Prior to implementing any workers’ compensation policy or program, make sure your corporate legal counsel does a review because terms may need to be varied or policies and programs brought into alignment to comply with different state and federal laws covering workers’ compensation.
Here is another useful and cost-savings tool. Use this 16-point Account Servicing Instruction (ASI) Checklist when implementing a workers’ compensation cost control program to gain more control of the claims and litigation process.
ASI, 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.
A 16 Point Account Servicing Instruction Checklist
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?
· Are your attorneys members of Council of Litigation Management ?
· How often do you receive status reports for open claims from your insurer? Over 30, 60 or 90 days?
· Does the insurer provide a written explaination 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 claims in each office?
6. Payment/Review of Legal Bills
· Do you receive copies of bills for legal services?
· How do you request investigations?
8. Structured Settlements
· Do you consider structured settlements for all cases over $10,000?
· 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?
10. 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?
11. 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 timing is appropriate for an IME?
12. 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?
13. Utilization Review
· How do you decide which bills and services will be reviewed?
· Who provides this service?
14. 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?
15. 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?
· 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 they’re spending! 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.
For more information and tools, see www.reduceyourworkerscomp.com/lower-reduce-workers-comp-costs.php. There are several free forms and tools on the site.
Robert Elliott, senior vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, health care, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He can be contacted at: Robert_Elliott@reduceyourworkerscomp.com or 860-553-6604.
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