Workers' Compensation Claims Management

ESM Solutions, Inc.  provides the tools and training for employers to return an injured worker back into a productive team member. Many factors influence and impact the outcome of a workers’ compensation claim, which can be a time of discomfort and uncertainty for the employee, and requires additional time, effort and expense for the employer and coworkers. Easing the transition back to normalcy occurs when all Parties are given a clear understanding of the process and know what to expect. Our team provides you with expert advice focused on helping you make the most ethical, financial and legal decision when managing your Workers’ Compensation claims.

 
 

Why Claims Management

Aligning all of the Workers' Compensation stakeholders ensures maximum benefit. Here are just a few ways ESM has an impact on our client's Worker’s Compensation claims management:

  • Provide Workers’ Compensation technical expertise to employers
  • Facilitate ongoing communication between employer and insurance carriers/TPA
  • Interpret loss runs and other loss data
  • Establish action plans for the resolution of claims
  • Analyze claim statuses and critique carrier action plans
  • Analyze reserves for accuracy
  • Provide reports to employers regarding action plans and reserve recommendations
  • Analyze experience modification worksheets and complete X-mod projections
  • Strategize litigated claims for optimum resolution
  • Verify employer compliance with Workers’ Compensation requirements
  • Resource for Workers’ Compensation claims issues
  • Audit of Third Party Administrator
  • Supervisor Training
  • Create Essential Function Job Descriptions
  • Evaluate Medical Provider Network (MPN)

Critical Time Lines in Claims Management

Unit Stat Valuation

  • 18 months after inception of the policy
  • Annually thereafter
  • All claims are valued for use in the next year’s X-mod calculation
  • Open claims include paid and outstanding
  • The outstanding balance is negotiable

Renewal

  • Are the outstanding reserves accurate?
  • Is there any subrogation potential?
  • Any other pertinent underwriting information?
  • Are Safety issues addressed?
  • Is the Return-To-Work program implemented?
  • Has the Medical Provider relationship changed?
 

ESM's Claims Management Goals

  • Provide valuable oversight and direction with the claims administrator to ensure that the employer has the information and resources to make the best financial, legal and ethical business decision for the management of their Workers’ Compensation claims.
  • Empower the employer with assistance in best practices that will provide ownership and internal management of their Workers’ Compensation claims.
  • Act as an advocate for employer and liaison with the claims administrator to ensure that the claims are positioned for cost effective resolution and are accurately reserved.