Include These 5 Things In Your Account Handling Instructions

Account Servicing Instructions (ASIs) is the way smart companies manage workers compensation claims and litigation.

Finding out how medical billing and other factors will be reviewed is a critical component to developing a clear ASI that gives your company the edge.(WCxKit)

Also known as account instructions, claim service instructions or account handling instructions, ASI represent the agreement or understanding between the insured and the field adjusters at the insurer’s branch offices that guides the handling of all suits and claims, both litigated and non-litigated.

After ASI are negotiated, the insured must familiarize all internal claims handling personnel with the provisions of the ASI and provide them with a written copy to ensure they understand the responsibilities for key areas of claims handling.

In addition to containing policyholder information and details about coverage and dissemination of data (loss runs), ASI can also contain other lesser-known guidelines.

For example, the referral of medical reports to a physician consultant for preparation of a letter to set up an independent medical examination (IME), or a requirement saying subrogation can be waived only upon receipt of a written evaluation and agreement by the company.

The following should be addressed by or incorporated into ASI for a company to gain more control:

1. Medical Bill Review

Who audits medical bills for your open claims? How and when are medical bills audited? Who will audit the hospital bills? What level of hospital bills is audited? Do you decide if medical case management is warranted? Is there immediate and automatic referral of complex lost-time cases to medical case management?

2. Utilization Review

How do you decide which bills and services will be reviewed? Who have you retained to provide this service? When peer-to-peer review of claims is performed, it results in proactive pharmacy benefits management. List the providers in your account instructions.

3. Referral to Vocational Rehabilitation and Physical Therapy

Who decides if vocational rehabilitation is warranted? Do you automatically refer complex lost-time cases to vocational rehabilitation? Will reports be sent to your company? Will Physical Therapy help healing, avoid surgery, make sure your preferred vendor is in the account instructions.

4. Alternative Dispute Resolution/Mediation

Is alternative dispute resolution considered on all claims for all lines?(WCxKit)

5. Miscellaneous

Do you have the option to change your account instructions? Do you have the right to review the complete original claim file? Are you or are subrogating insurance carriers members of the Center for Public Resources (a non-profit organization whose members agree to avoid litigation and try to pursue alternative means of dispute resolution)? If so, is this noted?

Writing an ASI to combat workers compensation costs. Five things to think about #WorkersComp.

Author Rebecca Shafer, JD, President of Amaxx Risks 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: [email protected] .

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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.