Category Archives: Agents

Synergy…Working Together to Prevent Injuries

Synergy often utilizes communication between our Claims and Loss Prevention departments to enhance our customer service and experience.  Recently, a Claims Adjuster recognized a dangerous machine guarding situation while reviewing a minor claim generated by a near-miss (stemming from improper machine guarding).  Immediately, the Claims Adjuster communicated the cause to one of our Loss Prevention Consultants.  With this information, Loss Prevention was able to schedule a safety meeting with the organization and assist with corrective action to prevent future, perhaps more serious, injuries.

While this may sound like a simple occurrence, this is just one example of how Synergy goes above and beyond to protect our policyholders.  Because we are big believers in effective communication and collaboration, the way we do business only offers an even more enhanced effect for our customers.

To learn more about our Loss Prevention services, please visit www.synergyinsurance.net or contact us at info@synergyinsurance.net.

Accident Investigation and Aggressive Claims Management Leads to Positive Outcome from the NC Industrial Commission

Synergy Coverage Solutions is committed to providing extensive loss prevention services and aggressive claims management.  The workers’ compensation industry is surrounded by exaggerated and fraudulent claims; therefore it is of utmost importance for an employer to have an accident investigation program in place and conduct an accident investigation immediately following any alleged injury (accident investigations also offers insight so a similar or more disastrous accident may be prevented).  In the same way the employer conducts the accident investigation, the workers’ compensation service provider must begin a thorough claims investigation to research and piece together all details of the claim.

A recent claim handled by Synergy Coverage Solutions demonstrates the importance of timely accident investigation and aggressive claims management, resulting in a positive ruling for Synergy Coverage Solutions and the employer by the North Carolina Industrial Commission.  In summary, the claimant was working when she was unable to exit a room due to a door jam.  She was eventually instructed by the custodian to exit via the first floor room window, 40 inches from the ground, and use a ladder on the outside of the building to reach the ground.  The claimant contends she suffered neck and low back pain from climbing out of the window and lowering herself onto the ladder on the outside of the building.

Typically, the NC Industrial Commission is favorable towards neck and back claims.  However, in this case, Synergy’s aggressive and diligent claims investigation lead us to the decision to challenge the way the commission typically rules, based on the detailed facts gathered in the investigation.  After reviewing medical records from the claimant’s doctor (who had performed surgery from a prior incident involving a neck injury), and reviewing the employer’s accident investigation information, the Claims Adjuster denied the claim based on the conclusion that the pain and treatment received was not a direct or natural result of, or causally related to the incident.  The North Carolina Industrial Commission concurred with Synergy’s decision and upheld the denial.  The Commissioner’s opinion indicated that to be compensable, an injury “must result from an accident, which is considered as a separate event preceding and causing the injury; the mere fact of injury does not of itself establish the fact of accident.” 

Working with the employer, Synergy took a decisive, yet fair, stance after gathering all the details regarding the incident.  The employer’s ability to complete a thorough and timely accident investigation helped build a strong representation of the incident.  The employer was able to identify and gather detailed statements from witnesses in a timely manner, so the details from the incident were not lost, but easily recalled.  A tool that our competitors don’t typically use is obtaining information on past medical treatment.  Synergy Claims Adjusters are trained to think creatively, and out-of-the-box, to gather details that paint a clearer picture of the alleged injury.  Our Adjusters obtain information through a variety of resources; in this situation, prior medical records proved to be a critical reason for the success of this case.  After quickly obtaining past and current medical information and reviewing the accident investigation, Synergy was then able to construct a strong legal argument supported by the facts.

The fact of the matter is the workers’ compensation industry continues to change throughout the years.  Previously, standard accidents could be resolved by adhering to proper medical restrictions with a Return to Work program.  Today, it’s not that simple.  With an aging workforce, unhealthy habits, and healthcare conditions such as obesity and diabetes, claim costs continue to increase and the link between the workplace and an injury becomes unclear.  Increasing numbers of workers’ compensation claims are financially motivated and perhaps even tied to the weak job market, stagnant low wages, access to prescription drugs, and an expanding Social Security Disability program.

Synergy Coverage Solutions is dedicated to providing superior workers’ compensation services and adjusting to today’s reality.  We work hard to stay ahead of the curve and identify programs, such as Fitness for Duty, to ensure employers are finding the right candidates to perform their job duties in a safe and effective manner.  Our dedicated Claims Adjusters aggressively research claims to determine compensability, and are committed to taking a strong stance for the facts a workplace incident may reveal.  In the workers’ compensation industry, Synergy Coverage Solutions stands ready to change with the times to consistently offer superior workers’ compensation services.

What Businesses Should Know About MSAs and How it Affects Workers’ Compensation Claim Costs

What is an MSA?  Medicare Set Aside, or MSA, is a portion of a settlement between a claimant and the workers’ compensation insurance company that allocates funds to be used on future medical expenses that would otherwise be payable by Medicare.  The funds in an MSA account should only be used on a claimant’s future medical expenses that are a direct result of work-related injuries, illnesses, or diseases sustained while on the job.  If the MSA funds are exhausted and additional medical expenses are incurred, Medicare will then start coverage for the claimant.  If a claimant passes prior to exhausting the MSA, the funds will then go to the designated beneficiaries under the MSA agreement.

Who is eligible for an MSA?  Anyone that is 65 years or older is eligible, as well as anyone with a reasonable expectation to be enrolled in Medicare within 30 months of a settlement exceeding $250,000.  Additionally, claimants who have filed for Social Security Disability, or may file for Social Security Disability within the next 3 years, are eligible.  Just to give some insight, the number of disabled workers receiving Social Security Disability has significantly increased in the past seven years.  In 2006, 6.8 million disabled workers received Social Security Disability.  By 2013, the number has reached 8.9 million – not only increasing the disability roles, but also increasing the workers compensation claimants eligible for a Medicare Set Aside. In 2007, Section 111 of the Medicare, Medicaid, and SCHIP Extension Act created the MSA for workers compensation (and other lines of insurance) and became effective on July 1, 2009.

How is the MSA allocation amount determined?  The MSA allocation amount is determined on a case-by-case basis, calculated using an anticipated amount of future medical care, including pharmacy expenses, (based on current medical records) and the remaining life expectancy of the claimant.  The Centers for Medicare and Medicaid Services, or CMS, will review proposed allocation amounts for settlements over $25,000; however, CMS approval of a proposed MSA allocation amount is not required.

How do MSAs affect workers’ compensation costs?  MSAs directly affect a business’ experience modification and loss results, therefore having the potential to increase workers compensation premium for the business.  In addition to claims being more expensive, MSAs can also make claims more difficult to settle and close out future liability.

Synergy Coverage Solutions is dedicated to helping employers proactively provide safe work environments for their employees, while also controlling workers compensation costs.  Preventing workplace injuries is just one way businesses can have more control over workers compensation costs.  If you, or any businesses you work with, have any questions about MSAs, feel free to reach out to our workers’ compensation specialists at info@synergyinsurance.net.

How can Modified Duty Help Employers Reduce Workers Compensation Costs?

Did you know injured employees absent for greater than 180 days have only a 10% chance of returning to their regular job?  An early return to work program can help employers reduce workers compensation costs, while reducing lost productivity and experiencing more successful medical outcomes for injured employees.

A recent Claims success story further demonstrates the benefit of early return to work programs and modified light duty.  An employee was working in a janitorial position when he tripped over a machine at work and injured his shoulder, knee, and lower back.  After receiving treatment from a medical provider, it was determined the employee could immediately return to work on restricted light duty.  The employer was notified of the injured employee’’s light duty restriction, but felt they could not accommodate, as they did not believe they had any work that fell within the light duty restrictions.

As the cost of the claim increased due to paying out-of-work benefits to the injured employee, our Claims department brainstormed ways to reduce the final cost of the claim.  If the employer was able to determine a way to offer light duty to the injured employee, the cost of the claim would be dramatically reduced.  With that conclusion in mind, our Claims Adjuster reached out to the employer to discuss different ways to implement light duty for the injured employee.  However, the employer continued to face challenges in identifying a light duty position that would fit within the injured employee’’s restrictions.  At that point, our Loss Prevention Consultant stepped in to offer more education and assistance to the employer on modified duty and return to work programs, reinforcing the benefits for both the company and the injured employee.  After multiple discussions with our Loss Prevention Consultant and their corporate office, the employer was able to offer the injured employee modified duty at their main office.  A written offer was made to the injured employee, which he then accepted.  The injured employee was able to return to work, company morale was not affected, and the final claim cost was dramatically reduced.

This is just one example of how our Claims and Loss Prevention departments worked with an employer to reduce workers compensation costs.  Synergy Coverage Solutions’ Loss Prevention team is dedicated to providing the attention and assistance needed to help employers reduce accident frequency and minimize severity of workers’ compensation claims.

Where is Workers’ Compensation Headed Within the Next Few Years?

Synergy Coverage Solutions has been involved in the workers’ compensation industry for nearly a decade.  Committed to innovative solutions, we are constantly looking at industry trends to stay ahead of the curve.  One thing we have noticed throughout the past few years is the importance of health and wellness among a business’ employees.  Hiring employees who are fit for duty makes sense, as it ensures your potential employee can perform their daily job functions without high risk to injury.

In the past, our company has focused on implementing proactive Loss Prevention programs.  This is still a large focus of ours, but we have also realized a shift in the importance of employee health and wellness.  Companies with an effective wellness culture can show cost savings in retention, recruitment, reputation, and employee engagement.  Additionally, a 2007 Duke University study involving 11,700 individuals tied increased workers’ compensation claims costs as an individual’s body mass index, or BMI, increased.  Comparing medical claims costs per 100 workers, an individual with a normal BMI had an average cost of $7500, whereas an individual with an overweight BMI had an average cost of $13,300.  These costs increased for each level – $19,000 for mildly obese, $23,300 for moderately obese, and $51,000 for severely obese BMI classifications.

As more companies are investing in long-term solutions to improve employee health and wellness, the most important aspect is to have an effective wellness program – one that is enjoyable and challenges your employees to live a healthier lifestyle, without disengaging interest throughout the year.

Synergy Coverage Solutions Launches New Website

Synergy Coverage Solutions is excited to launch our newly designed website!  Our revamped website will contain all of the helpful information and tools that were available on our original site, with an improved look and feel.  We have designed our new website with both our agents and policyholders in mind, with the ability to login and access your accounts as you typically would.  Additionally, we have updated the website with more detailed information to help you better understand how we can assist with your unique situation, as well as case studies and even a blog to help you stay up-to-date with Synergy news!

We hope you will take some time to browse our new website and let us know what you think, as we’re pretty excited about the revamp ourselves!  As always, Synergy Coverage Solutions is dedicated to providing our agents and policyholders with quality customer service and delivering a more proactive approach to help businesses drive costs down in the long-run.

What are Synergy’s Core Values?

Synergy Coverage Solutions believes that partnering with employers to create and maintain a safer workplace can only produce an even greater effect than working individually (thus, the word “Synergy” in our company name).  Although our corporate office is located in Charlotte, North Carolina, our territory also includes Illinois, Indiana, South Carolina, Georgia, and Virginia.  Synergy Coverage Solutions specializes in providing workers’ compensation services, and our approach includes working with employers to proactively maintain a safe working environment for their employees and staff.  However, in the event that a workplace injury occurs, Synergy Coverage Solutions aims to provide aggressive claims service and enhanced loss prevention to decrease the likelihood of future workplace injuries.

Now that you know us a little better, you may be wondering which industries we typically serve.  We provide workers’ compensation services to a number of healthcare communities, nonprofits, school systems, temporary service agencies, restaurants, retail stores, and manufacturing (this is by no means an exhaustive list).  More importantly, one of the traits we look for in an employer partnership is a quality-focused business.  This means the employer is committed to the safety and welfare of its employees through use of loss prevention and claims management.

So why do Agents choose to work with Synergy Coverage Solutions?  We understand that quality service begins before, and continues after, an incident occurs.  Each claim is assigned to a specific Claims contact at Synergy so the employer can rest assured that the small details will not be forgotten.  Additionally, our approach to workers’ compensation provides our Agents with the flexibility of multiple markets with the consistency of Synergy’s quality claims and loss prevention services.  This combination of flexibility of markets and consistency of service is unmatched in the industry.

Why Agents Will Want To Read Our Blog

Welcome to Synergy Coverage Solutions’ company blog. While I am sure we will be inviting guest bloggers in to keep things interesting, I, Jill Bowyer, Marketing Extraordinaire will be your primary blogger. I have been with the company for several years and I have learned a lot from many of you during those years. My intention for this blog is to return the favor by sharing some knowledge and research and invoking thoughtful comments and ideas. I want this blog to be about the world we share, the world of insurance and sales. I want to keep you up to date on the goings on of the industry and Synergy and to bring you valuable suggestions for your clients which will help us all to provide better customer service and be better relationship managers.

Each of my posts will have room for comments. Please make comments or if you want a more private conversation, email me at jbowyer@synergyinsurance.net. Contact me if you have any suggestions for my posts – I am all ears! I will be posting on this blog regularly, so please come back periodically throughout the month to read the blog. I know, what you are thinking… when will I have time for that?? I will commit to making it worth your time – with quick, informative and helpful posts!