When a carrier gets a new account, it is a time of transition. There are new ways of doing things, new people to deal with, and new risk exposures to consider. Every carrier will attempt to make this transition as painless as possible, but there are a lot of things to consider, and a lot of unknowns that have to be ironed out before everything can be running smoothly on all cylinders.
One of the first things to be completed is Client-Specific instructions, or Special Account Instructions. Basically this is a blueprint for the carrier of how the employer runs their comp program, and expectations are laid out as to what the new account demands from a service-standpoint.
How the new instructions are obtained will vary from carrier to carrier. I have been involved in these meetings, and some answers always amaze one. I recall one meeting where the account did not even know where their adjuster was located, or where his office was. All they knew about him was his name. Upon my questioning of how this was possible, the employer just shrugged and said they just knew that this person was their contact and that was it. I am guessing that was part of the reason why they were unhappy that carrier and switched to another one.
Even more surprising was when we got in to prior claims-handling aggressiveness. It turns out this adjuster was not in the same state as the employer, and he failed to really handle their claims at all. The icing on the cake was a questionable hernia claim. This adjuster told the employer that they had no evidence to show that it did not happen outside of work, so that meant that they were obligated to accept the claim (which was not true in this jurisdiction and given the claim details and injury scenario—at least in my opinion). The employer unhappily accepted the claim, and it turned in to a disaster. This injured worker needed two surgeries to correct this hernia, and also had some post-op complications with some nerve involvement. The claim was still open years later, with no end in sight.
Team Up With Local Adjusters
This proves the old point of teaming up adjusters in the same state as the employer. Not only are these adjusters better educated on the local jurisdiction, but they are also usually a lot more aggressive than out of state adjusters just covering a territory. So my first point is to team up local adjusters with local accounts, and let them take it from there.
Basic Flow Of Communication
Next up in these meetings are the basic flow charts of communication. Adjusters need to know the chain of command from the workers on the floor, who they report to, which supervisors are in charge of which workers, who is in charge of the supervisors, who gets notice of the injury, who calls in the claim to the carrier, and who should the adjuster contact upon receipt of the claim to get injury details. Who is in charge of light duty work assignments? Who has the normal job descriptions and light duty job descriptions? Who does the adjuster contact for wage histories? Who is contacted to discuss legal matters and settlement authority? All of these questions need to be clearly answered and placed in the instructions, so the adjuster knows who to go to for what, and how to obtain this vital information.
Where Are Injured Employees Being Treated
Another great point that is sometimes glazed over is where the injured workers are going for treatment. Is this a jurisdiction where the carrier can direct the care, or are the workers free to go wherever they want to go? If the carrier can direct care, is the employer happy with their clinic of choice? Are there other options out there? What has the feedback been from injured workers on the clinic conditions, wait times, treatment, physical therapy, etc. These are all very important questions that should be addressed because if a change needs to be made, now is a great time to make it. Carriers will know about other clinics in the area that may be better performers than others. If the employer is not pleased with their current clinic, this is where a new carrier/adjuster can make a great impression by shifting care to somewhere new, which can lead to a better claim result.
Does this new account have any vendor relationships they want to maintain? Examples of this could be a specific nurse case manager, surveillance company, attorney, diagnostic vendor, occupational clinic vendor, etc. If the new account already has the steps in place and the relationships established, the carrier should do whatever they can to keep that relationship. Solid results must have already been obtained for the employer to make this vendor a partner of choice, and the last thing you want to do is sever the relationship and start over from the beginning with a new vendor.
Good Communication & Good Vendor Relationships
These are really just a few of the little things that can ease transition from one carrier to another. Each carrier has their own way of doing things on new accounts, but these factors listed above are often the most crucial. Consider adjuster location, communication levels, managerial levels, vendor relationships, and occupational care. All claim results are going to stem from good communication between carrier/adjuster/employer/injured worker, and good vendor relations to keep that claim moving forward to resolution.
Author Michael Stack, Principal of Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool. As the senior editor of Amaxx’s publishing division, Michael is on the cutting edge of innovation and thought leadership in workers compensation cost containment. http://reduceyourworkerscomp.com/about/. Contact: firstname.lastname@example.org.
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