American Association of State Compensation insurance Fund
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member fund.


CopperPoint Mutual Insurance Company
Phone: (602) 631-2000
Address: 3030 North Third Street
Phoenix, AZ   85012
Website: www.copperpoint.com

State Compensation Insurance Fund
Phone: 888-STATEFUNDCA
Address: 333 Bush Street
Suite 800
San Francisco, CA   94104
Website: www.statefundca.com

Pinnacol Assurance
Phone: (303) 361-4000
Address: 7501 East Lowry Boulevard
Suite 800
Denver, CO   80230-7006
Website: www.pinnacol.com

Hawaii Employers' Mutual Insurance Co. Inc.
Phone: (808) 524-3642
Address: 1100 Alakea Street
Suite 1400
Honolulu, HI   96813
Website: www.hemic.com

Idaho State Insurance Fund
Phone: (208) 332-2100
Address: 1215 West State Street
P.O. Box 83720
Boise, ID   83720-0044
Website: www.idahosif.org

Kentucky Employers Mutual Insurance
Phone: (859) 425-7800
Address: 250 West Main Street Suite 900
P.O. Box 83720
Lexington, KY   40507-1724
Website: www.kemi.com

Louisiana Workers' Compensation Corporation
Phone: (225) 924-7788
Address: 2237 South Acadian Thruway
P.O. Box 83720
Baton Rouge, LA   70808
Website: www.lwcc.com

Maine Employers Mutual Insurance Company (MEMIC)
Phone: (207) 791-3300
Address: 261 Commercial Street
P.O. Box 11409
Portland, ME   04104
Website: www.memic.com

Chesapeake Employers’ Insurance Company
Phone: (410) 494-2000
Address: 8722 Loch Raven Boulevard
P.O. Box 11409
Towson, MD   21286-2235
Website: www.ceiwc.com

SFM Mutual Insurance Company
Phone: (952) 838-4200
Address: 3500 American Boulevard West Suite 700
P.O. Box 11409
Bloomington, MN   55431-4434
Website: www.sfmic.com

Missouri Employers Mutual Insurance
Phone: (800) 442-0590
Address: 101 N Keene St
P.O. Box 11409
Columbia, MO   65201
Website: www.mem-ins.com

Montana State Fund
Phone: (406) 495-5015
Address: 855 Front Street
P.O. Box 4759
Helena, MT   59604-4759
Website: www.montanastatefund.com

New Mexico Mutual Group
Phone: (505) 345-7260
Address: 3900 Singer Boulevard NE
P.O. Box 4759
Albuquerque, NM   87109
Website: www.newmexicomutual.com

New York State Insurance Fund
Phone: (212) 312-7001
Address: 199 Church Street
P.O. Box 4759
New York, NY   10007
Website: www.nysif.com

Workforce Safety and Insurance
Phone: (701) 328-3800
Address: 1600 East Century Avenue Suite 1
P.O. Box 4759
Bismarck, ND   58506-5585
Website: www.WorkforceSafety.com

Ohio Bureau of Workers Compensation
Phone: (800) 644-6292
Address: 30 West Spring Street
P.O. Box 4759
Columbus, OH   43215-2256
Website: www.ohiobwc.com

CompSource Mutual Insurance Company
Phone: (405) 232-7663
Address: 1901 North Walnut Ave.
P.O. Box 53505
Oklahoma City, OK   73152-3505
Website: www.compsourcemutual.com

State Accident Insurance Fund (SAIF)
Phone: (503) 373-8000
Address: 400 High Street SE
P.O. Box 53505
Salem, OR   97312-1000
Website: www.saif.com

Pennsylvania State Workers Insurance Fund
Phone: (570) 963-4635
Address: 100 Lackawanna Avenue
P.O. Box 5100
Scranton, PA   18505-5100
Website: www.dli.state.pa.us/swif

Beacon Mutual Insurance Company
Phone: (401) 825-2667
Address: One Beacon Centre
P.O. Box 5100
Warwick, RI   02886-1378
Website: www.beaconmutual.com

South Carolina State Accident Fund
Phone: (803) 896-5800
Address: P.O. Box 102100
P.O. Box 5100
Columbia, SC   29221-5000
Website: www.saf.sc.gov

Texas Mutual Insurance Company
Phone: (800) 859-5995
Address: 6210 East Highway 290
P.O. Box 5100
Austin, TX   78723-1098
Website: www.texasmutual.com

Workers Compensation Fund
Phone: (800) 446-2667
Address: 100 West Towne Ridge Parkway
P.O. Box 2227
Sandy, UT   84070
Website: www.wcfgroup.com

Washington Department of Labor and Industries
Phone: (360) 902-5800
Address: P.O. Box 44001
P.O. Box 2227
Olympia, WA   98504-4001
Website: www.lni.wa.gov

Wyoming Division of Workers Safety & Compensation
Phone: (307) 777-7159
Address: Cheyenne Business Center
1510 East Pershing Boulevard
Cheyenne, WY   82002
Website: wydoe.state.wy.us

Workers Compensation Board - Alberta
Phone: (780) 498-3999
Address: 9925-107 Street
P.O. Box 2415
Edmonton, AB   T5J 2S5
Website: www.wcb.ab.ca

Workers Compensation Board of British Columbia (WORKSAFEBC)
Phone: (604) 273-2266
Address: P.O. Box 5350 Station Terminal
P.O. Box 2415
Vancouver, BC   V6B 5L5
Website: www.worksafebc.com

Manitoba Workers Compensation Board
Phone: (204) 954-4321
Address: 333 Broadway
P.O. Box 2415
Winnipeg, MB   R3C 4W3
Website: www.wcb.mb.ca

WorkSafeNB
Phone: (506) 632-2200
Address: 1 Portland Street
P.O. Box 160
Saint John, NB   E2L 3X9
Website: www.worksafenb.ca

Workers Compensation Board of Nova Scotia
Phone: (902) 491-8999
Address: 5668 South Street
P.O. Box 1150
Halifax, NS   B3J 2Y2
Website: www.wcb.ns.ca

Prince Edward Island Workers Compensation Board
Phone: (902) 368-5680
Address: 14 Weymouth Street
P.O. Box 1150
Charlottetown, PE   C1A 7L7
Website: www.wcb.pe.ca

Saskatchewan Workers Compensation Board
Phone: (306) 787-4370
Address: 200 - 1881 Scarth Street
P.O. Box 1150
Regina, SK   S4P 4L1
Website: www.wcbsask.com

Puerto Rico State Insurance Fund Corporation
Phone: (787) 793-5959
Address: G.P.O. Box 365028
P.O. Box 1150
San Juan, PR   00936-5028
Website: www.cfse.gov.pr
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AASCIF Newsletter

Catastrophic Claims Management—A Review of Best Practices

By Ted Jeffries, Missouri Employers Mutual, and Kelley Neal, State Compensation Insurance Fund

With medical expenses now representing the majority of claims costs, a comprehensive and well-orchestrated approach to catastrophic claims management is more important than ever. Following are some of the most important considerations for managing these most complex claims.

Identify early
The earlier you identify a catastrophic claim, the better the potential outcome. Unfortunately, this isn’t as easy as it used to be. The standard definitions of a brain injury, spinal cord injury, major burns, and amputations still apply. However, with an aging workforce, advances in medical care, and more, recognizing a catastrophic claim is often no longer a simple equation.

So called “jumper” claims, with several seemingly separate and benign factors, can spiral into a catastrophic claim with little notice. To address this, it is important to have structures in place to flag claims from the outset with potential severity risks. Experienced intake staff, medical only representatives, and claims representatives should be trained to spot risks early.

Evaluate
Have a defined team to triage potential catastrophic claims as soon as possible. This should include nurse case managers, your medical director (if you don’t have one, consider hiring one!), senior claims management, and your claims staff with experience in handling claims of this type. This team should consider all factors on the claim, including:

  • The nature of the injury or injuries—Obvious, but a logical place to start any evaluation.
  • Comorbidities and other complicating factors—These factors can turn a relatively straightforward case into one that should be considered a catastrophic loss. Ask: What is the age of the worker? What other medical conditions do they suffer from that could complicate their recovery? What does their support network look like at home for the duration of their convalescence?
  • The appropriate medical treatment for the worker—Maintain relationships with “centers of excellence” around the country so that you can engage when the injury or complicating factors require it. Fortunately, catastrophic claims do not come along as frequently as other injury types, but this also means that your staff and usual medical providers may not be the best choice to ensure an optimal outcome for the injured worker. A relatively nominal increase in the cost of acute care for the injured worker could be the difference between a positive outcome and one that leaves the worker unable to care for himself and with a poor prognosis and quality of life, not to mention greatly expanded costs over the course of the claim. A center of excellence for brain, spinal cord, and other severe injuries can make all the difference.  Familiarize yourself with the many good options out there and have them available when needed.
  • Identify your most experienced internal resources—This includes nurse case managers, claims representatives and defense counsel (if indicated). Make sure they are assigned the catastrophic loss as soon as practicable in the evaluation process.

Communicate, communicate, communicate
Communication should really be first on the list. Never lose sight of the fact that the injured worker, his or her family, and potentially even the employer are going through one of the most profound crises of their lives. It is imperative that the various constituents understand the claims and medical process and what to expect. Involve them in the process from the beginning, and work to ease their concerns and answer their questions. The more focus you place on the most important task of recovery for the worker, the better the outcome will be for everyone. The financial, compensability, medical planning, and myriad of other factors to address with these claims make the simple act of communication often overlooked, to the detriment of the claim’s outcome.

Be proactive
Catastrophic cases will not develop as a “typical case.” There will be ups and downs, and the path to maximum medical improvement is rarely linear. The key is to anticipate these potential pitfalls and have a plan in place for when they occur. This is sometimes not an intuitive process but is imperative for quickly dealing with emerging issues before they impact the file outcome and recovery of the injured worker. What can sometimes be an entirely minor complication for a noncatastrophic injury can have dire consequences for a catastrophic patient who simply does not have the physical ability to ward off even a seemingly minor setback. Think ahead, and map the process beforehand.

Ask for expert help
External vendors specialize in catastrophic claims management from the medical perspective. Some will even provide their services at a fixed cost in return for a contractual agreement to attain a specified outcome for a particular claim. This agreement to provide a specified outcome creates for the vendor a natural alignment between cost control and outcome achievement, neither of which can be optimized without focusing on the other. Finally, these entities often have access to elite medical experts, direct access to centers of excellence, and the best independent nurse case managers available to engage on a given case.

The proven outcomes and financial certainty that these models can provide are often worthy of consideration. This can be a very attractive option depending on the injury severity, reinsurance structure, experience of your local staff, access to medical expertise, and overall organizational resource level available to devote to what could be a very intensive single case.

Many AASCIF members may also find themselves with the need to manage a case far outside their normal area of operation, or perhaps in a rural area without a great deal of access to appropriate medical facilities. In these cases in particular, an external partner can prove invaluable to assist with navigating the medical process in an unfamiliar or otherwise unsuitable locale.

Deliver on the promise
Catastrophic claims are an unfortunate reality for any claims operation. With the proper approach and planning, they can become an opportunity to showcase one of the most meaningful ways a claims department can fulfill the insurance promise to provide professional, compassionate, and outcome- focused expertise to injured workers, their families, and policyholders in their moments of need.

 

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