How to Help Frustrated Injured Workers’ OUT of Work Comp System…And Save Money Settling Tough Claims

Imagine a scenario where an injured worker who’s been receiving workers’ compensation benefits for years and shown no interest in settling the claim is suddenly willing and even happy to do so, and both he and the payer are pleased with the agreement. The payer gets the long-term claim off the books, and the injured worker has someone guiding him through the medical system while helping to manage his money long after the settlement is reached. Both parties save money in the process.

 

This panacea is not only possible, it is happening; and at no extra cost to the payer or injured worker. Professional administration is enabling an increasing number of settlements to occur and leaving all parties feeling grateful with the results. Professional administration organizations that have a solid background in all aspects of workers’ compensation are becoming the answer to the frustrations faced by long term injured workers.

 

The concept of professional administration is not necessarily new in the workers’ compensation industry, but until recently it was generally cost prohibitive for many organizations. Recently that has changed, as newer entrants have found ways to save money for all concerned.

 

The way it now works is simple and effective:

 

  • Those with the appropriate competence are able to offer significant discounts to injured workers through their networks of medical providers and pharmaceuticals.
  • They function much as an engaged claims adjuster would in terms of helping the injured worker find the best providers.
  • However, the injured worker’s care is not subject to utilization review.
  • The professional administer also helps the injured worker manage his settlement money, whether lump sum or structured, and can ensure injured workers receiving Medicare are compliant with government reporting requirements.

 

 

Overcoming Frustrations

 

Professional administration can work well for any injured worker with a long-standing claim but is especially advantageous for those exasperated with the system;

 

  • Tired of Utilization Review denials.
  • Required to drive many miles from home to see an approved physician – whom she may not like.
  • Attorney has abandon the injured worker as she has already settled the indemnity portion of claim.
  • The idea of settling the medical portion of claim makes her even more anxious, as she is afraid she will ultimately run out of money.

 

Such stories are fairly commonplace in the workers’ compensation system. Injured workers who have been in the system for a long time are afraid of the unknown, post-settlement scenario and are therefore willing to continue receiving benefits indefinitely.

 

Professional administrators can be invaluable in helping to reach a settlement and after the agreement is set.

 

 

Pre-Settlement

 

Among the many concerns of long term injured workers facing a potential settlement are the financial unknowns; how much will various treatments and medications cost, now and in the future? What if unexpected complications arise – will there be enough money to treat them? What if durable medical equipment becomes necessary – is there enough for that? Is the settlement money enough to ensure living expenses can be covered for the long term? Who should manage the money?

 

More concerns are present when the injured worker is receiving Medicare:

 

  • What medical services should be funded through Medicare?
  • What if Medicare is mistakenly billed for a treatment the injured worker should have covered?
  • How, when and where are the Medicare reporting requirements handled?
  • What if they are reported improperly?

 

It’s easy to see why many injured workers would be leery of settling their workers’ compensation claims. A professional administrator can price out the prescriptions and treatments and show the injured worker an accurate picture of the costs, especially when network discounts are included. Competent organizations get involved with all parties to the claim before a settlement to reach the best solution for all concerned.

 

 

Post-Settlement

 

Typically, there is no help for an injured worker after a settlement is reached. Those with extensive and expensive medical needs and/or those not comfortable managing the settlement money feel lost.

 

  • With a professional administrator involved, the injured worker has full control over choice of providers, and an expert helping to manage the settlement funds.
  • In addition to discounts for medications and providers in the network, there may be a 24-hour/7-day-a-week phone line available to discuss care issues.

 

Because of the savings associated with a professional administrator, injured workers often have money available for things such as a child’s education, starting a new business, or taking an exciting trip. Above all, they have peace of mind about the future.

 

 

 

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.

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