of work receiving workers' compensation, used a travel pass to travel for free, and continued to accrue seniority while collecting a generous combination of benefits. Heck of a good deal, if you asked me. Where do I sign up… So, consider the impact on your workers' comp costs when providing certain benefits.
1. Salary and Wage Continuation: Some companies pay 100 percent of salary in lieu of having an employee collect workers compensation for injuries of short duration.
2. Occupational Injury Pay Supplements : Many firms pay supplemental benefits to make up the difference between workers compensation benefits and regular earnings.
3. Open-Ended Job Return: Instead of holding jobs open indefinitely, employers should hold jobs open for a specific time period, such as six or nine months.
4. Vacation and Sick Time: Companies frequently allow vacation and sick time to accrue for employees on workers compensation. Some even allow employees to borrow more sick time if they need to stay out of work longer.
5. Short-Term Disability: In some companies, disabled employees receive STD benefits in lieu of salary after six weeks. But the standard definition for disability may differ from workers comp, allowing an employee to collect both.
6. Perk Continuation: Employers often maintain ancillary benefits and privileges such as car allowances, club and professional dues, company store privileges and periodical subscriptions for employees on disability.
7. Loan Protection Policies: Individual insurance policies are available to pay mortgages and consumer loans such as car loans and credit card debts in the case of a disability.
8. Unemployment Compensation: In a few states, an employee receiving workers comp also can qualify for state unemployment benefits.
9. Pension and Retirement Plans: If these plans do not allow for offset of workers comp benefits, an employee can receive workers compensation benefits and a full pension.
10. Product Liability Actions: An employee can file an action against the manufacturer of a product that injured him to collect damages. The employer should seek reimbursement for workers comp payment from any such settlement. While these things are great perks and can entice employees to stay on the job with service to your company for many productive years, in the wrong situation that benefit can be offset if you do not combine the benefits with a complete injury management program — with excellent employee communication.
Fail to communicate with your employees and I guarantee your costs will go up. Involve all departments. In a large company, human resources, labor/industrial relations, workers' comp and employee benefits and compensation departments must all be involved in designing, administering and maintaining policies. Incentives to remain at and return to work must be built into the management systems. Disincentives must be removed from all direct and indirect sources. Substantial savings can be achieved when a company coordinates its salary, benefits and compensation programs so employees are not rewarded by staying out of work.
For more cost savings tips go to WC Cost Reduction Tips.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Public Sector: Empowering the Public Sector Through Risk Management, FREE SEMINAR, Wednesday, November 19, 2008, Elmsford, NY. Learn about Public Sector risk management. For more information and to register contact: Deb_Brinkman@ajg.com or call 630-285-3909.
Contractors: Reduce Workers Comp Premiums for Contractors, FREE SEMINAR – Wed, November 5, 2008, S. Sioux City, NE. For more information and to register contact: Chuck_Goodman@ajg.com or call 515-440-8426 or http://www.ajg.com/WC
For more cost savings tips go to WC Cost Reduction Tips.
Companies with guaranteed cost programs should review their experience modification worksheets to make sure claims are coded correctly. While this doesn’t affect companies with loss-rating plans, it does affect those companies with “mod-rated” plans. Think of it as “loss rated” vs. “mod-rated.”
For example, If a medical-only claim is incorrectly coded as a lost time claim, you will pay more than necessary. In some states medical-only claims are discounted 70%. So for every miscoded claim, that’s inflates your experience rating.
If you are in certain industries, for example construction, you may be precluded from even bidding on a project if your experience modification factor is higher than the norm. So, have a professional review this. Check with your agent or broker to find out if your experience modification affects the cost of your insurance. Some brokers do this, others don’t. If your broker falls into the later category, be proactive and hire a professional to do this.
Check our Resources Tab for a company to work with: http://www.reduceyourworkerscomp.com/resources.php
For more cost savings tips go to WC Cost Reduction Tips.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
We are proud to share our clients success, so we’ll share what one hospital said about getting their National Workers’ Comp Score (NWCS)â„¢. Last week, a regional hospital in South Dakota took the assessment, and recieved a NWCSâ„¢ score and recommendations. ” I received my WC Score (48) and recommendations. Just seeing the questions was very helpful! In the recommendations for improvement, I found 14 items I can implement right away, none of which requires financial resources. Thank you for the opportunity to participate.”
The National Workers’ Compensation Score (NWCS)â„¢ is a web-based assessment determining which operational best practices the hospital was missing. It is very easy, the CEO’s admin completed the survey in less than one-hour. You’ll learn what you don’t know and what you do know about workers’ comp best practices. And from there, you’ll have a starting point to reduce your costs. The Recommendations for Improvement can be used to brainstorm which changes to make first.
Click here for more information about getting your National WC Scoreâ„¢ and recommendations: http://www.reduceyourworkerscomp.com/assess-workers-compensation-practices.php Contact us if you’d like to take the assessment. We reply usually within 1-hour to set up your User Name and Password to take the Assessment.
For the 7 Biggest Mistakes Companies Make, click here: http://www.reduceyourworkerscomp.com/lower-reduce-workers-comp-costs.php
For more cost savings tips go to WC Cost Reduction Tips.
Employers can choose from a variety of transitional work programs. The first are alternate or lighter duty programs. These allow employees to work at less demanding jobs, different jobs until they are physically able to resume their original work duties. For example, an employee who does physically demanding labor could work in a more sedentary capacity, such as answering telephone or taking inventory. To find out how much transitional duty will save your company try the TD Calculator: http://www.reduceyourworkerscomp.com/transitional-duty-cost-calculator.php The second type of transitional work program is the modified duty or transitional duty position where their original jobs are modified through engineering alterations of the workstation. Work hardening is another alternative. This is where employees perform job-related tasks in increasingly difficulty until they regain the physical ability to perform the entire original job. There are work-hardening programs off site which can be an excellent alternative if there is no way transitional duty can be accommodated at the work site. Read how to get employees back to work at: http://www.reduceyourworkerscomp.com/employees-back-to-work-sooner.php The key is thinking creatively. Most employees want to come back to work as soon as possible, so think outside the box to see how you can get them back within their restrictions, of course, as quickly as possible. For more cost savings tips go to WC Cost Reduction Tips.
Some thoughts from the Md's perspective on how to make your employees' visits with an occupational physician more productive. Find more ideas at: http://www.reduceyourworkerscomp.com/wasteful-workers-compensation-practices.php 1- Establishing a cooperative relationship before-hand is essential. What is key is having the medical advisor available to call the treating physician. This is a step that must be set up in advance so the medical advisor is very responsive and can take quick action when an injury occurs. 2- A Medical Advisor can contact the treating physician prior to the exam: The medical advisor can let him know the patient is coming and ask him to call the medical advisor back after the exam. The medical advisor may ask specific medical questions, such as asking questions and conducting an exam that helps distinguish a work-related injury from non-work related injury. If the treating physician knows he will be speaking to the medical advisor, he may take a more careful history and be more aware of getting the person back to work. 3- The medical advisor can suggest something he may/may not do routinely. Depending on the type of injury, the advisor might suggest a particular Waddell test if symptom magnification is suspected. Giving background such as letting the doctor know the worker is unhappy with the job situation can be helpful. 4- Treating Doctors should give medical restrictions and then the company decides if the employee can return to work, if they can accommodate the physical restrictions. It is helpful to let the doctor know a company can accommodate nearly all restrictions. 5- Ask them to not give "off duty" – just give medical restrictions for every worker. If he or she is contemplating taking someone off work, give us medical restrictions – unless the worker is bedridden. The doctor should keep in mind that a worker may not even know the company can accommodate him; he may be unaware there is a transitional duty program. Once there are medical restrictions, it is then up to the workplace to decide if they want to make those accommodations and how they will make them. 6- Make sure the physical restriction form is easy: it is easier to fills out a simple form with check boxes that nearly all doctors are familiar with such as "Lifting: heavy/ medium/ light, pushing or pulling, sitting, standing and a space for the doctor to write in any additional comments." 7- It does not have to be a "recordable" claim: If the treating physician is familiar with the OSHA rules, he/she will know that if the incident is just first aid, that medications needed by the worker are over-the-counter, and physical therapy (often over-prescribed) is not ordered, then the incident is not OSHA recordable it is first aid. WC Calculator www.ReduceYourWorkersComp.com/calculator.php TD Calculator www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101 www.ReduceYourWorkersComp.com/workers_comp.php Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Contractors & sub-contractors can learn how to reduce their workers’ comp costs easily and quickly. You’ll learn:
- How to protect your company from third-party lawsuits;
- Legal and financial consequences of relationships between contractors and subcontractors;
- The top 10 safety standards commonly cited by OSHA and what a contractor can do about them;
- The type of safey information that helps lower Workers’ Comp premiums.
- Indirect costs of workers’ comp claims is is 7X direct costs.
All seminar information will be available in downloadable format. To register, go to: http://www.ajg.com/portal/server.pt?open=512&mode=2&objID=3803
If your workers’ comp costs are $50,000 and your profit margin is 7.5%, your company will need to sell $666,666. Figure out YOUR real costs of Workers’ Comp, then learn how to reduce those costs. http://www.reduceyourworkerscomp.com/calculator.php?total=50%2C000.00&margin=7.5&calculate=Calculate
A service you might find useful, and should have a look at is Jim Moore's. Occasionally, I recommend firms my visitors and clients will find useful, and auditing your files is one of the BEST things you can do. Make sure your claims are administered according to your carriers best practices and reserving accuracy. Jim has an excellent understanding of claim administration practices. It's good to get an independent audit at least once every 3-4 years even if it's just at several offices/states of your current carrier. www.CutCompCosts.com If you are not satisfied with how your claims are being handled, this is a good first step to evaluate carrier and TPA performance. For more cost savings tips go to WC Cost Reduction Tips.
Posted in
Claim Management, Coordinating Medical Care, Litigation Management, Settling WC Claims, TPA and Claims Administration |
