We’re happy to introduce our Front Line Claims & Risk Services to small and medium businesses! These services will make available expertise which was customarily affordable to only large businesses! Now, small to medium sized businesses can count on the same expert coaching and expertise in both English and Spanish! We expect this service module to do well in Southern California!
Call us at (949) 830-2027 or email to glortiz@bmawest-msa.com
Question 1 – What do the following cities have in common?
• Atlanta
• Los Angeles
• Santa Monica
• Philadelphia
• Pittsburgh, PA
• Berkley, CA
• Marion County
• San Bernardino, CA
Question 2 – What do these two public entities have in common?
• Pittsburgh, PA
• Marion County
The answer to question number one is that these public entities are/were all suffering from the gross increases in workers compensation costs that threaten their very existence. The answer to question number two is very simple. These two entities took a proactive approach to reducing their workers compensation claims losses. While a few of these entities took the time and expense to audit their claims administration program, the most obvious course of action was overlooked – settle the claims.
Too many answers and not enough focus
A few entities on the list believed that enhancing their loss control procedures would help to alleviate their troubles. Another was focused on fraud. All audits did identify the same departments as creating the bulk of the claims – police, fire and public works. The most frequent and costly were the police and fire departments. The audits also identified issues with claims administration, training and labor unions. While these entities are correct in their findings, it’s a combination of all of these that create the multi-million dollar losses that threaten these and all public entities throughout the country.
Many contributing factors
There are other issues that directly impact claims costs such as the growing girth of aging
American workers, a decline in professional claims handling education and best practices, collective bargaining agreements and a lack of effective Early Return to Work (ERTW) programs. However, from a fiscal perspective, which is really what matters, the growing inventory of future medical and long term litigated claims are the culprits. The fact that the police and fire departments file an excessive number of claims is symptomatic of the employment culture.
Taking a proactive approach to claims
Pittsburgh and Marion County both recognized that in order to repair or preserve their entities and the tax dollars supplied by the people of their respective jurisdictions, they needed to cut long term costs such as medical and legal and reduce their reserve exposure. The only way to do this is by settling claims. In Pittsburgh, a massive audit into the finances of the city showed that 21% of workers comp payments in 2003 went to former employees injured over 20 prior. The restructuring plan devised for the City of Pittsburgh, entitled the Act 47 Recovery Plan, included the implementation of a workers comp claims settlement program. By settling out claims, the city would save millions in long term costs and reserves. The story was similar in Marion County, where reserves were reduced the following year by $2 million dollars. The realization being that legacy claims (cases over five years old) cases get worse with time and significant dollars can
be saved over time by ridding the claims inventory of the old dog files. It’s simply a numbers game. Forget the nature of the claim and focus on the numbers. If a claim can be settled for less than the total exposure, in spite of the issues of the claim, then a lump sum settlement should be pursued. Doing so can save thousands, if not, millions in
taxpayer dollars, medical expenses, legal fees and excess insurance costs. The effect of
proactive claims approaches such as this reverberates throughout a city, county or school district. There is a positive trickle-down effect for the public entity, and the taxpayers it serves. It’s a good business decision.
We’ve had the pleasure of working with public entities for the past thirteen years and have helped them close hundreds of claims by targeting certain claim types, valuating them and moving them into a settlement position. The use of structured settlement solutions have saved these same entities hundreds of thousands of additional dollars. A future medical claim settlement project should be no more complicated than that. Always remember that an injured employee would much rather have medical control over their injury, rather than waiting for his/her claim to come up again on an adjuster’s diary. Proactive is the word!
Medicare Compliance & Settlement Solutions 