A school system, originally on a Guaranteed Cost policy, moved to a Large Deductible policy to obtain additional premium savings. In the first year of their Large Deductible policy, claim costs decreased by 62% and claim count decreased by 39%. This organization’s success can be attributed to strong management commitment to safety, implementation of crucial safety programs including Post-offer Medical Questionnaires, and a strongly enforced Early Return to Work program.
With a Large Deductible policy, our team at Synergy works in close conjunction with the employer to keep all parties informed and up-to-date on claims. This includes areas such as:
- Regular claim reviews
- Consultations on establishing reserves
- Settlement of claims
- Assignment of 3rd party vendors
Why choose our Large Deductible program?
- Cost Savings. Workers compensation premium is significantly discounted and employees remain fully insured.
- Flexible Products. Choose the premium and deductible level that best fits your organization. Deductibles range from $10K to $1M, with A rated carrier options available
- Quality Service. Aggressive claims management, combined with constant collaboration and communication with the employer, ensures satisfaction among all parties involved.
The cost of a workers’ compensation claim goes beyond medical and claim costs. If a workplace injury occurs, your organization’s Experience Modification Rate (EMR) is negatively impacted, affecting your workers’ compensation premium for the next three years.
One way to control workers’ compensation costs is to hire appropriate candidates with the use of Post-offer Medical Questionnaires.
Learn more about Post-offer Medical Questionnaires in our webinar here.
With increasing medical expenses in the workers’ compensation industry, how is Synergy Coverage Solutions working proactively to control medical costs?
- Medical billing is handled in-house, giving us the ability to examine every medical bill, line by line, and only approve appropriate expenses (oftentimes, medical billing is outsourced and bills are paid without question).
- Payment representatives are fully informed of individual claim details, offering a full perspective of the claim, rather than a segmented view.
- Our network of medical providers deliver effective care at reduced prices and are informed of our Return to Work procedures. When injured workers receive appropriate care, they are able to reach maximum medical improvement and return to work in a shorter time period.
- Pharmacy network discounts are equal to wholesale costs.
- Our 24/7 Nurse hotline connects employers and the injured worker to qualified nurses who can direct appropriate care over the phone, reducing doctor visits, time away from work, and unnecessary medical expenses.
- Internal Nurse Analyst ensures injured workers are receiving effective care using the most cost-effective approach, proactively avoiding complications, and returning injured employees back to work as soon as medically appropriate.
- Average medical costs are reduced by more than 50% of the original billed amount.
Synergy’s medical cost containment programs are just one of the many benefits we are able to provide for our Policyholders. We remain dedicated to staying at the forefront of the industry and delivering quality programs that add value to our workers’ compensation services.
When claims are effectively managed by the insurance company, employers can experience significant savings through a reduction of their Experience Modification Rate. Below is an example of a case managed by Synergy Coverage Solutions which resulted in an estimated $100,000 savings in additional workers’ compensation costs. How did just one claim make such an impact on the employer’s bottom line?
An employee had injured her back at work and filed a claim, which was deemed compensable. It was initially determined, by the claimant’s general physician, that surgery would be required; the claimant received a 2nd opinion also recommending back surgery. However, Synergy’s Claims Adjuster received two additional opinions, both stating surgery was not required. The claimant later decided to undergo back surgery. The claimant requested compensation for lost wages, medical treatment, and surgery costs with estimated total costs of over $200,000. Who was responsible for coverage?
In this situation, Synergy denied coverage because surgery was not authorized. The North Carolina Industrial Commission ruled in favor of the employer and Synergy. The conclusions of law set forth by the North Carolina Deputy Commissioners were as follows:
- Synergy Coverage Solutions and the Employer have the right to direct medical care
- Synergy Coverage Solutions and the Employer are not responsible for unauthorized medical treatment. The surgery was not authorized because it occurred one year later and two medical providers had advised against surgery.
Aggressive claims management and focus on cost containment improved the employer’s Experience Modification Rate. The decrease of loss reserve directly reduced their Experience Modification to such an extent that the employer will experience a workers’ compensation premium calculation reduction of at least $100,000 over the next three years. Synergy Coverage Solutions is focused on providing strong claims management as it allows our employers to experience significant workers’ compensation savings over the long term.
Synergy Coverage Solutions is committed to superior service and innovative solutions. To honor our pledge in delivering quality customer service, Synergy has implemented a personalized “Welcome Call” to all Policyholders to serve as a brief introduction and answer any questions our Policyholders may have.
What’s the purpose?
- A personalized approach to introducing Synergy Coverage Solutions
- A method to start the partnership in a successful manner: reviewing helpful information and procedures before an incident occurs
- Assistance in signing up for access to Synergy’s Online Service Center account
What can Policyholders expect?
- An overview of claim reporting procedures
- Support in selecting medical providers that are in-network so injured employees are able to receive effective medical care at discounted rates (if not previously selected)
- An introduction to their Customer Service team (Claims Adjusters, Loss Prevention Consultant, and Billing Representatives)
What’s going on behind the scenes?
- Policyholders’ preferred medical providers are obtained and contacted to inform them of the employer’s Early Return to Work program, Post-Accident Drug Testing, Pharmacy Approved Medications list, and billing instructions.
- If preferred providers are not in-network, they are nominated for inclusion in our medical network to help Policyholders reduce costs, but also keep the providers they are comfortable with.
Synergy Coverage Solutions is dedicated to delivering the highest standard of quality service. Our Welcome Call has two main purposes – to give our Policyholders peace of mind and control over their workers’ compensation costs, and to help Medical Providers understand our expectations. This open communication aids Synergy in proactively handling claims and controlling medical costs, the largest driver of workers’ compensation claims costs.
When one door closes for an employer, Synergy finds a new way to open a window. We have all seen it in the marketplace – appetite changes lead to non-renewals or poor loss experience leads to high premiums in the state assigned risk pool.
How is Synergy able to see windows of opportunity in difficult situations? Our Underwriting team looks beyond the surface to determine:
- How we can improve losses
- The silver lining for the class of business
- The employer’s willingness to share in the risk
- Potential long-term programs that have historically helped similar employers succeed
An Employer’s Success Story: From Assigned Risk to Model Employer
Five years ago, we took a chance on an account with a history of tough losses and no coverage options since the incumbent carrier stopped writing their class of business; the account was destined for the assigned risk program. Because the employer presented a renewed commitment to improving loss experience and Synergy was willing to fill a need in the market for this class of business, we decided to offer a solution which included a Dividend Program that would serve as an incentive to help the employer become more engaged in their safety goals.
Our Loss Prevention Consultant worked consistently with the employer to implement and improve necessary safety programs through education and training. The programs initially implemented were basic, but emphasis was placed on making sure that the programs were being used properly and effectively.
Due to the customized service provided and the dividend incentive program, the employer’s results improved and they gained a new perspective on safety. In fact, at our recommendation, they hired a Safety Director who is implementing Post-offer Medical Questionnaires and considering other Best Practices pertaining to Hiring. Through the employer’s renewed sense of confidence, they were able to advance to a Large Deductible program this July, benefiting from lower premiums while still experiencing a high level of service from Synergy Coverage Solutions.
As a workers’ compensation specialist, it is our goal to work with employers to improve their loss experience while giving them the tools and resources to be successful. This is just one example of how Synergy was able to develop innovative solutions for our employers. Our products—from small business, to dividend programs, to multiple deductible options—allow employers to have options as they continue to evolve. What challenge can our Underwriters help you overcome?
Synergy Coverage Solutions’ recent settlement of a claim involving a back injury was reduced by $70,000 due to information gained during our aggressive claims investigation. Upon injuring her lower back while picking up a patient, the claimant underwent back surgery and was determined to have permanent work restrictions. Her employer was able to accommodate her work restrictions; however she chose to resign from her position due to unrelated medical complications.
Initially, her attorney demanded a settlement of $90,000, taking the stance that the claimant was permanently and totally disabled. However, upon deeper investigation of the claim, our Adjuster discovered the claimant had just returned from a trip involving high physical activity, rendering the permanent and total disability claim false. Synergy was able to provide evidence that the claimant was not actually disabled, which lead to a $70,000 reduction in settlement.
Synergy Coverage Solutions prides itself on diligent and aggressive claims investigation. Our Claims Adjusters take control of the situation, researching and obtaining details through a variety of resources; in this situation, finding evidence that the claimant was able to participate in high levels of physical activity while on vacation helped us construct a strong legal argument in the case.
Synergy Coverage Solutions has been in the workers’ compensation industry for nearly 10 years. In a special series called “Synergy Moments,” we would like to share the situations that capture the true collaborative nature of our business.
In our most recent Synergy Moment, one of our Claims Adjusters noticed a reoccurring injury claim. Our Adjuster had received several claims from the employer in which employees cut their hands on glass or blades while handling trash. As our Adjuster was able to note and recall the frequency of these particular injuries from this employer, he notified our Loss Prevention team and brainstormed ways in which this frequent injury could be avoided. By utilizing special gloves while handling trash, cuts and scrapes would be prevented. Isn’t the cost of protective gloves worth the spend to reduce employee injuries, as well as claims costs, in the long run?
In a recent Claims Success Story, Synergy used medical canvassing to uncover a claimant’s past medical history and ultimately settle the case in our favor. An employee filed a workers’ compensation claim, alleging he injured his back when lifting an apparatus at work the previous week. While investigating the claim, our Adjuster used medical canvassing to retrieve prior medical records showing the claimant was receiving medical treatment for his back weeks before the alleged work incident. Additionally, a written witness statement revealed the claimant complained about back pain when he was new on the job, stating the pain was not work-related, but stemmed from a car accident a few years ago in which back surgery was required. The medical canvas, combined with the witness statement, helped Synergy prove that the compensability of the claim was questionable.
In this situation, Fitness for Duty assessments would have been extremely beneficial for both the employer and the employee. These assessments are used to determine an employee’s risk of injury while carrying out typical job duties. Had these fit-for-duty assessments been completed, the results may have revealed that this individual would have an increased risk of injury due to his previous back surgery, and would not be a safe candidate for hiring in this particular position.
Synergy Coverage Solutions is dedicated to helping employers control workers’ compensation costs and investigating every claim thoroughly for compensability. To learn more about hiring practices and Fitness for Duty testing, click here or contact us by email here.
Including background checks in your company’s hiring practices is a smart business decision, as it is one step you can take to minimize the risk of a bad hiring decision. How will employers be able to tell if a future employee will be a valuable asset, or a big liability? Hiring an individual who is not appropriate for the job can lead to increased business costs, lost productivity, and damage to your company’s reputation, among other issues.
What are the major benefits of performing background checks on prospective employees?
- Protection of your company and employees from potential theft, workplace violence, closure, and other legal issues
- Preservation of your company’s image and reputation – staff is a direct reflection of your company
- Controlled workers’ compensation costs: 13% of workers’ compensation claims are fraudulent (exaggerated, fake, or old injuries), leading to higher workers’ compensation premiums and less productivity
- Clear separation of trustworthy job applicants from those that are dishonest on their resume, as 50% of resumes contain false information
- Completing a background check is less expensive than dealing with disruptions in the workplace, liability and legal issues, financial loss, decreased productivity, turnover, etc. Even a simple internet search can convey valuable information about prospective employees (and public records that may include driving records, criminal records including wants and warrants, sex offender records, court records, and various licenses including professional and business licenses).
Including background checks can help prevent bad hires and avoid problems that may be caused by hiring an individual that is not suitable for the job. Hiring the wrong person can cost employers tens of thousands of dollars…isn’t a background check a valuable investment to ensure your organization is hiring an individual that is the right fit for the job?