16 Points you MUST include in your Account Handling Instructions

What ARE “account handling instructions,” you ask? Account service instructions (ASIs), also called “account handling instructions” or “special account instructions,” are the instructions your insurance adjusters live by.

They tell the adjusters what must be done when handling your claims. So, make sure you have input into the preparation of these instructions. Every insurance company or third-party administrator has them, although the names vary. Items you want in your ASIs will vary depending on the carrier or TPAs best practices; ASIs will be developed “around” what they are already providing.

A 16 Point Account Servicing Instruction Checklist:

• Settlement Authority Who has settlement authority — the company or the adjuster? A “consult” is totally different than “authority.” How much authority you get depends on the type of insurance program you have.

• Selection of Counsel Do you select your own legal counsel? What type of legal counsel does your company utilize – panel counsel or outside counsel?

• Reporting How often do you receive status reports for open claims from your insurer? Over 30, 60, or 90 days? Even though you may have been provided access to run reports, if you’d prefer to have them run for you, ask for that.

• Reserves Does the insurer provide a written explanation each time reserves are raised over $10,000 or more? Do the reserves set consider the company’s aggressive return-to-work program, probably resulting in lower-wage loss?

• Dedicated Adjuster How many adjusters are dedicated to processing claims for your account? One adjuster with a full-time admin can handle more than an adjuster without an admin.

• Payment/Review of Legal Bills Do you receive copies of bills for legal services?

• Investigations How do you request investigations? Will you receive copies of the investigation reports and video for review? Are emergency room records/notes obtained for every worker who is treated in the ER? Are drug tests required at the clinic after an Emergency Department visit?

• Structured Settlements & MSA Set-asides Do you consider structured settlements for all cases over $10,000? Are MSA settlements structured? Who handles compliance?

• Subrogation Are all cases reviewed for subrogation potential? Who closes a file and waives subrogation recovery? Do you want to be consulted before a lien is waived or compromised?

• Workers Compensation Do you see copies of payments being made on each open file? Do you review checks or a list of all payments made for accuracy? Are statements recorded on all claims where compensability is questionable, such as heart attacks, stress claims, unusual injuries, claims where liability is not clear?

• Referral to Physician Consultant/Medical Advisor How are outside vendor services activated and coordinated? Are all medical records sent to the Medical Advisor before an independent medical examination is conducted? Does the MD write the IME cover letter and make sure the timing is appropriate for an IME?

• Medical Bill Review How and when are medical bills audited? Who will audit the hospital bills? What level of hospital bills are 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?

• Utilization Review How do you decide which bills and services will be reviewed? Who provides this service?

• Referral to Vocational Rehabilitation 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?

• Alternative Dispute Resolution/Mediation Is alternative dispute resolution considered on all claims for all lines? 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?

• Miscellaneous Do you have the option to change your account instructions? Do you have the right to review the complete original claim file? Don’t be afraid to negotiate for what you want in your account handling instructions. Remember, if you have a large deductible insurance program, it’s YOUR money!

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 asking for what you want.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is the founder & lead trainer of Amaxx Workers’ Comp Training Center, which offers the Certified Master of Workers’ Compensation national designation.

Contact: [email protected].

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