It PAYS to Ask Questions.

It PAYS to Ask Questions.

The Story of a CLOSED Self-Insured Group (SIG)!

ESM saved a SIG’s members $21,000 by asking a simple question of the Office of Self Insured Plan’s (OSIP) chief. “WHY?”

ESM was successful in overseeing and directing the settlement by Compromise and Release of all remaining open claims that were in a private Self-Insured Group that had revoked their self-insured certificate.

This is the first revoked private SIG to have all claims resolved in the history of Self Insured Groups-since 1999.

There were 2 claims that had been settled by Stipulated Award with open future medical.  Since the future care did not include the need for surgery, the claims had been administratively closed after 2 years of no treatment. It had been 7 and 9 years, respectively, since any medical treatment had been provided on these 2 claims.

The Estimated Future Liabilities for both claims was $29,000. The SIG offered $29,000 for the OSIP to close out the SIG and to cover the potential exposure in the unlikely event that these claims would reopen.

The OSIP responded that they would accept $50,000 to close out the liability for the SIG. No explanation was given as to how the $50,000 amount was calculated.

“Why $50,000?”, was asked.

ESM had provided a thorough explanation and the basis for the offer of $29,000. This rationale was reiterated. The OSIP reviewed ESM’s rationale and approved.

  • Case closed.
  • SIG closed.
  • Members Happy.
Top 10 Claim Concerns Most Often Heard

Top 10 Claim Concerns Most Often Heard

New “Utilization Review” rules as of 1/1/18 to combat the rise in UR costs

New “Utilization Review” rules as of 1/1/18 to combat the rise in UR costs

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