With the arrival of warmer weather, the time for reviewing your work comp program is upon us. Most often during the first of the year, your mind as a risk manager can be elsewhere working on other projects. Now is a good time to focus your attention to how your work comp program is running, and how you can make improvements to your system.
Review Your Vendor Contracts for Performance
If you have signed contracts with national vendors, you may not be in tune with how they operate every day. This is where you should solicit some feedback from your claims adjusting crew.
IME and Nurse Case Management
A good starting point is with the vendor programs you use. How do the IME and nurse case management vendors you utilize most often work for you? Did their costs increase, but their service and attention to your account decrease? Are adjusters complaining about the time it takes to get an IME back from the doctor, or lag time in case updates from the nurses in the field?
If so, it may be time to switch to a different vendor. Just because your vendors sign a contract to secure your business it should not prevent them from complying with the demands for service towards your account. If anything, you should demand even more attentiveness towards the handling of your files.
Oftentimes a contract means the vendor can get lazy, and focus their attention on the carriers and employers to which they have no contract. Do not allow them to take comfort in your contract. A better scenario is to not sign a contract at all. This prevents them from falling back on their laurels, and makes sure you continue to get top notch service in exchange for your continued future business.
Transportation and Translation
How about your transportation and translation programs? Did you utilize them properly? Did they satisfy your needs at the costs they promised? Were they available and present at doctor appointments, or were some appointments rescheduled due to their conflicts?
You should never have to move your appointments around to satisfy their schedules, if anything it should be the other way around. If you are not getting that type of attention from those providers, it is time to shop around for some new companies to cover those areas for you.
Diagnostic and Physical Therapy
Looking at diagnostic and physical therapy providers, how did the outcomes turn out? Was therapy going along with the course of the file, or was excessive therapy being recommended by the various clinics? Did the MRI and other diagnostic vendors have appropriate facilities in network, or did they have to schedule many tests outside of their own network? If most came out of network, you are probably not seeing the cost savings they have promised. The only way it is effective to use a diagnostic vendor is if they are providing you cost savings on top of state fee reductions. If they are just providing savings on the testing, but then charging additional costs for scheduling and obtaining the reports, then it is not worth your while.
Special Investigations Unit
Next take a look at the results from your SIU vendors, and those that performed on-site surveillance. Were they successful in gathering film of your claimant? Or were they charging you for watching an empty house all day? Were they charging a flat fee for surveillance, and then racking on tons and tons of mileage charges? Were the background checks thorough and applicable to the file? Did they comb the internet for social media accounts and other information, or did they just pull the DMV info on the type of car the claimant drives?
Make sure you are satisfied with their overall product, and that results were positive in the defense of your files. I understand that positive hits on surveillance are part luck, but if your provider was always unlucky, it’s time to look for a new one. It is impossible for them to strike out 90% of the time on their cases. If that were the case that vendor would be out of business. Again some vendors get comfortable with those service contracts, and do not put their 100% effort in to helping you achieve your goal.
You as the risk manager may have many more vendors that you have to deal with, and I have only scratched the surface here. Now may be a good time to ask your adjusters how things are going, and if they have any complaints or issues with the vendors assigned to your work comp program.
Author 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: [email protected].
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