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Changing your Workers’ Compensation Insurance provider will cost money and time.  Not only will you need to spend time researching your options, but you will also probably end up spending more time answering employees’ questions. One way to save money on Workers’ Compensation expenses is to develop a strong long-term relationship with your third-party administrator (TPA).

A competent TPA can help lower your worker's comp insurance cost

The best TPAs have strong medical management skills that allow them to control the medical cost of your claims and work in conjunction with workers’ compensation adjusters.

Before hiring a TPA, ask which of the following techniques they use to control medical costs:

• Telephonic nurse case mangers (TCM) or Field nurse case managers (FCM) – experienced nurses help coordinate and manage the medical care of an injured employee, including consulting with physicians; providing frequent updates to the adjuster; and facilitating communicate between the employee, employer, and physician.
• Senior nurse reviews – a highly experienced nurse who provides continuous oversight of medical care, identifying recovery obstacles early in the claim.
• Utilization reviews – provides an independent confirmation that medical services are necessary with a pre-certification review, a concurrent review, and/or a retrospective review.
• Medical bill reviews – reviews and verifies the accuracy of the diagnostic codes and charges.
• Prescription management – helps ensure the best prices and the prevention of overutilization of drugs.
• Physician review – If an injured worker isn’t responding to medical care within the normal recovery time, a specialist can evaluate and document the past, current , and future medical treatments.
• On-site clinics – a medical clinic located on an employers’ worksite can reduce the cost of medical care for both personal and work-related injuries and illnesses.
• Injury triage – a triage nurse evaluates the injured employee’s needs and directs them to the most appropriate medical providers within the network.
• Wellness programs – a company sponsored wellness program lowers the cost of health insurance and the cost of workers’ compensation costs, lowers absenteeism, and increases productivity.
• Preferred provider networks – a network of doctors, hospitals, diagnostic facilities, and other medical providers that have agreed to provide medical services at a reduced cost to injured employees covered by workers’ compensation insurance. 

Get educated and lower your Workers Comp costs!

• Become more informed about the services offered by your claims administrator. Ask for samples of reports and deliverability’s. Read through their brochures and ask lots of questions.
• Visit one or two of their claims offices and learn their processes. Find out if adjusters have backup or clerical assistance. Watch the process as a medical bill enters the system through to the time that it is paid. You’ll have a better understanding and appreciation of how they work and how you can work with them more efficiently.
• Educate your adjusters on your business. Invite them to come in and see what your business does, the kinds of jobs and skills your employees have. This will help them understand better how an injury can occur. This may also allow them to offer more possible transitional duties for injured workers.

Need help finding a good TPA?

Amercian Insuring Group can help you find the right TPA for your organization. We can also help you find the best Workers Compensation Insurance coverage. That's because as independent agents, we're free to shop among competing insurance providers to find the best workers comp insurance to meet your unique needs at the best price.

Give us a call at (800)947-1270 or (610)775-3848 or click here to contact us. 

Fraud, waste, and abuse continue to drive up the cost of administering workers’ compensation programs. Workers’ compensation fraud, which accounts for approximately one-quarter of all insurance fraud, comes in all forms: injury while off work, multiple claims, injury concurrent with termination, and many more. 

Workers comp insurance fraud is a crime. Tens of billions of dollars in false claims and unpaid premiums are stolen every year.  Scams are increasing the cost of insurance premiums — draining business profits and costing honest workers their pay and their jobs.  In addition, these increasing costs are being passed on to you as a consumer with higher prices at the cash register.

Medical Records Investigations: Cost Effective Sleuthing to Cut Workers Comp Insurance Costs

Aggressive pursuit and investigation of fraud can help lower the financial impact of workers’ compensation on businesses. If you’re willing to do a little sleuthing, there is one interesting method of reducing workers’ compensation fraud in your business - the use of medical records for investigation.  This method is often more cost-effective and less expensive than many of the more formal investigative tools.

Where should you look?

There are a few things to consider if you decide to use medical records to investigate a workers’ compensation insurance claim. 

1. Start at the beginning. Using this investigative technique at the onset of a claim allows you to better monitor treatment trends and develop a better understanding of the case.  It’s important that you get ahead of the case before it becomes too complicated.
    
2. Start with primary care providers.  Records from a primary care provider will often provide a good overview of a person’s health, including yearly physicals. 
    
3. Don’t overlook urgent care clinics.  In addition to checking the records of your local emergency rooms, you should also take a look at urgent care facilities in the vicinity of where the claimant both lives and works.  Urgent care facilities are on the rise.  They provide a more affordable option to health care for people who don’t have medical insurance, and they offer access to medical treatment for injuries that occur after hours or on the weekend.
    
4. Look at other medical facilities.  In today’s health care environment, proper treatment often requires a visit to a specialist.  Specialists can also provide information about underlying conditions.

What should you look for?

Here are a few of the “red flags” you should look for in an investigation of medical records:

1. If a claimant receives medical care and/or treatment at more than one facility in one day.
    
2. If a claimant sought medical treatment on a Monday morning or after a holiday, it could indicate that an injury took place over the weekend or during a holiday – and not in the workplace.
    
3. If a claimant received treatment and/or referrals from providers that share common waiting rooms or are located in adjoining buildings.
    
4. If a claimant has a medical appointment while he or she is out of town or on vacation.
    
5. If a claimant receives medical care on a weekend, holiday, or during inclement weather.
    
6. Look for evidence that the medical records have been changed or altered, or if they aren’t consistent with what the primary doctor is recommending. 

Be Proactive and Increase the Odds of Cutting Your Workers Comp Insurance Costs!

Today, you need to be proactive if you want to limit the amount of fraud, waste, and abuse within your business’s workers’ compensation programs, and medical record investigation may be one method to consider for your business. 

For additional methods to reduce the cost of workers’ compensation, including getting the best rate on quality workers comp insurance, contact us at (800) 947-1270 or (610) 775-3848. We're independent agents with the power to lower your worker's comp insurance costs by offering policies from multiple competing insurance providers, so you'll get the best insurance at the best price.

Yes, Workers Compensation Insurance Can be Costly, but Don't Cheat

Providing workers compensation insurance for employees can be a significant expense, especially in industries prone to serious injuries, such as those requiring heavy or potentially dangerous machinery.  While some employers may be tempted to misclassify workers as independent contractors rather than as employees in order to avoid worker’s comp insurance and other costs, the penalties for misclassifying employees as independent contractors can be severe.

IRS Guidelines for Determining Independent Contractor Status

According to the IRS:

You are not an independent contractor if you perform services that can be controlled by an employer (what will be done and how it will be done). This applies even if you are given freedom of action. What matters is that the employer has the legal right to control the details of how the services are performed.  

Consequences of Treating an Employee as an Independent Contractor

If you classify an employee as an independent contractor, whether to avoid workers compensation costs or purely by accident, and you have no reasonable basis for doing so, you may be held liable for employment taxes for that worker as well as incur severe penalties. See the IRS guidelines for determining employee vs. independent contractor status for more information. 

Some Common Sense Guidelines for Determining Independent Contractor Status

While the IRS provides detailed guidelines for determining independent contractor status, it may be helpful to consider how one state simplified the criteria. New York State noted these requirements to be eligible for independent contractor status:  

• Advertising
  Has his/her own advertising (business cards, commercials, phone book listing, etc.)
• Authority
  Performs work via his own contract, permit, or authority
• Control
  Controls the manner and time for work performed
• Different Work and Customers
  Performs work that differs from the primary work of the hiring business, and performs work for other businesses
• EIN or Business Tax Return
  Has a Federal Employer Identification Number (EIN) from the Federal IRS or has filed federal business or self-employment income tax returns for work or services performed in the prior calendar year
• Equipment
  Provides all equipment and materials needed to perform services under the contract
• Liability Insurance
  Has liability insurance (and if appropriate, has worker’s comp and disability insurance policies) under its own business name and Federal EIN
• Obligations
  Has recurring business liabilities and obligations
• Profit & Loss
  Operates under a specific contract, is responsible for satisfactory performance of work, is subject to profit or loss in performing the specific work under such contract, and is in a position to succeed or fail if the business's expenses exceed income
• Separate
  Maintains a separate business establishment

For most small businesses, workers compensation insurance costs can eat up a fair percentage of their income. While this type of coverage is essential, especially for riskier professions, there are a few ways to minimize your workers comp insurance expenditures without sacrificing the level of coverage necessary for your enterprise.

Here are some helpful tips to keep your costs under control:

Correctly classify your employees

Take a look at what you are paying in workers comp insurance per employee, and then ask yourself if all of these employees require the same level of coverage in relation to the riskiness of their profession. For instance, a typical office manager is far less likely to require workers compensation payments than a typical carpenter. Most workers compensation insurance companies charge different rates for these professions accordingly, so make sure that you aren't being overcharged for workers compensation insurance that you don't need. 

Familiarize yourself with relevant OSHA safety standards, and train your employees accordingly

As they say, an ounce of prevention is worth a pound of cure. OSHA regulations exist for a reason, and one should always be careful about staying within the letter of the law in this matter. If you are unsure of the relevant standards, your local OSHA safety office can offer clarification. Make sure that your employees are well aware of their rights under OSHA statutes, and what they need to do in order to remain compliant. A workforce that is familiar and compliant with the basic safety standards of their industry is one that is less likely to utilize workers compensation insurance over the course of their tenure.

Ensure that all tools, equipment, and grounds are safe/in good working order

Make it a point to periodically check any motorized tools for dirt, debris, or other potential hazards, and have your employees periodically check things like brakes, fluid levels, and other vehicular aspects that can potentially pose a safety hazard if not up to par. Your workers compensation insurance is less likely to be needed if all tools and vehicles are in proper working order, so make sure that your employees understand that it is part of their regular work duties to clean, maintain, and lubricate their tools, vehicles, and work stations alike. You should also make sure that any physical grounds (such as your office, parking lots, and walkways,) are easy to access, free of debris, ice, or snow, and are as safe as possible. Workers compensation insurance will need to be tapped into if someone hurts themselves while on your property, so bear this in mind as you go!

Address claims quickly and compassionately

Whenever the unthinkable happens despite the best laid  plans, you can help to minimize the impact on your workers compensation insurance rates in a number of different ways. Make sure that the employee gets the medical help they need immediately, and make sure that their expenses are paid accordingly. Minimize the need for lawyers to get involved, make it as easy as possible for the employee in question to recover and return to work, and show genuine concern all the way through. This should help keep your workers compensation insurance rates reasonable throughout the life of your business.

In short, make sure that you look over your workers compensation insurance rates closely, itemize what you are paying per employee and why, and take all necessary steps to help your employees realize that their safety is priority number one!

Need help with reducing workers compensation costs? Contact American Insuring Group today to learn more.

Workers Compensation Insurance - A Potential Minefield

Purchasing workers compensation insurance can be a potential minefield for some businesses, who often don’t know where to start and can feel like they’re going in blind without a workers comp specialist to guide them along the way. It can seem like a daunting, upward struggle, especially since some insurance companies and agents won’t even consider writing workers compensation insurance – and they have their reasons - but with the right insurance broker, applicants can get through the process scratch-free. 

Choosing the Right Insurance Broker

It’s also important to note that purchasing workers compensation insurance from a business insurance agency with several markets available, is the best way forward for business owners looking for this type of insurance. At American Insuring Group LTD, we represent a number of A rated insurance companies that specialize in Workers Compensation insurance.  

Never Let Your Workers Compensation Insurance Lapse

The most important thing for business owners to remember is to never let their workers compensation insurance lapse, as that could lead to disastrous results. Although financial issues may seem dire, it’s likely clients will pay the price if they let their workers comp lapse, in the form of considerably higher premiums on re-application. The other obvious advice is to always pay premiums on time, as late payments could cause standard carriers to write off a client with a non-renewal notice – almost as bad as a lapse in coverage.

Re-application

If workers compensation insurance is allowed to expire and business owners go through the re-application process, they should be aware it’s not going to be easy – they’ll likely be bombarded with seemingly endless documentation in order to explain the expiration in the first place. Anyone finding themselves in this situation would be wise to save their sanity and consult an insurance broker or expert to help get them through the paper trial and advise them on the situation.

Claims can also be an issue. If a business has filed numerous claims with an insurance broker, then they are likely to get issued with higher premiums; that’s just the way insurance, as a whole, works.

Conclusion

When applying (or re-applying) for workers compensation insurance, business owners should work closely with an insurance broker. Ask questions, and be sure to find a broker who instils confidence. One last thing to bear in mind is the fact that all workers comp quotes are custom, with no ‘big rate books’ like the ones life insurance agents are familiar with. 

Get Help with Workers Comp Insurance

Have additional questions about workers compensation insurance? Contact us, or request a free, no-obligation workers compensation insurance quote. We'll compare policies and prices from competing carriers to make sure you get the right coverage at the right price.