Three Key Steps in a Well-Designed Plan
1-Improving Insurance Company Relationships
MaxCo educates its broker, third-party administrator, and its insurance division so they understand the program and know management wants all employees back at work as soon as medically possible. Everyone involved knows MaxCo goes to great lengths to return employees to the work force and requires their assistance in this effort.
MaxCo also redesigned its insurance program so all auxiliary services provided by outside vendors fit together into the total program. The program is designed to be a vehicle for these services.
MaxCo implemented very detailed Special Account Instructions, which include lower than normal “authority” levels and require written status reports every 30 days on all claims in excess of $10,000. The settlement authority level for all workers’ compensation claims is only $5,000.
2-File Audits
MaxCo audits all workers’ compensation files at least twice each year in an attempt to develop a strategy to resolve each claim. These are face-to-face meetings composed of the division representative (usually personnel director and general manager), the insurance division file adjustor, insurance division supervisor, insurance broker, physician consultant, and often, corporate counsel. It is very important to follow up after these meetings to make certain all “action items” are completed.
File audits are a two-way street so MaxCo makes an effort to keep the insurance company informed of the actions it takes to return an employee (workersxzcompxzkit) to work. MaxCo sends insurers copies of all correspondence and communicates frequently with them by phone so there is a cooperative effort and a good working relationship. There have been times, however, when MaxCo is successful in spite of its insurance carrier.
3-Investigation and Surveillance
Each accident is investigated in the plant immediately after it occurs to determine the root cause and to identify corrective measures.
In addition, claims with “red flags” are investigated by professional private investigators to determine whether the extent of the injury is legitimate, or whether it is being exaggerated. MaxCo divisions budgeted approximately 5 percent to 10 percent of the total cost of the claim for surveillance.
Watch this blog for MORE on “Red Flags.”
Author: Robert Elliott, J.D.
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WC 101 www.ReduceYourWorkersComp.com/workers_comp.php
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