Due to the dynamics of today’s workplace, there are going to be incidents or circumstances where pre-employment screening will not be cost effective. Even with the best efforts of safety departments, accidents happen. Our sole purpose is to remedy the current system that does not work well for the employer. It is accomplished in the following way:
Creating Deflationary Pressure
The current system lacks any inherent incentive to control costs. The model is such that either costs are controlled or the system is out of business. The elements of the model are:
- Business Process Outsourcing Model: Depending on the employer’s need, the program provides as much as a fully staffed workers’ compensation risk management department or simply an adjunct to an existing risk management department.
- Accountable Only to the Employer: There is only one responsibility: to control clients’ costs.
- Fees are Capped: One annual flat fee is charged. There are no event–based costs or charges to the claim file. This removes the incentive to increase costs and creates an incentive to work profitably.
- Effectiveness is Guaranteed: A money back guarantee that your return on investment will be at least 100%.
Consists of three areas:
- Forensics: Some of the work is forensic in nature. Analysis of the data is used to determine bottom line costs and to fix the fixable, including old claims – whether open or closed.
- Risk Financing Consulting: If a client could benefit from alternative risk financing methods we will assist in designing a model that works, and will adjust service styles to match the risk financing plan - especially if it is loss-sensitive.
- Claims Management: The vast majority of the work done, as well as the value provided, comes from proprietary claims management system.
This is the only cost management service we know of that has been able to demonstrate verifiable savings of this type. A third party actuarial analysis was performed, and that analysis was commissioned by a separate third party. The results were:
- Reduction in claim frequency: Our clients experienced an average decrease in claim frequency rate of 21%
- Reduction in cost per claim: Our clients experienced an average decrease in cost per claim of 51%
Over the past 21 years this process, built around the following intentions, has demonstrated the highest likelihood of limiting the impact injuries have on costs.
- Total Cost and Reserve Management: Involvement at the time of injury allows control of how the incident is handled from the outset. This intimate involvement results in monitoring reserve practices, determines implications, and steers the claim in the best interest of the employer. The outcome is the lowest impact on costs possible, including the limiting - and usually elimination - of the impact reserves have on costs.
- Limiting Fraud: One of the main motivations in starting the program was to limit and/or eliminate fraud from workers’ compensation claims. The telephonic involvement before the injured employee is seen by a physician includes taking a recorded statement which preempts fraud.
- Limiting Indemnity Costs: The 24 hours following an injury are critical for managing the impact that injuries have on costs. By adhering to the philosophy that no indemnity cost is acceptable, direct communication with the medical provider is utilized to initially allow for modified duty, and then progress the claim through to full-duty and eventually maximum medical improvement. Depending on the jurisdiction, this could have as much as a 91% reduction in the impact of the claim has on costs.
- Elimination of Claims: Because initial involvement at the time of injury is through a nurse, 38% of the injuries handled ever incur any claim cost at all.
- ALAE Management: Employers on loss sensitive plans, especially those whose claims are paid by Third Party Administrators, have a need to have allocated loss adjustment expenses managed. Not only is consulting instituted on the usage of services incurring these costs, but billings will be audited.
- Claims Team: Each client has a claim team. That team is made up of a Claim Manager, a Senior Claim Manager, and is overseen by the Vice President of Claims. Combined, the team that would manage a client’s exposure would have almost seventy years of claims experience.