11 Excess Carrier Vendor Partners That Can Improve Injured Worker Care

An injured worker’s recovery time can be extended when ineffective medical providers are utilized or when treatment is delayed. The vendor resources provided by an excess workers’ compensation carrier can keep a care plan on track with their unique and specialized expertise that can appropriately steer both treatment and a claim’s progress forward.

“Claims, especially catastrophic or high exposure, are a balancing act that requires prioritizing treatment for the individual, but also mitigating claim exposures and moving it to closure,” said Christian Kolb, Assistant Vice President of Excess Workers’ Compensation Claims at Safety National. “The claims adjuster, broker, excess carrier, and any other claims handling personnel will work with specialized vendors to navigate medical needs, but will simultaneously administer solutions, like settlements, that may involve payments for future medical treatments.”

These vendor resources can be utilized on claims to assist in positive outcomes.

1. Pharmacy Benefit Management (PBM)

PBMs are primarily responsible for developing and maintaining the formulary, which is the list of covered pharmaceuticals. They also contract with pharmacies, negotiate discounts and rebates with drug manufacturers, and process and pay prescription drug claims.

2. Drug Regimen Review (DRR)

Medication reviews are used to identify and prevent potential adverse effects and drug reactions from an injured worker’s prescriptions. This includes ineffective drug therapy, significant side effects and drug interactions, duplicate drug therapy, and noncompliance with drug therapy.

3. Chronic Pain Intervention

A thorough assessment of chronic pain is necessary to develop an effective pain management plan. Chronic pain intervention vendors comprehensively review an injured worker’s condition and build a program using experiences and techniques designed to create an effective and cost-conscious strategy.

4. Medicare Set-Aside (MSA)

Workers’ compensation payers are under increasing pressure to consider and protect Medicare’s interests when settling claims. To do so, an appropriate amount of settlement money should be set aside to pay future medical costs that Medicare might otherwise pay. MSA vendors assist in meeting these obligations.

5. Annuities

Annuity vendors educate and partner with excess carriers and clients to help identify candidates for structured settlements. When settling a claim that requires an MSA allocation, annuity vendors identify the advantages and disadvantages related to an MSA account, then administer and partner with MSA vendors through the lifecycle of the annuity.

6. Home Modification

Skilled home modification vendors have licensed occupational and physical therapists who can travel anywhere in the country to the location of the injured worker’s home. They thoroughly review the home and then submit a detailed report to the excess carrier for review.

7. Durable Medical Equipment (DME)

DME equipment is any medical equipment used in the home to improve an injured worker’s quality of life. DME vendors work to provide cost containment through transparent billing, fair-market-value priced products, and reliable service and delivery.

8. Complex Care Solutions

These vendors offer programs that provide real-time guidance from leading experts in trauma, rehabilitation, and other specialties. They weigh in on catastrophic diagnoses and treatment plans, which ultimately help reduce claim costs.

9. Attendant Care

Attendant care helps injured workers perform the day-to-day tasks they normally would if not for their injuries. Attendant care vendors strive to provide the highest quality and most responsive home care services at a competitive price.

10. Medical Bill Review

Medical bill review is an essential service that provides reviews of medical bills related to claims. Bill review vendors audit the bills for accuracy, duplication of charges, and reasonability.

11. Settlements

Settlement partners are accustomed to settling very complicated cases. They help negotiate and settle legacy files, allowing you to lower your outstanding reserves and focus your efforts on less costly claims.