Claims Management | Sunbelt Insurance Holdings

 

THE PURPOSE

The WCCA method is a cost containment program designed exclusively for workers compensation. The program’s sole purpose is to make the workers’ compensation system work for employers. We recognize that currently, the workers compensation industry works against the employer; in other words, the players within the workers’ compensation system make more money when it costs the employer more money (i.e.carriers, doctors & clinics, TPA’s, etc...)

The WCCA method is currently used in over 40 states in the U.S. across more than 300 employers representing more than 50,000 employees.

 

ALIGNING YOUR INTERESTS

  • BPO Model – We adopted a BPO, or business process outsourcing model. We offer multiple levels of service depending on client needs. When hired, we provide as much support to our clients as a fully staffed workers’ compensation risk management department or we act as an adjunct to an existing Risk management department.

  • We are Accountable Only to The Employer - We have only one responsibility and that is to control our clients’ cost.

  • We Capitate our Fees - We charge one flat fee per year for the WCCA program. There are no event- based costs or charges to the claim file. This removes the incentive to increase costs and creates an incentive for us to work profitably.

  • We Guarantee our Effectiveness - We provide a money back guarantee that we will be able to return at least a 100% return on investment.

 

Operations

The WCCA model focuses on three areas: 

Forensics – We will analyze the statistical rating data used to determine the costs of your workers compensation policy each year and rectify any errors including, but not limited to: old claims, misreported claims, incorrect claim status, incorrect reserve reporting, etc.

Risk Finance Consulting - If a client would benefit from an alternative risk financing method, we will help design a model that works and will adjust service style to match the risk financing plan; this is especially effective for loss sensitive rating plans.  

Claim Management - The vast majority of the work we do, as well as the value we provide comes from our proprietary claims management system - The WCCA Method.

 

The Outcome

Over the past twenty-one years we have found that our process, built around the following intentions, has the highest likelihood of limiting the impact injuries have on costs

Total Cost and Reserve Management – We are involved at the time of injury. This allows us to control how the incident is handled from the onset. Because of our intimate, immediate on ongoing involvement in every claim we can monitor reserving practices, determine the implications and steer the claim in the best interest of the employer. The result is the lowest impact on costs including the limiting and/or elimination of the impact reserves have on costs.

Limiting Fraud – The WCCA method was born from an intention to limit and/or eliminate fraud from workers’ compensation claims. We have twenty plus years of experience managing fraud. We have found that by making it hard for exploitive parties to benefit from the system goes a long way towards elimination fraud. However, since our involvement is telephonic before the injured employee is seen by a physician we now preempt fraud by including a recorded statement at that time

Limiting Indemnity Costs – The 24 hours following an injury are critical for managing the impact that injury has on costs. Our philosophy is that no indemnity cost is acceptable and we use direct, to the point, communication with the medical provider to initially allow for modified duty and thenprogress that claims through to full-duty and eventually maximum medical improvement. Depending on the jurisdiction this could have as much as a 91% reduction in the impact that claim has on costs

Elimination of Claims – Because our initial involvement at the time of injury is through a nurse we are able to keep 38% of the injuries we handle from ever incurring any claim cost at all. 

 

ALAE Management – We have found that employers on loss sensitive plans, especially those whose claims are paid by Third Party Administrators have a need to have allocated loss adjustment expenses managed. Our team not only consults on the usage of services incurring these costs but will audit billings.

 

 Claim Team – Each of our clients has a claim team. That team is made up of a Claim Manager, a Senior Claim Manager, and is overseen by the Director of Claims. Combined, the team that would manage a client’s exposure would have almost seventy years of claims experience.

 

Contact Sunbelt Insurance Holdings

Thank you for taking the time to review our program. We look forward to providing you a full proposal and thank you for the opportunity to earn your business.

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