If you are going to sell business insurance to the business community, you need a strong basic understanding of workers compensation insurance. While companies will be concerned about having insurance for their buildings, inventory, and vehicles, and will understand the need for various types of property insurance, the same companies will look at work comp insurance as a governmental mandated cost of doing business.
As their agent, you need to be able to explain to your client business the importance of workers compensation and how it works.
While your clients, the companies, will think about their property insurance exposures, they will have a far higher frequency of workers compensation claims then property claims. Therefore, selling and servicing workers compensation insurance can be challenging for any agent, even experienced ones. The successful insurance agent will be the agent who can explain the advantages of all types of business insurance including workers compensation.(WCxKit)
A major part of the challenge of workers compensation insurance is the way it is different from the other various business lines. With property insurance, the cost of the claim can normally be ascertained fairly quickly and easily. The longer life of some work comp claims, along with the variables of medical treatment, income replacement, and a third party (the employee) who has a different perspective and different motivation, makes the evaluation of the cost of the work comp claim much more complex.
The complexity of work comp is what often keeps insurance agents from being as educated in workers comp as they are in the other insurance products they sell and service. However, learning the parameters of work comp is not nearly as difficult as you might think. To assist you in becoming more proficient in work comp, we have put together a guide that has become quite popular both with agents/brokers and with risk managers/corporate financial control management.
Our guide will assist agents in better understanding the entire work comp process which will assist you, the agent, in providing a higher level of service to your clients when they have a claim or even when they just want a better understanding of workers compensation. The chapters of the guide that will be of special interest to insurance agents include:
1. How an employer should assess their work comp program.
2. How the employer should structure their work comp team.
3. The forms and documents the employer will need to process/submit their work comp claims.
4. The training the employer will need in their work comp program.
5. The management and monitoring of the employer’s work comp program.
Additionally, as the agent, you will want to understand what is going on with the client’s work comp claims. Learning more about the claim progress will allow you to answer the questions your clients have about their claims. Knowing the differences between the way property and work comp claims are handled will allow you to better service your clients. Some of the topics that benefit insurance agents and allow for a better understanding of workers compensation include:
1. The role of the third party administrator in the work comp claim.
2. The differences between bundled and unbundled services.
3. The importance of proper account handling instructions.
4. The role of medical management in the claim.
5. The best practices of work comp claim handling.
6. The ability of the employer to control the selection of the medical providers.
7. The importance of a return to work program at the client.
8. The importance of a solid safety program.
9. How to fight fraudulent claims. WCxKit
It is important that the agent can answer all of their client’s insurance questions including the questions on workers compensation. We encourage you to learn work comp to the point that you can answers all your client’s questions. If you want to know more about cost containment, learn more about our book Workers Compensation Management Program: Reduce Costs 20% to 50%.
Author Rebecca Shafer
, JD, President of Amaxx Risk 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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
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.
Two-thousand-eleven has been an interesting year in the workers compensation industry. New software has helped many administrators take better control of their costs, studies on safety have led to an increase in preventative measures and legal changes have led to unusual and sometimes controversial administration in some states.
Here at Roundup we asked one of our favorite experts, Curtis Smith, executive vice president of Medcor, Inc., a national on-site health services company, what he thought the top WC issues were for 2011. What follows are his conclusions:
Conflicts of Interest Inherent in the Industry
The very organizations employers depend on to help manage and reduce costs depend on claims for their core revenue – and this can lead to potential conflicts of interest, according to Smith. He offers these examples: contingent commissions for brokers and consultants, TPAs (third-party administrators) and MCOs (managed care organizations) who select network providers and share revenue from provider discounts. Smith also cautions against pharmacy chains that put pharmacies on-site in large worksites for convenience also employ the practitioners who write the prescriptions.
Prescription Drug Abuse
Thousands of people incur illness and injury each year from abuse of prescription medications, especially pain medications. Addictions and overdoses are increasing, as are deaths, Smith wrote. Addictions often arise from treatment after a work-related injuries but the medical community is not policing or restricting doctors who write these prescriptions. What’s more, TPAs are not excluding these unrestricted doctors from networks of approved providers for fear of litigation.
Prescription Drug Costs
The same medication can cost 10 times as much in workers compensation cases as it does in general health applications. Medications’ fee schedules have been negotiated down and controlled in group healthcare far more than in workers comp situations. Consequently, drug companies and others are moving into the comp space to take advantage of increased profitability, Smith said.
Increased Litigation in the Industry
The fundamental premise behind the workers compensation system is falling apart in many states (e.g. California and New York) where an increasing percentage of claims are contested and litigated. Huge settlements out of proportion to true economic need are forcing employers to be defensive and deny claims; denying and resisting legitimate claims forces employees to seek counsel and litigate. The comp system is turning into a battleground of plaintiff and defense attorneys working the system.
Injury Triage
Smith said he would be remiss if he did not mention injury triage. “This truly is an effective way to reduce unnecessary claims and costs, to identify serious cases, and to provide early intervention for all cases,” he wrote. Financial and health outcomes are improved with the use of triage. “It’s also innovative – wining several U.S. patents — are there any other WC methods that have been patented in the last 10 years? Or ever?” he asks. Thousands of companies are using triage and many competitors have joined the market, providing a variety of service and pricing models. Yet, many employers (even most) still don’t use it and the claims-driven industry still resists it.
Even those who offer injury triage often do so begrudgingly to satisfy their employer-clients, to block another triage provider from taking claims away, or to acquire business – but they are slow to introduce triage to an existing book of businesses, or, once introduced, often let implementation and utilization languish so claims can continue to flow.
In conclusion, look to hear more about these important topics in 2012. Though they may not be resolved in short order, they are certainly going to be on the minds of those of us in the industry in years to come.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
LexisNexis Workers Compensation Law Community directed by attorney
Robin Kobayashi recently teamed up with Work Comp Roundup to deliver expert opinions on the 10 most critical myths and facts about workers compensation.
The article goes into depth on the following 10 myths, in no particular order:
Myth #1: Large discount networks are the key to success in workers compensation managed care – from
Kenneth F. Martino, president and CEO of Broadspire Services, Inc.
Myth #3: Workers compensation claims improve with age, by
Mark Walls, assistant vice president of claims at Safety National.
Myth #4: Technology will cure all of our ills, from
Robert Wilson, president & CEO of WorkersCompensation.com, LLC.
Myth #5: Because FECA is so different from state workers compensation systems, private sector case management best practices won’t work, contributed by
Marianne Cloeren, MD, MPH, FACOEM, and medical director of Managed Care Advisors, Inc.
Myth #8: Doctors prescribe narcotic pain medications because of concerns they may be sued if they don’t treat pain from
Stuart D. Colburn, Esq., shareholder in Downs Stanford, P.C.
Remember, these are all MYTHS! The
article itself goes into depth explaining why they are not FACTS. Work Comp Roundup considers it required reading for everyone in the field – it’s a great way to start the new year.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
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, contactInfo@ReduceYourWorkersComp.com.
Stuart Colburn
Stuart Colburn, an attorney for Downs
Stanford recently shared a blog regarding a November 2011 Centers for Disease Control and Prevention (CDC)
report that described prescription painkiller abuse as “a public health epidemic.”
Colburn noted the CDC feels that changing the the way prescription painkillers are prescribed would reduce misuse, abuse and overdose but still allow access to safe, effective treatment.(WCxKit)
Colburn frankly citizens the workers compensation system as contributing to these addictions and indirectly by contributing to lost time and injuries “attributable to decreased alertness and other ill effects of working while abusing prescription drugs.”
Colburn continues, “America's prescription drug abuse (PDA) problem is not nearly as well known as our War on Drugs. No war has been declared and yet American lives are being lost. The statistics are well known. American citizens make up 4 percent of the world's population. Yet, we consume 66 percent of the world's illegal drugs.”
His blog continues to site fascinating drug statistics not only from the CDC but also the U.S. Military, various states and many others. It is well worth a read.
Brian J. Caveney
He concludes that the Patient Protection and Affordable Care Act (PPACA) of 2010 has changed much for the workers compensation industry including The United States Department of Health and Human Services adding eight substances to its Report on Carcinogens.
“Formaldehyde and aristocholic acids are now listed as known human carcinogens, and six other substances-captafol, cobalt-tungsten carbide, inhalable glass wool fibers, onitrotoluene, ridelliine, and styrene-are now considered as reasonably anticipated to be human carcinogens. This brings the total to 240 identified substances in the listings demanding thoughtful approaches to minimize exposure to workers,” Caveney wrote.
He also said the Fukushima Daiichi nuclear power plant in Japan has had great affect on the WC industry. “Readers of Occupational Injuries and Illnesses (LexisNexis) can refer to Chapter 44 for recent updates on the physics of radiation contamination and possible human health effects of exposure,” he wrote.
For WC matters regarding low back claims, Caveney directs readers to the updated Chapter 15 in Occupational Injuries and Illnesses (LexisNexis. And, lastly, he noted 2011 is the 30th anniversary of the identification of the human immunodeficiency virus (HIV). “The infection has transcended its original death sentence upon diagnosis to a chronic disease state when adequately treated with the panoply of various treatment options these days. Once widespread fears of transmission in a host of occupational situations has thankfully now been limited to mostly preventable scenarios. Chapter 46 of Occupational Injuries and Illnesses (LexisNexis) reflects these advances,” he wrote.
To read more, follow the above link to Caveney’s article.
She cites physician Nortin M. Hadler, MD new book
Rethinking Aging: Growing Old and Living Well in an Overtreated Society. “Dr. Hadler continues his no-holds-barred approach, warning that the Baby Boomer Generation and Generations X and Y hold unrealistic notions about defying the aging process with medical technology, thereby making them more susceptible for ‘medicalization and overtreatment,’ “ she wrote.
Kobayashi notes that marketing has become “sophisticated and pervasive in playing off people’s fears about health and longevity. … It’s no secret that Dr. Hadler has had it with insurance companies and even the AMA Guides for that matter. He once argued that attempts to adhere to the AMA Guides to quantify impairment were, in his opinion, ‘an unappealing, if not Orwellian, exercise, and not just for musculoskeletal diseases but for all diseases.’ “(WCxKit)
Read more of Kobayashi’s research and opinion by following the link above. She concludes, “Here, in our world of workers’ compensation, we can’t deny the fact that workers’ compensation medical costs are soaring. Whether you’re an injured worker, attorney, judge, or claims adjuster, we need to make the right choices about medical care, to educate ourselves, and to stop being conditioned into believing that medical treatment can always help/save us.”
Author Rebecca Shafer
, JD, President of Amaxx Risk 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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
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
The Workers Compensation Research Institute (WCRI) recently released medical price index data geared toward thee specific states. Regardless of where you are based, we all can learn from them.
They are:
In the Virginia study, WCRI found the 2010 price for non-hospital services was nearly 30 percent higher than the median price in states with fee schedules. The original nine-year study, Medical Price Index for Workers’ Compensation, Third Edition (MPI-WC), showed prices grew much faster than the typical growth rate of 11 percent in states with fee schedules.
The study further showed in Wisconsin, their system had the highest prices and fastest growth in their WCRI’s Medical Price Index. “The price for non-hospital services in Wisconsin in 2010 was the highest of the 25 study states, more than twice the prices in the 25-state median, and nearly 50 percent higher than the median of the 6 states with no fee schedules,” the study says.
A WCRI press release indicated, “The prices in Wisconsin increased 42 percent, much faster compared to median growth rate of 11 percent of the states with fee schedules, also faster than the 28 percent typical growth rate of the states without fee schedules.”(WCxKit)
Lastly, the Indiana portion of the larger study indicated the 2010 price for non-hospital services in that state was the third highest of the 25 study states, more than 50 percent higher than typical prices paid in the study states with fee schedule regulation. The nearly 30 percent growth in Indiana was much faster than the typical growth rate of 11 percent in states with fee schedules, according to a WCRI press release.
ABOUT WCRI:
The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Since 1983, WCRI has been a catalyst for significant improvements in workers' compensation systems around the world with its objective, credible, and high-quality research. WCRI's members include employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia and New Zealand.
Author Rebecca Shafer
, JD, President of Amaxx Risk 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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
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
Few people realize the workers’ compensation industry is actually 100 years old. It’s one of the most-successful public-private partnerships in U.S. history.
Since 1983, the Workers Compensation Research Institute
(WCRI) has been providing the public with research on WC public policy issues. Based in Cambridge, Mass., the organization includes among its members employers, labor organizers, public and private insurers, health care providers, managed care companies, and state government representatives from the U.S., Canada, New Zealand, and Australia.
Dr. Richard Victor, WCRI executive director, oversees the institute’s studies and analysis that has added ammunition for the reforms to various aspects of the workers' comp system. Prior to working at the institute, he spent seven years conducting research at The Rand Corporation in Washington , D.C., and Santa Monica , Calif. His law degree and Ph.D. in economics is from the University of Michigan.
LowerWC recently asked Victor for his impressions of the industry. What follows are some of his comments:
“One of the most important, and troubling, areas for workers’ compensation systems is to find the appropriate ways to use narcotics – and to discourage abuse and diversion. A second critical issue is to find new and innovative ways for help workers return to productive employment,” Victor says.
To this end, WCRI is conducting several research phases to help find answers for WC narcotic use and return-to-work issues, he says.
Victor says the latest trends in workers’ compensation also include medical cost management. “Medical costs now represent more than half of workers’ compensation costs in most states. There is increasing focus on pharmaceutical costs and utilization and the payments made to hospitals and ambulatory surgery centers,” he says.
Further, everyone wants to know how to save the employers money. Victor says, “Most large employers are focused on three legs of the four-legged cost containment table – risk financing, injury prevention, and claim management. The fourth leg is a large opportunity because employers have underinvested in it – improving the ‘rules of the game’ to make the system more effective for workers and more cost effective for employers.”
He continues, “This requires that employers join together to formulate political positions and strategies and gather available evidence about how a given state system is performing, how it might be improved, and what lessons can be learned from other states.”
California and Texas are good examples of where employers have taken collective action and costs have fallen significantly, Victor says. One of the chief objectives of the WCRI CompScope benchmarking studies is to help stakeholders and public officials set priorities and debunk myths.
One important part of this research is an upcoming conference. The WCRI Annual Issues and Research Conference will be Nov. 16-17 in Boston with keynote speaker Peter Barth, professor of economics emeritus at the University of Connecticut. This will be its 28th year.
The goal there to present new ideas and alternative views, Victor says. “Whether you are managing workers’ compensation claims, involved in strategic planning, concerned with medical costs and utilization, or just looking for a better understanding of workers' compensation – this is the conference for you.”
All of the sessions highlight the first presentations of the latest research findings from WCRI while drawing upon the diverse perspectives of highly-respected workers’ compensation experts and policymakers from across the country, he says. “Attendees tell us that they value the large attendance because it allows them to leverage their time while at the conference. There are also opportunities to meet and interact with WCRI researchers.”
“The most important advice I can give remains a secret until the WCRI conference, when I (present) ‘The Elephant in the Room.’ It will highlight some things that are underappreciated, but are likely to shape workers’ compensation systems for the next decade. The future is not always like the past,” Victor says. “Of course, I would like to see your readers attend to stretch their thinking, gain a competitive edge, and network with peers.”
Author Rebecca Shafer
, JD, President of Amaxx Risk 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. She is the author of Manage Your Workers Compensation: Reduce Costs 20-50% on cost containment techniques. www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
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
Posted in
Assessment & Diagnostics,
California Workers Comp,
Communication with Employees,
Drug, Alcohol & Impairment Testing,
Employment Law Issues,
Federal Workers Compensation,
Implementation and Rolling Out Your Program,
Management Commitment,
Professional Development Issues,
Return to Work and Transitional Duty,
Seminars and Courses |
Workplace safety is set to get a boost as changes to Manitoba's occupational health and safety provisions will soon make it mandatory for employers to implement violence-prevention policies, according to a report from Canada OH&S News.
Employers in specific sectors will be required to monitor, track, and report annually on violent incidents in the workplace. They will have to put in place procedures enabling employees to get immediate help when a violent or threatening situation occurs. Employers can also release personal information when deemed necessary to protect employees from the risk of violence, according to Joe Czech, a spokesman for Manitoba Labour and Immigration in Winnipeg.(WCxKit)
The changes cover the following sectors: health care, security, policing, corrections, crisis counseling and intervention, financial, pharmaceutical, education, and public transit and taxicab services. Workplaces that are not included in the elevated risk category will still be required to assess the risk of violence. "If a risk is identified, the employer must put in place measures to protect their workers," Czech said.
The new rules are based on recommendations from the Minister's Advisory Council on Workplace Safety and Health, and consultations with a number of stakeholders, including representatives from the health care sector.
Sandi Mowat, president of the Manitoba Nurses Union (MNU) in Winnipeg – which partnered with the provincial labor department to address the issue of workplace violence in health care facilities – said she is "very pleased with the changes." Findings from MNU focus groups investigating the extent of workplace violence incidents in the sector indicates many of these incidents are underreported, Mowat said.
In her blog entry for Working Families Manitoba, a community campaign launched by the Manitoba Federation of Labor to raise awareness of issues of concern to workers and their families, Mowat cites research that health care providers are victims of violence at an increasing rate. National studies also show that 48 percent of all non-fatal injuries from occupational assaults and violent acts occur in health care and social service settings.
"This fact is extremely alarming to us, since nurses were identified as the most likely of all health care workers to be assaulted," she writes.
With the regulatory amendments, it becomes clear that health care providers can flag a patient’s file who has exhibited violent behavior in the past. This measure, which also applies to mental health patients, will make information more readily available to the caregivers concerned, Mowat said.
"Health care workers, and in particular nurses, have a right to know if this individual has put a health care provider at risk in the past," she said. While existing regulations have provisions enabling health care providers to flag patients with violent tendencies, "most employers didn't do it because they believe that it was a breach of confidentiality," Mowat said.
A system to annually review and report violent incidents, which will include results of investigations and the measures taken, will help ensure that such occurrences cannot be ignored. "Literature does say that in places where the incidents were tracked, there was a decrease in those incidents," Mowat said.(WCxKit)
In addition, changes to the provincial employment standards regulation will require police services to provide adequate transportation home, within the boundaries of a city or town, to members who have to work after midnight and before 6 a.m. The move, notes Czech, is aimed at reducing the risk to law enforcement members from potentially violent situations while commuting to or from work during late-night shifts.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
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.
Comparison Report Generator is one of the new features on WorkCompResearch
WorkCompResearch (WCR), the nation’s leading workers compensation Compliance and Regulatory Research System, has recently been enhanced with a new Custom Comparison Report Generator (CCRG), designed to allow members to create and print instant comparative reports for a variety of compliance topics for up to 53 jurisdictions. The CCRG is based on a more limited Topic Comparison service previously offered in the WCR Compliance Center.
WorkCompResearch is one of several comprehensive data services offered by WorkersCompensation.com .
The report generator is now positioned with the State Comparative Charts that the company has maintained for years, but, according to Robert Wilson, WorkersCompensation.com President & CEO, the CCRG represents the future of WCR comparative data systems. “The Comparison Report Generator is the first generation of dynamic data manipulation, and represents the future for our custom information delivery services,” Wilson says. “Eventually our 50 State Comparative Charts will be driven by similar systems, being dynamically generated for the end user in real time, and on demand.” (WCxKit)
According to Wilson, the underlying system will allow the WCR service to provide even greater flexibility for their subscribers, while easing the maintenance burden on their Compliance Department. In addition to the Comparison Report Generator, which is now available in a beta format, the WCR service is expanding its Compliance offering with the addition of comprehensive Utilization Review and Medical Billing information. Kathy Lella, Vice President of Compliance and Research for WorkersCompensation.com, says that these additional topic areas have been among the most requested from the company’s existing subscribers.
For more information, visit WorkCompResearch.com or WorkersCompensation.com.
Robert Wilson, President & CEO, WorkersCompenstion.com.
WorkCompResearch (WCR), the nation’s leading workers compensation Compliance and Regulatory Research System, has recently been enhanced with a new Custom Comparison Report Generator (CCRG), designed to allow members to create and print instant comparative reports for a variety of compliance topics for up to 53 jurisdictions. The CCRG is based on a more limited Topic Comparison service previously offered in the WCR Compliance Center.
In the world of insurance, it is hard to tell if your carrier or third-party administrator (TPA) is doing a good job if you do not interact with them often. Of course, the goal is to have as little interaction with them as possible — if you do not have to file any claims that is a good thing.
But, accidents will eventually happen. Property damage happens. Workers get injured. Customers get injured. So how can you tell if your carrier or TPA is doing a great job and looking out for your bottom line? (WCxKit)
5 Ways to Tell Your TPA Is Looking Out for Your Bottom Line:
1. Ask your injured workers when they return to work how their interaction went.
Your injured worker should have had plenty of interaction with their adjuster during the course of the file. The amount of interaction depends on the severity of the injury, but they should at least be able to name their adjuster and give some feedback on how the claim went.
If your injured employee’s claim was denied, you may not get a truthful answer. But, for a normal, routine claim that was accepted and uncomplicated, the worker’s responses should be a good indicator of how their claims process went.
A sample of questions you might ask a recently returned worker:
Was the adjuster helpful?
Did he or she explain you worker’s rights as defined by the Comp Act?
Did he or she explain your medical condition to you?
Did the adjuster return phone calls promptly?
Did the adjuster listen to your questions and answer them to your satisfaction?
Any negative responses to these questions is usually a good indicator of how your carrier is doing while handling your claims. A lot of negative responses from your workers could indicate it is time to explore using another carrier or TPA.
2. Ask your agent what they hear about your carrier or TPA within the industry.
If you have a good-sized agency, or broker, that handles your insurance needs, it should be more than familiar with their clients' companies. If you ask for an unedited opinion, chances are they will give it to you. Agents hear a lot about the pros and cons of certain carriers and TPAs from other clients. Issues an agent speaks of may or may not be of importance to you, but, the more information you have the better.
Ask your agent about these factors to learn about your carrier or TPA:
What is the carrier’s reputation with other agents?
What does your agent hear about the carrier or TPA’s litigation response; do they deny and fight every claim, or accept and pay out on every claim? (either is bad – there should be a balanced approach)
How are their reserving practices? Do they constantly bump or stair-step reserves? Do they inflate reserves in an effort to raise premiums?
How are their adjusters? Do they return calls and help agents with questions or are they impossible to reach?
How is the carrier’s local management? Are they knowledgeable and experienced?
Does your carrier/TPA write a lot of businesses like yours, similar in size?
Does this carrier/TPA only like to write very large national accounts or do they prefer lower-level, local markets?
How are your TPA’s underwriters? Are they usually accurate or do they have to do a lot of work when submitting a premium estimate?
All of these questions will give you a feeling about how your business fits in with the other businesses your carrier/TPA writes for. A smaller company that uses a carrier/TPA that prefers large national accounts may find their business needs are not tended to when you need them.
3. Ask for a meeting with your carrier/TPA management and the team of adjusters assigned to your account.
The best option is a team handling your account within your immediate community. If it is a major road trip to meet with your insurance team, question if they are the right fit for you; if it's a flight, question it even further. Some businesses want that local presence so they can physically meet with them when issues arise. Some businesses do not really care about the location, as long as their needs are met immediately. It is your choice. Consider TPAs that will provide a dedicated unit ON SITE at your location if you wish; yes, there is a price for such a high level of service, but the overall value may have an excellent ROI. Short-sighted companies concerned only with today's price rather than total price might want to reconsider the price-first approach.
Every Carrier/TPA knows who would be handling your claims if any were to happen, so meet with this person. Get to know him or her and find out about their industry experience. Find out if you mesh with them or not. If you get a good vibe, then there should not be a lot to worry about. But, if you walk away feeling less than confident, you already know you should start shopping around before it is too late. Check their "grades" – the best TPAs score their adjusters.
4. Ask for your business peers thoughts.
This will not apply to everyone, but typically if you are a niche business and know your competition, ask your peers about their experiences. Ask how their claims were handled and if they were satisfied. All business competition aside, most managers run into the same people from their competition at certain events, trade shows, etc. If you are amicable with any of them, it will not hurt to ask. It is almost like a test drive. If your competitors had bad experiences with certain carriers/TPAs, chances are you would as well. This can save a when it is your turn to file a claim with your Carrier/TPA.
5. Do your research.
Most Carriers/TPAs will have websites that show their capabilities, office locations, new technology, agent relationships, etc. Do some searching around to see who you like.
Some things to look for include:
Who has cutting-edge technology for claim handling?
Who has invested time and effort into research and hiring practices to ensure they have the best of the best in staffing adjusters and counsel?
Who has local offices in your area?
Which agents are partnered up with your carriers/TPAs of choice?
Is your carrier/TPA involved in local charities and in giving back to their community?
Not all of these items may play a factor in learning if you have the right carrier/TPA for your business needs, but it cannot hurt to find out the answer to some of these questions. (WCxKit)
The goal is to not ever have to file an insurance claim. But, as we all know, that is unlikely. You will have to cross paths with your carrier/TPA at some point. Making sure you have the right one who will take care of your needs when you need it the most is worth the effort. Ask around; do your research, and take time to meet with your prospective team of insurance professionals. This will help you know you made the right choice, and not a choice you will regret when you need help or have questions about your insurance needs.
Author Rebecca Shafer
, JD, President of Amaxx Risk 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. Rebecca is the author of Manage Your Workers Compensation Program. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Our WC Book: www.WCManual.com
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.
We all know medical treatment costs per claim have grown exponentially in some jurisdictions. To help policy and business decision makers understand the growth better, the Workers Compensation Research Institute (WCRI) created a Medical Price Index for Workers Compensation, Third Edition.
The tool focuses on prices paid for medical care that injured workers receive, according to Ramona Tanabe, WCRI counsel and deputy director. Previously, the consumer price index for medical care was used, but it only measured general prices paid for medical goods and services. “If you are a policy maker or other stakeholder and want to understand the growth of medical prices in workers compensation, you need this unique tool,” she said.(WCxKit)
The tool will help state accurately understand how prices for medical care for injured workers in their state compare with other states. It helps them decide if prices in their own state are rising slowly or rapidly. The tool can help them learn if rapid price growth is part of a national phenomenon or if it might be unique to the home state and therefore subject to local management or reform.(WCxKit)
Since medical prices for workers compensation are regulated in about 80 percent of states, the consumer price index for medical care does not reflect changes in actual prices paid in the regulated workers compensation market.
To learn more about this tool, look
here.
Author Rebecca Shafer, JD, President of Amaxx Risk 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.
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.
