But My Carrier Said So

Comp System States What You Can & Cannot Do


Have you ever asked anyone in the comp system – agent, broker, carrier, the Board, attorney – what you can and cannot do before, during, and after a claim? Chances are you have, and chances are you accepted it. Nearly everyone does. But people who handle comp problems for a living come to accept the fact that the simplest questions are answered with a laundry list of conflicting answers.


How do the pros handle this? Years ago, your correspondent decided to limit arguing matches by accepting whatever method the other party proposed, as long as it would get us closer to the correct result without dangerous compromise.



Two Different Answers to Same Question


Recently, an employer needed to see information in its work comp files in order to engage in effective cost control. The broker was involved and in the AM stated that the carrier could not release the desired information. A call to the carrier confirmed this.


Why couldn’t they release a list of prior claims they had obtained? “It would violate medical privacy laws.” A ten minute call to the carrier showed that they would not budge. But how did the carrier obtaining the info from other carriers NOT violate those same privacy laws? “It just is.” But the carrier agreed to release the info if the worker’s signed release could be obtained. (A bit of work, but doable. OK, well do it.)


In the PM, the very same broker forwarded prior claim info to the same employer, but on a different claim.  “What?!” The answer was simple. The second claim had a different carrier who read the law differently. The same two people getting two contradictory results on the same issue. Happens all the time.




Never Assume Rules Are Chiseled in Stone


An employer can use this example in many ways, not just in comp. When relying on the statements of others about what can, and cannot, be done NEVER assume that the statements were chiseled in granite and signed with letters of fire. But don’t argue.


Check with others. If necessary, call the staff attorney at the comp board. Yes, properly approached (and promised anonymity) they will give an answer. After a while you will get a feel for the range of uncertainty. Then, work with the method closest to your needs.


Effective, efficient people seldom win arguments but usually produce results.



Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net


Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com.  Contact:  mstack@reduceyourworkerscomp.com.


©2012 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

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