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. > Services > - workers’ compensation > claims administration

Claims Administration
Those experienced in workers’ compensation can readily attest that effective cost control can be attained only through the coordination of several related areas. Claim frequency and severity is truly a function of safety programs; accident prevention; hiring, training and disciplinary practices; complete post-injury analysis; proper medical treatment, proactive claims management; and a thorough understanding of the disability management process.

CompManagement has developed an extremely effective modular approach to the complex problem of rising workers’ compensation costs that includes:

• Initial Investigation and Claim Set Up -  Our claims examiner reviews the claim for initial information, mechanism of injury, diagnosis and supporting medical; performs a limited Social Security number check for a history of like claims; reviews the Managed Care Organization (MCO) contact with the injured worker and discusses the results of these investigations with the employer in order to help the employer make a determination on certification or allowance. In addition, the claims examiner contacts the MCO and/or the attending physician to discuss the possibility of transitional work in those cases where lost time may be involved, and requests a list of physical restrictions with which to assist the employer in offering transitional work.

• Ongoing Claims Management - As the claim progresses, other claims management issues are addressed, including requests for 90-day examinations, rehabilitation and documentation of the injured worker’s prognosis. As appropriate, we will discuss claims management options such as independent medical examinations, private investigation, involvement of legal counsel and rehabilitation referral, with the objective of returning the injured worker to work and/or terminating benefits to which the worker is no longer entitled.

• Rehabilitation Services - Rehabilitation services may be appropriate in those allowed claims where the injured worker is receiving temporary total compensation, salary continuation, or non-working wage loss. Rehab services may also be considered when the physician indicates that the injured worker has reached a treatment plateau with documented permanent physical limitations resulting from the allowed claim; where job retention services are needed; or in a catastrophic claim where a vocational goal can be established.

• Monitoring Medical Treatment – We review C-9 approvals from the MCO. If treatment appears excessive (exceeds normal recovery guidelines), we will discuss the case with the MCO nurse case manager and request medical/treatment reviews. If needed, we will also review records of prescribed medication purchases for evidence of excessive use; these are discussed with the MCO nurse case manager. If the client agrees that medication use appears to be excessive, a motion is filed with BWC for a review of the issue.

• Review of Benefit Continuation programs – We can provide feasibility studies to determine whether benefit continuation programs (wage continuation, transitional duty, $15,000 Medical Only program, etc.) would be beneficial to the client. If the client elects to participate in any of these programs, CompManagement's claims department offers a full range of administrative services.

• Cost Containment Strategies – We review all lost-time claims to determine if a handicap reimbursement, due to a pre-existing condition, is an option.  Supporting medical documentation is obtained and the appropriate application filed. When appropriate, subrogation referrals are made.  CompManagement also has a separate settlement team whose sole responsibility is settlement of open claims. We have extensive guidelines relating to settlement of claims, and settle more claims than any of our major competitors year after year.

Our objective is to close all claims quickly, cost-effectively and in the most professional manner possible.