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Include Physical Therapy, Nurse Triage and Occupational Clinics in Account Instructions
17 Mar, 2011 WorkersCompensation.com
A company on top of its workers compensation costs implements Account Servicing Instructions (ASIs). Without them managing claims and litigation is nearly impossible.
　
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.(WCxKit)
　
These instructions are disseminated to all branch offices across the country.
　
The ASI includes information about how claims are to be handled in every line of insurance including workers compensation, products liability and automobile insurance. (Third-party administrators who provide claims servicing without insurance also use ASI to guide their adjusters.)
　
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 of its claims and litigations.
　
1. Settlement Authority
Who has settlement authority? The company or the insurer?
　
2. Selection of Counsel
Do you select your own legal counsel? What type of legal counsel does your company utilize?
　
3. Reporting
How often do you receive status reports for open claims from your insurer, 30, 60 or 90 days?
　
4. Reserves
Does the insurer provide a written explanation each time reserves are raised over $10,000 or more? Do reserves set take into consideration the company's aggressive return-to-work program, probably resulting in lower wage loss?
　
5. Dedicated Adjuster
How many adjusters are dedicated to processing company files in each office? Are you adjusters "designated" or "dedicated" — there's a big difference, so as you negotiate terms make sure to determine the difference in these two different arrangements. Designated adjusters means you will always have the same adjusters handling your claims, probably one in each office, but they will handle the claims of other companies. Dedicated adjusters will handle ONLY your claims, not claims from any other company.
　
6. Investigations
How do you request investigations? Are all investigation reports sent to you for review. That's a good start. Specify this in your account instructions. Don't rely on adjusters to review the reports. READ THEM YOURSELF!
　
7. Structured Settlements & MSA Compliance
Do you consider structured settlements for all cases over $10,000? Do you have a reputable firm to handle all your MSA Compliance needs? Even if you are self-insurance, self-administered you will want an MSA Complaince company on board. Find one that does compliance audits to make sure you are crossing all the t's and dotting all the i's as there are large fines for non-compliance.
　
8. 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?
　
9. Workers Compensation Lost Wages
Do you receive copies of payments being made on each open file? Do you review checks or a list of all payments made for accuracy?(WCxKit) Make sure checks are not automatically deposited into claimant's bank accounts because they will no longer need to sign the fraud endorsement language on the back of the checks. It's there for a reason, and you want to have it seen and signed!
　
10. Referral to Physician Consultant & Nurse Triage
How are outside vendor services activated and coordinated? Are all medical records sent to the physician consultant before an independent medical examination is conducted? The TPA may have these services, but if not, make sure to consider a full range of services. Nurse Triage provides medical advise upon intake to a trained triage nurse, much like having an EMT available for all injuries. The ROI is about 4 to 1, and there really isn't any downside.
How are outside vendor services activated and coordinated? Are all medical records sent to the physician consultant before an independent medical examination is conducted? The TPA may have these services, but if not, make sure to consider a full range of services. Nurse Triage provides medical advise upon intake to a trained triage nurse, much like having an EMT available for all injuries. The ROI is about 4 to 1, and there really isn't any downside.
11. Physical Therapy & Occupational Clinics
This is one area you can save money, by having a network in place rather than relying on the adjuster or doctor to make a random referral, you can work with a PT operation that focuses on return to work. The right network will be local or might even come onsite to treat your employees. If you have a spare room, you might consider having onsite PT or even an onsite occupational clinic. If you have this type of facility, make sure to mention it in your account instructions or the adjuster might not know.
Even Federal Agencies can benefit from some of these services, so make sure to explore all options.
　
Eleven questions to ask when setting up your account service instructions that will save you money #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: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
WC IQ TEST: http://www.workerscompkit.com/intro/
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MODIFIED DUTY CALCULATOR: http://www.LowerWC.com/transitional-duty-cost-calculator.php
WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
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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.
SUBSCRIBE: Workers Comp Resource Center Newsletter
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.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
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