Posts Tagged ' claims management'

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‘Aggravated’ is Only Half the Story

Written by on 5/21/2018 7:15 AM in , , , . It has 0 Comments.

What Went Wrong?

According to Minnesota’s work comp laws, you can get your experience mod corrected, but only if you can figure out what went wrong in the first place. The so-called “Aggravated Inequity” rule allows you to get an updated mod, but only if 3 things happen first:

  1. An open claim on the experience mod closes between valuation and your renewal date
  2. The claim results in 5 point or greater improvement to your experience mod
  3. The carrier issues new stat cards to the rating bureau

The rating bureau then uses the updated information to issue a new mod.

How You Can Get Your Mod Corrected

  1. Determine your valuation date(s); you may have more than one if you’ve changed renewal dates
  2. Review open claims and identify potential candidates for aggravated inequity – anything that might close after valuation
  3. Continue to monitor and follow up with the adjuster on open claims, at least once per month, following valuation
  4. Submit proof to the insurance carrier that the claim has closed between valuation and renewal and will impact your mod by at least 5 points

The carrier will then issue new stat cards to the rating bureau, and the rating bureau will send you a new mod.

It’s not the responsibility of the insurance company to know when your experience mod is being calculated. If you want a new mod, it’s up to you to go get it. This is why it’s so critical to have someone reviewing open claims, working to get claims closed, and calculating the impact on your experience mod.

See Rule 4 of the Minnesota Experience Rating Plan Manual for more details about the statute.

 

 


Catastrophic Workers Comp Insurance Claims - Top Tips for Controlling Expenses

Written by on 12/6/2017 1:22 AM in , , . It has 0 Comments.

When workers suffer serious, debilitating injuries in the workplace, they’re able to file catastrophic claims. Since these cases often involve long-term or even permanent disability, it’s important for managers to understand how to handle them and how to reduce costs. Our workers comp management consultant offers the following tips on keeping expenses under control.

Watch for Red Flags

Clinical care coordinators who are involved with catastrophic claims cases should watch for red flags on a regular basis. These include physical signs of potential problems, such as unusual weight loss or weight gain, or skin problems. Coordinators should also watch for signs that employees who were seriously injured aren’t adhering to care instructions, since this could prolong the amount of time they’re out of work and lower their quality of life.

Consider Comorbidities

Factors such as age and weight can affect the length of time that workers need to recover and the severity of their injury. Those who handle catastrophic claims cases should take these factors into consideration in order to ensure that workers get the care they need after being seriously injured.

Get Early Notification

Getting notification early, such as when the injured worker is still in the hospital, allows the catastrophic claims team to ensure that proper care is provided. This might mean putting together a coordinated care team that has the expertise needed to help the injured worker make a full recovery.

If you need help with workers comp issues, please contact Minnesota Comp Advisor. We’ll provide you with assistance from a workers comp management consultant, so your company can keep expenses low while also ensuring that employees receive fair compensation for injuries.