Account handling instructions inform insurance adjusters on how to handle a company’s workers’ compensation claims. Every insurance company or third-party administrator (TPA) has them, although they may refer to them by different names. Account handling instructions are also called “account service instructions” (ASIs) or “special account instructions.”
Make sure you have input into the preparation of these instructions. Items you want in your ASIs will vary depending on the carrier or TPA’s best practices. The following items are taken from our Workers’ Comp Kit’s Improvement Plan.
Don’t be afraid to negotiate for the terms you want in your account handling instructions. 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 trying to get what you want.
Make sure to look at least the following items on your ASI Checklist:
- Can you change your account instructions?
- Can you review the complete original claim file?
- Do you see copies of all payments made on each open file?
- Do you review for accuracy checks or an itemization of all payments made?
- Are statements recorded on all claims where compensability is questionable such as heart attacks, stress claims, unusual injuries or claims where liability is not clear?
- How and when are medical bills audited?
- What levels of hospital bills are audited?
- Who will audit these hospital bills?
Referrals to Physician Consultants and Medical Advisors
- How are outside vendor services activated and coordinated?
- Are all medical records sent to a Medical Advisor before scheduling an independent medical examination (IME)?
- Does a doctor write an IME cover letter?
- Does a doctor make sure the timing is appropriate for an IME?
- Does your company decide if medical case management is warranted?
- Is there an immediate and automatic referral of complex lost-time cases to medical case management?
- How often do you receive status reports for open claims from your insurer?
- Is the reporting period for 30, 60 or 90 days?
- Even though you may have been provided access to run reports, can you request the insurer to run them for you?
- Are you provided with a written explanation each time the insurer raises reserves over $10,000 or more?
- Does the reserve amount take into consideration things like your company’s aggressive return-to-work program, which may result in lower wages lost?
- How many adjusters are dedicated to processing claims for your account?
- Does the adjuster have a full-time administrator? One adjuster with a full-time administrator can handle more than an adjuster without an administrator.
- How do you request investigations?
- Will you receive copies of investigation reports and videos?
- Are emergency room records always obtained for every worker treated there?
Structured Settlements & MSA Set-Asides
- Do you consider structured settlements for all cases over $25,000?
- Are Medicare set-aside (MSA) settlements structured?
- Who handles compliance for these types of settlements?
- Are all cases reviewed for subrogation potential?
- Who closes a file and waives subrogation recovery?
- Are you consulted before a lien is waived or compromised?
- How do you decide which bills and services are reviewed?
- Who provides this service?
Referral to Vocational Rehabilitation
- Who decides if a referral should be made to vocational rehabilitation?
- Are complex lost-time cases automatically referred to vocational rehabilitation?
- Will voc rehab reports be sent to your company?
- Who selects legal counsel?
- What type of legal counsel is used- panel or outside counsel?
- Are your attorneys members of the Council of Litigation Management? See http://litmgmt.org.
- Is alternative dispute resolution (ADR) considered on all claims?
- Are you or your subrogating insurance carriers members of the non-profit Center for Public Resources that avoids litigation and pursues ADR? If so, is this noted?
- Do you receive copies of bills for legal services?
- Who has the authority to settle a claim? Whether your company or the insurance adjuster has the authority to settle a claim can make a big difference in your bottom line. How much authority you get depends on the type of insurance program you have.
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.
Editor Michael B. Stack, CPA, Principal, 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: firstname.lastname@example.org.
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