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					Betty Arinder, Attorney – Wells Marble and Hurst, PLLC
Hal Caudell, District Manager – CorVel Corporation
Bob Fusinatto, Regional Claims Manager – Safety National Casualty Corporation
Steve Link, Executive VP of Marketing – Midwest Employers Casualty Corporation




                                             September 30, 2010
   Timely Report of Injury
   Investigate and Adjudicate
   Predict and Intervene – Right Resources at the
    Right time!
   Concurrent Reviews
   Analytics and Trending
   Impacting Outcomes
   Agent Reporting
    ◦ Why is the Center for Medicare Services (CMS)
      Requiring Reporting
   Complying with Medicare Mandatory Insurer
    Reporting Requirements (MMIRR)
   Identifying Authorized Representative,
    Account Manager and Account Designee
   Testing
   Going Live
   What are the CMS Requirements for MSA’s
    ◦ Claims estimated to settle for more than
      $250,000 when the beneficiary will become
      eligible for Medicare in less than 30 months
    ◦ Claims estimated to settle for more the $25,000
      when the beneficiary is already eligible for
      Medicare
   What about Liability Claims?
   Current Medicare Guidelines and Affect on
    Settlement Values
    ◦ Major Cost Driver’s – Pharmacy
      Real Life Example of MSA Impact:
        Lifetime Medical Treatment -         $22,528.08
        Lifetime Medicare Prescription -     $611,994.04
                                      Total   $634,522.12


   What Type Settlement Should I Pursue
   What Interventions/Options are Available
Top Five
   Explain workers’ compensation process to
    injured employee
   Employer: stay in touch with injured
    employee; re-assure of employment
   Adjuster: communication is key; prompt
    payments
   Explain choice of physician to injured worker
   Make sure that employee has clear choice
   Document choice
   Temporary
   Longer out of work, less likely to return
   Permanent
   Attorney represents employer, not just carrier
   Communication with adjuster and attorney
   Providing information and documents
    promptly
   You have more control
   Less costly than hearing
   More options for concluding; can be more
    creative
   Maintains relationships
 Reduces Direct Costs
  (losses)
 Reduces Indirect Costs (Lost
  productivity, increased labor
  costs, etc.)
 Reduces Excess Premium
  and Self Insured Retention
 Improves Employee Morale-
  Increased Productivity
   Investigation
   Medical Management
   Vendor Management
   Reserving
   Recoveries
   Return to Work – Settlement
   Supervision, Documentation, Action Plans
   Excess Reporting
   We Share the Risk of our Clients
   TPA “Quality is Critical to our own Mutual
    (Client/Excess Insurer) Success
   High Quality Claim Administrative Services
    Alone cannot Guarantee an Employer will
    Achieve Best Practice Results
   Best Practice Results can only be Achieved
    Through Proactive Employer Management of
    all Aspects of the Program
16%                                                              Average annual increase in WC medical
                                                                 severity from 1995 through 2008 was
                                                     13.6%       more than twice the medical CPI (8.1%
14%                                                                vs. 4.0%). New healthcare reform
                                                                   legislation is unlikely to have any
12%                                                                         impact on the gap.
                                     10.6%
                      10.1%
10%                                                                                 9.2%
                              8.3%                                                         8.6%
               7.4%                           7.3%           7.6%
 8%                                                                 7.2%
                                                                            6.2%
                                                                                                   5.8% 6.0%
 6%    5.1%

 4%                                                  4.6% 4.7%
       4.5%                                                                 4.4% 4.2%      4.4%
                                              4.1%                  4.0%              4.0%
               3.5%                                                                             3.7% 3.4%
 2%                           3.2% 3.5%
                       2.8%
                                                              Change in Medical CPI
                                                              Change Med Cost per Lost Time Claim
 0%
       1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Sources: Med CPI from US Bureau of Labor Statistics, WC med severity from NCCI based on NCCI states. Insurance Information
Institute.
Medical Distribution of Total Costs
                                                                            2008

                                   1998                     Indemnity
                                                               42%
                                                                                      Medical
                                                                                       58%

        1988           Indemnity
                          47%             Medical
                                           53%

            Medical
Indemnity    46%
  54%




                      Source: NCCI (based on states where NCCI provides ratemaking services).
  Medical Claim Cost Inflation
WC Insurers Experience Inflation More Intensely than
               2009, CPI Suggests




           Healthcare Costs Are a Major WC Insurance Cost Driver. They Are
         Likely to Increase Faster than the CPI for the Next Few Years, at Least

                               Source: Bureau of Labor Statistics; Insurance Information Institute.
          Obesity Trends* Among U.S. Adults
              BRFSS, 1990, 1999, 2008
             (*BMI 30, or about 30 lbs. overweight for 5’4” person)

                 1990                                                          1999




                                         2008




No Data   <10%      10%–14%    15%–19%       20%–24%       25%–29%         ≥30%



                                          Source: CDC Behavioral Risk Factor Surveillance System
   Questions?

				
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posted:1/24/2011
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