SPECIAL INVESTIGATIONS The special investigations unit is a model for many insurance companies throughout the country. Staffed with six veteran law enforcement professionals skilled in investigative techniques, they obtain over 20 criminal convictions each year.A 24-hour fraud hotline is available for anonymous reporting of suspected fraud at 801-288-8140 or 800-446-COMP x8140. LEGAL SERVICES Our in-house legal staff is available to consult with adjusters on complex legal issues.
A D D I T I O NAL SERV I C E S MULTI-STATE CLAIMS HANDLING Out-of-state claims are adjusted thro u g h our subsidiary administra t o rs . Our mu l t i state claims director coordinates the cl a i m s handling between our T PAs and our c u s t o m e rs . L A N G U AGE SERV I C E S Our Spanish interpreter assists with telephone calls and personal contacts with Spanish speaking injured employe e s . We also contract with AT&T Language Line S e rvices to provide access to interpre t e rs f luent in over 90 language s . This allows us to provide the same excellent cl a i m s s e rvice to non-English speaking employe e s and employe rs . PAYMENT OPTIONS I n j u red wo rke rs can have their ch e ck s m a i l e d , p i ck them up at our Salt Lake o ffi c e , or re c e i ve them direct deposit
INTERNET SERV I C E S ELECTRONIC CLAIM FILING For immediate claim filing, use our secure, online form on our web site at www.wcf-utah.com ACCESS TO CLAIMS INFORMATION To help you monitor and control claims costs, you can access claims data and loss runs on our web site.You also have the ability to print loss ru n s ,c e rt i ficates of insurance, and update OSHA logs. • For more info rmation or to re c e i ve a password call 801-284-8919.
Corporate Offices
392 E.6400 S. Salt Lake City, UT 84107 801-288-8328 800-446-2667 www.wcf-utah.com
Ogden Office
472 S.Harrison Blvd,#201 Ogden,UT 84403 801-476-2400 800-611-4550
St. George Office WCF will continue to pursue inno vative solutions to meet the evolving needs of you and your employees.Our management and employees have a strong commitment to con tinually improve our claims management, resulting in cost savings to you.
134 North 200 East,#101 St.George,UT 84770 435-652-5000 800-324-9470
C L A I M S M A N AG E M E N T S E RV I C E S
When an employee is injured on the job, we are here to help. WCF implemented the following claims services to ensure you and your employees r e c e ive t he highest quality workers’ compensation care.
CLAIMS HANDLING STA N DA R D S KEY CONTACTS Once a lost-time claim is received, your adjuster contacts you, our customer, and your injured employee within 2 business days, and medical providers as needed.The adjuster stays in close contact with your injured employee, you, and the physician until the injured employee returns to work and completes treatment. This can include phone contacts,personal meetings and written status reports. PAYMENT STANDARDS Once liability is accepted, injured employees’ benefits are paid promptly. • 88% of injured workers’initial compensation payments are made within 21 days. • 97% of provider payments are made within 30 days. QUALITY ASSURANCE Files are audited by experienced claims managers to ensure accuracy and compliance with WCF’s high standards.15% of all new losttime claims are reviewed. EMPHASIS ON SUBROGATION In 1998,WCF formed a subrogation unit to aggressively pursue recoveries against liable third parties. • With this implemenation we are exceeding the industry standard recovery rate.
M A NAGED CARE PROGRAMS A major goal at WCF is to provide injured employees with top quality medical care while containing costs. • Our managed care programs save over 28% of benefits paid. PROVIDER BILL REVIEW Our medical bill review unit analyzes every bill and the doctor’s notes,to make sure appropriate codes are used and payments are made according to the Utah Labor Commission’s Fee Schedule.They also conduct billing procedure training within the medical community. PREFERRED PROVIDER ORGANIZATION (PPO) Our PPO network provides broad geographical coverage through Intermountain Health Care (IHC),the University of Utah Hospital,WorkMed and other IHC urgent care facilities. These facilities have agreed to provide excellent care at a significantly lower cost. PRESCRIPTION DRUG CARD PROGRAM Implementing our prescription card program in 1993 significantly reduced prescription costs. Injured employees are provided a card to use to obtain injury-related medication. UTILIZATION REVIEW Registered nurses and physician consultants offer proactive reviews of in-patient hospitalizations and many out-patient procedures.
EXPERIENCED CLAIMS ADJUSTING STA F F WCF’s adjusters are among the most educated and well respected in the industry. Senior adjusters average 10+ years of experience in managing claims. MANAGEABLE ADJUSTER CASELOADS To efficiently investigate and manage claims, adjusters need time to work with the employer, injured employee, and physician. We reduced caseloads to an average of 110 per adjuster,50 to 100 cases less than industry average. SINGLE POINT OF CONTACT You will be assigned a personal adjuster who is able to analyze your company’s accident trends and suggest ways to reduce injuries and claims costs. Your adjuster can provide assistance in selecting company clinics and modified duty programs. • 1992 - 2000 lost-time claims decreased by 31% • 1992 - 2000 compensation payments were reduced by over 38%
MEDICAL CASE MANAGEMENT Our medical case managers are registered nurses with specialty certifications in disability and rehabilitation. They provide on-site evaluation of the injured worker’s situation and coordinate with health care providers to facilitate reco very and return to work. We also have a specialized catastrophic claims team to monitor employees with catastrophic injuries. VOCATIONAL REHABILITATION Vocational rehabilitation counselors coordinate with employers and physicians to verify work capabilities and assist with job modifications enabling early return to work.They also conduct seminars and assist employers in developing their own return to work programs. • By using in-house medical case management and vocational rehabilitation we save millions in administrative costs.
A D D I T I O NAL RESOURCES STATE-OF-THE-ART CLAIMS MANAGEMENT SYSTEMS WCF’s document imaging system eliminates service delays caused by paper processing, enabling immediate response to questions. TRAINING AND CONTINUING EDUCATION Each adjuster must successfully complete an intensive initial training program. They also continually participates in advanced classes taught by our in-house training staff and local experts.