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Tri-State Employer Services. “Your Complete Employers’ Outsourcing Solution” Claims Management is Cost Management A Claims Management Presentation By Tri-State’s Claim Management Department. Tri-State Claims Management. Risk Management Mission Statement

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tri state employer services

Tri-StateEmployer Services

“Your Complete Employers’ Outsourcing Solution”

Claims Management is Cost Management

A Claims Management

Presentation

By Tri-State’s

Claim Management Department

tri state claims management
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 liabilities.

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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 resources,
    • 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 companies.
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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 companies.
    • Be proactive in the development, implementation and management of rehabilitation and injury management policy programs for injured employees.
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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.
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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
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Tri-State Claims Management
  • Tri State’s “Best Practices” Philosophy:
    • Educate our clients on their roles and responsibilities.
    • 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.
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Tri-State Claims Management
  • Tri State’s “Best Practices” Philosophy (continued):
    • Claims Administrator constantly questions DOL (date of loss).
    • Client maintains a safe and healthful workplace.
      • Participates in Safety Assessments and hazard identification.
      • Reports all unsafe conditions to help prevent incidents.
      • Communicates, educate and dedicate.
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Tri-State Claims Management
  • Tri-States’ Partners (Clients) “Best Practice” Philosophy:
    • Training
      • Supervisors train new employees in proper procedures , equipment usage, reporting “near misses.”
      • 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 descriptions.
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Tri-State Claims Management
  • Tri State’s Partners (Clients) Best Practices (Continued)
    • Medical Control – select a clinic that:
      • Treats your injured workers promptly and respectfully
      • 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.
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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 practitioner.
      • Keep lines of communication open.
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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
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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
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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
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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
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Tri-State Claims Management
  • Insurer Quarterly Claims Review (Continued):
    • Financial Information
      • Indemnity
      • Medical
      • Expense
      • Total
        • Incurred
        • Paid to Date
        • Outstanding Reserve
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Tri-State Claims Management

We need this type of service !

Let’s contact Tri-State now!

Claims Management is Cost Management !

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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 Operations

      • pbok@tristatepeo.com

“Your Complete Employers’ Outsourcing Solution”