Tri State Risk Management

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     Employer Services
        “Your Complete Employers’ Outsourcing Solution”

Claims Management is Cost Management
      A Claims Management
                By Tri-State’s

Claim Management Department
Tri-State Claims Management
   Risk Management Mission Statement
    Tri-State Employer Services, Inc. (and affiliated
    companies) Mission Statement for Risk
    Management (Loss Prevention, Underwriting &
    Claims Management) is to develop and maintain
    an integrated multi-disciplinary program to
    effectively manage and preserve Tri-State
    Employer Services, Inc. (and affiliated companies)
    and our client companies’ resources, assets and
Tri-State Claims Management
   Vision Statement
    The vision of the Risk Management Department is to:
    • continually improve services to our organization and
      client companies,
    • protect human, physical and financial assets and
    • help maintain a safe and healthy work environment,
    • assist and educate others in meeting regulatory
      compliance-related responsibilities, and
    • promote a risk-conscious climate in a manner consistent
      with the mission and vision of Tri-State Employer
      Services, Inc., its affiliated companies and our client
    Tri-State Claims Management
   Tri-State Claims Department Responsibilities:
    – Professionally administer the workers’ compensation
      claims management function at Tri-State Employment
      Services and its affiliated companies.
    – Manage the processing and payment of workers’
      compensation claims in a timely manner.
    – Oversee and manage the defense of litigation brought
      against Tri-State Employment Services and its affiliated
    – Be proactive in the development, implementation and
      management of rehabilitation and injury management
      policy programs for injured employees.
    Tri-State Claims Management
    What Benefits Does Workers’
     Compensation Provide?
    –    Workers’ Compensation benefits
        include payment for time off work due
        to total or partial impairment and
        reasonable medical expenses.
Tri-State Claims Management
   Direct Worker’s Compensation Costs
     •   Medical expenses (Unlimited)
     •   Disability / Indemnity (Statutory Limits)
         •  Temporary Total
         •  Permanent Total
         •  Temporary Partial
         •  Permanent Partial
     •   Death Benefits (Statutory Limits)
     •   Rehabilitation Benefits (Statutory Limits)
     •   Benefit Administration
     •   Legal costs (Coverage “B”)
         •  Defense Costs
    Tri-State Claims Management
   Tri State’s “Best Practices” Philosophy:
    – Educate our clients on their roles and
    – Claims Administrator maintains weekly contact
      with disabled employees.
    – Client plans for employee’s “return to work.”
    – Claims Administrator stays informed about
      claimant’s medical and restricted duty status.
    Tri-State Claims Management
   Tri State’s “Best Practices” Philosophy
    – Claims Administrator constantly questions
        DOL (date of loss).
    – Client maintains a safe and healthful
         Participates in Safety Assessments and hazard
         Reports all unsafe conditions to help prevent
         Communicates, educate and dedicate.
Tri-State Claims Management
   Tri-States’ Partners (Clients) “Best
    Practice” Philosophy:
    – Training
        Supervisors train new employees in proper
         procedures , equipment usage, reporting “near
        New employees receive training when hired.
        Employees receive training when equipment,
         procedures or work assignments change.
    – Pre-Placement Physicals
        ADA approved job descriptions are prepared.
        Medical clinics have copies of approved job
Tri-State Claims Management
   Tri State’s Partners (Clients) Best
    Practices (Continued)
    – Medical Control – select a clinic that:
        Treats your injured workers promptly and
        Is mindful of your return to work program.
        Addresses work restrictions.
    – Transitional Duty Program:
        Establish a return to work policy that is accepted by
         the bargaining units.
        Establish a published version of modified positions.
        Consider a time limit for modified duty.
Tri-State Claims Management
   Tri State’s Partners (Clients) Best
    Practices (Continued)
    – Litigation Avoidance:
        Be responsive to the injured workers needs.
        Start injured worker on the correct path by referring
         him / her to a qualified occupational medical
        Keep lines of communication open.
Tri-State Claims Management
   Tri-State’s “Best Practice” Philosophy
    – Return to Work Programs
        Workplace Injury Management is about returning
         employees to productive employment quickly and as
         safely as possible following a workplace injury.
        The object of a workplace Injury Management
         Program is to establish a system that achieves
         optimum results in terms of a timely, safe and
         durable return to work for employees following
         workplace injury
Tri-State Claims Management
   Insurer Quarterly Claims Review:
    – Claimant (Injured Worker) revaluation
      should include:
        Employee Profile
             Date of Birth
             Current Age
             Hire Date
             Job Position
             Compensation Rate
        Accident Investigation & Compensability
             Accident Date
             Date Reported to Employer
             Date Reported to Carrier
             Accident Description
Tri-State Claims Management
   Insurer Quarterly Claims Review (Continued):
     Medical & Disability Management
          Injury Description
          Attending Physician
          Estimated Future Disability
          Comments
     Litigation Management
          Employee Attorney
          Defense Attorney
          Status
          Comments
Tri-State Claims Management
   Insurer Quarterly Claims Review (Continued):
        Recovery Management
             Recovery Potential: Y/N
             2nd Injfury Fund / Other: Y/N
             Comments
        Action Plan and Resolution Strategy
             Comments
             Time Tables
             Follow-ups
Tri-State Claims Management
   Insurer Quarterly Claims Review (Continued):
     Financial Information
        Indemnity
        Medical
        Expense
        Total
             Incurred
             Paid to Date
             Outstanding Reserve
Tri-State Claims Management
      We need this type of service !
       Let’s contact Tri-State now!

Claims Management is Cost
       Management !
 Tri-State Claims Management
 Contact     Us
  – Phone:          212-619-0160
  – Fax:            212-619-1611

  • Phillip Bok, CPCU, CWCP, CFSA, CIPA, APA, ARM
    Vice President of Risk Management & Insurance

      “Your Complete Employers’ Outsourcing Solution”

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