Workers’ Compensation Consulting

Our Self-Funded Workers’ Compensation experience has assisted both public and private employers, municipal cooperatives and consortiums.

OneDigital’s Claim Management and Reserve Adequacy Audits continues to provide our clients the peace of mind they need when entrusting their claim processing services to a third party. In addition to providing these services to our Plan Management clients, we have been working on behalf of the NYS Workers’ Compensation Board to evaluate the self-insured Trust market since 2008.

Whether you are currently taking advantage of alternative funding or are fully-insured and interested in exploring the benefits of self-insurance, OneDigital offers you the opportunity to recognize the cost containment alternatives available to your group. Our team of professionals can analyze your current plan, demographics and costs (claim and administrative) to determine the best strategy for self-insured implementation and on-going management.

Our Clients

We work with school district consortiums, counties and other large municipal entities, as well as large private employers, trusts and state regulating agencies. Large employers utilize our Workers’ Compensation Consulting services for the management of their self-insured Workers’ Compensation plan.

Key Features

Our independent and consultative approach assists employers with valuable solutions, innovative ideas and professional guidance.

• Workers’ Compensation Claim Management Audit

  The most costly component of any self-insured Workers’ Compensation plan are the claims – those that are open, and those that have yet to occur. The Third Party Administrator (TPA) is entrusted with processing claims, setting reserves, and managing injured workers. We developed the Workers’ Compensation Claim Management Audit to verify the service provided by the TPA and to ensure they are performing their tasks in a compliant and cost effective manner.

  OneDigital has audited the majority of regional and national TPAs across the United States. As a result of our broad client base we are familiar with the numerous software systems each organization employs and the limitations associated with them. Our Audit Department is staffed with seasoned Workers’ Compensation claims professionals, many of whom have worked for the TPAs being audited. Our team utilizes a detailed questionnaire, personnel interviews, system access, statistical analysis and claim management expertise to develop a report that details TPA processes, reserving practices and vendor management.

  The audit is designed to provide our clients an assurance that their TPA is performing at the level committed to in the contractual agreement. If claim administration falls below industry standards, recommendations are made to improve performance or seek an alternative. The OneDigital teams “inside” knowledge, in conjunction with on-going training, makes this service a formidable tool in the management of your Workers’ Compensation plan.

  We offer our Auditing services to our existing clients as well as a stand-alone service to other self-insured entities.

• Request for Proposals: TPA + PBM

  The structure of an RFP that addresses all the needs of a self-insured entity requires a thorough understanding of the components of the plan. Our team has developed an RFP template that, when customized, requests claim management cost and processing information that will allow for an apples to apples comparison of qualified Third Party Administrators and Pharmacy Benefit Managers.

  OneDigital Account Executives and their support staff analyze the submissions, develop addenda and create a detailed written report documenting the respondents’ customer service capabilities, financial impact, and provider network costs/penetration. Recommendations are made regarding finalists who will then be scheduled to present to client representatives. Final recommendations for TPA/carrier services are presented in a written report and presented formally when requested.

  Requests for Proposal for Workers’ Compensation claim and Pharmacy Benefit Management services are often the result of a thorough Workers’ Compensation claim audit. The results of the audit lead to a recognition of deficiency or areas of concern that can be incorporated into the RFP to achieve a cost effective improvement in claim administration.

• Excess Insurance Analysis and Placement
  The rising cost of self-insured Workers’ Compensation claims is leading to higher Self-Insured Retention amounts and increases in annual premiums. Our team analyzes the existing Excess Insurance in the context of historical claim trends. We utilize underwriting partners to provide quotations from the largest writers of Workers’ Compensation stop-loss insurance to produce the most competitive pricing and favorable contract language.

  Self-insured Workers’ Compensation claim management is dependent on a thorough knowledge of how a stop-loss insurance policy works in conjunction with the plan. Employers who self-insure their Workers’ Compensation plan need to have a consultant who recognizes the importance of reports of injury and continuous follow-up with the insurance carrier to ensure proper claims handling.