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STATE FUND SERVICES

Over the last 30 years Penser has helped hundreds of state funded employers reduce their workers’ compensation costs, and receive retrospective rating program premium refunds.

Through comprehensive program analysis, proper employer training, aggressive return to work program implementation, and proactive claims management, we have been successful in working with employers of all sizes in the management of their workers’ compensation exposure.

Details of our State Fund Services can be divided into the following headings:

Program Analysis
Claims Management Services


State Fund Services - Program Analysis

The first step in making cost effective decisions and appropriate changes to your workers’ compensation program is to obtain data and an evaluation of the current program. A valuable component of our State Fund Services is the overall program analysis we can provide employers. This analysis is individually designed to provide the most specific and relative information to the employer.

Below are some of the typical components of an analysis:

 
 
Evaluate existing programs and procedures in comparison to industry, state, and “best practice” standards.
 
Review historical loss data, and modification factor history to identify trends.
 
Reviewing current classification codes, premium audits, and experience modification factors to ensure clients are paying no more than they should for their coverage.
 
Reclassification audit to research the potential of reclassifying and/or to profile the other possible risk classes that may provide the client a lower rate.
 
Retrospective rating program analysis. This study will evaluate your industrial insurance program and apply it to the retrospective rating plan to determine its feasibility and to assist in selecting from the many individual and group plans available.


State Fund Services - Claims Management Services

Setup Phase

Penser’s State Fund claims management services are specifically designed to reduce an employers experience modification factor and thus their workers’ compensation premiums. In order to effectively do this we implement a two phase program.

The initial phase is the setting up of Penser’s cost containment program. This step includes analyzing and educating so that Penser can best integrate our loss control program into any existing programs. The following are steps involved in the setup.

 
Penser will evaluate current records with Labor & Industries to determine any adverse trends that are affecting the company’s current experience factor and rates.
 
Penser will review the records with your managerial staff so appropriate goals can be established.
 
Penser will conduct educational seminars and workshops with each company. Attendance is recommended for all management, supervisors and human resources personnel. The seminars will explain Penser’s services, review the established goals, teach basic cost control techniques, and discuss how the management staff can best interact with  Penser to make the cost containment program most effective. The workshop is also  designed to help educate management on how to investigate accidents and handle the  claims and claimant information and make sure that all information is funneled through Penser.
 
  Penser will meet with appropriate office personnel to collect current L&I claims information and determine what action is best for those claims
 
Retrospective rating program analysis. This study will evaluate your industrial insurance program and apply it to the retrospective rating plan to determine its feasibility and to assist in selecting from the many individual and group plans available. 

Claims Management Phase

This includes the ongoing services that Penser provides employers on a day to day basis. It ensures that all claims are handled in a fair and equitable manner and as cost effectively as possibly by eliminating claimant abuse and unnecessary expenses, including time loss and medical bills. To accomplish this, Penser will:

 
Facilitate all claims files with the Department of Labor & Industries. Penser will handle all data and material necessary for the proper adjudication of the claims in a timely fashion. This will be coordinated with the office personnel from each individual employer.
 
Review all microfiche and medical reports, and/or any other data that relates to any claim, and take action accordingly.
 
  Provide a computer-generated monthly report that shows the activity which took place on all open claims for that month.
 
Provide or advise on all advocacy needs relative to claims including special meetings with Labor & Industries, attorneys, the Board of Industrial Appeals or any other parties involved.
 
Correspond and deal directly with doctors, vocational counselors, attorneys, Labor and Industries, injured workers, or any other parties involved with the day-to-day claims management.
 
Review individual claims cost figures for medical aid, indemnity, and reserved to make sure that costs remain as low as possible and to look for potential excessive claims costs.
 
Identify light-duty jobs, write up job analysis and make formal job offers when injured workers are taken off work by their attending physician due to an industrial injury.
 
Provide any and all sundry claims management procedures necessary for the successful management of the claim from the date the claim is filed, to the date the claim closes or is rejected.
 
Make a quarterly comparison of every claimant’s wages to their unemployment benefits to make sure that claimants were not overpaid unemployment benefits.
 
Provide attendance to conferences and telephone hearings before the Board of Industrial Insurance Appeals and take necessary action.
 
Decide – after conferring with employer – whether to accept of protest the filing of a claim. Provide surveillance and investigations on possible fraudulent L&I claims.

For more information on Penser's state fund services or to obtain a free analysis please contact a state fund representative at statefund@pensernorthamerica.com. Or call Phil at 360-455-4128 x103.