Stay at Work: A Practical Solution for Workers’ Compensation

Posted by Dr. Myra P. Keleher on November 15, 2016 at 9:23 AM

In workers’ compensation claims, the main objective for an employer is to return injured employees to work as quickly and safely as possible within their functional limitations through transitional work. Stay at Work (SAW) programs allow this to happen.

Managing Your Medical Providers for Workers’ Compensation

Posted by Jeffrey Thomas on October 12, 2016 at 12:00 AM

Workers’ Compensation Self-insurance: Avoiding the Pricing Pitfalls (Part 2 of 2)

Posted by Glenn Backus on October 4, 2016 at 10:03 AM

In last week’s PRIMA Blog, we explored unallocated expenses. In this blog, we will discuss allocated expenses. According to IRMI, allocated expenses (ALAE) are defined as loss adjustment expenses that are assignable or allocable to specific claims. Fees paid to outside attorneys, experts, and investigators used to defend claims are examples of ALAE. Municipalities typically entrust their TPAs to select vendors as needed to administer the claims. One common example of an allocated expense is bill review, which is used to reprice medical bills to fee schedule.

Workers’ Compensation Self-insurance: Avoiding the Pricing Pitfalls (Part 1 of 2)

Posted by Glenn Backus on September 27, 2016 at 10:15 AM

You have just concluded a rigorous request for proposal (RFP) process and selected a third party administrator (TPA) at a very good price, or so you thought. At the end of the three-year agreement, your average cost per claim is still increasing at a steady rate. But you have just negotiated a hefty reduction in the fee per claim you are paying. The medical network, utilization review and pharmacy vendors are all showing much-improved savings. At the end of the day, your experience modification (e-mod) has not improved and still remains at an unacceptable level.

Doing the "Right Thing" for the Claimant is Also the Most Cost-Effective

Posted by Fernando Branco on March 15, 2016 at 11:17 AM

Without a clear clinical picture, treatment decisions for workers' compensation cases are often difficult. Surgeries, spinal interventions, opioids, stimulators, or intrathecal pumps are not always the best approaches. They may cause physical deterioration and drastically increase our expenses. Here are some suggested alternatives:

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