Article

When, Why, and How to Use Nurse Review on Third Party Medical Claims

… treating a claimant, the claimant has pre-existing conditions or the claim has been open for an extended period of time, insurance carriers benefit by bringing in medical professionals to perform claim reviews. An organization of trained nurses can be an invaluable tool in a third party adjusters’ toolbox. Not only can a nurse provide detailed … nurses have determined are unrelated to auto accidents or related to a pre-existing condition. An experienced nurse will personally look closely at all of the details of a claim and medical …
Article

Therapeutic Alternatives—A Closer Look

… Federal Drug Administration (FDA) , “A generic drug is a medication created to be the same as an existing approved brand-name drug in dosage form, safety, strength, route of administration, … Vimovo Vimovo contains naproxen 500mg and esomeprazole (generic Nexium) 20mg. Naproxen is an anti-inflammatory and esomeprazole is used to prevent gastric upset caused by … Similar to Vimovo, ibuprofen is a non-steroidal anti-inflammatory (NSAID) and famotidine is an H2 blocker, used to prevent gastric upset caused by the NSAID. Since famotidine (Pepcid) does …
White Paper

Mental Health Challenges

… someone gets hurt on the job, the workers’ compensation system is often adept at zeroing in on an injury and delivering timely care. But that well-intentioned focus on a patient’s physical … mental-health toll the episode might be exacting. Failing to do so risks treating only part of an injury and achieving an insufficient recovery. Today, a comprehensive approach that identifies and meets an injured …
News Release

Mitchell’s Virtual Claims Workflow for the Connected Consumer

… instead of speaking with a company representative. [1] From retailers to insurance carriers, an end-to-end self-service experience is not an option; it's becoming a necessity to stay engaged with the today's connected consumers. In … benders where there are no injuries may be overwhelming and cause confusion. Add anxiety to an uncommon occurrence, and it's understandable that some drivers may draw a blank on what steps …
Article

Ask The Pharmacist: Fixed-Dose Combination Drugs in Workers’ Comp

… the contribution of each ingredient to the claimed therapeutic effect. FDCDPs are often an opportunity for manufacturers to extend the market exclusivity of an OTC brand or a prescription brand whose patent is expiring. Advantages of FDCDPs may include: … or inadequate to treat a condition and may not allow dosage flexibility to individualize an effect. Caregiver and consumer lack of familiarity with the combination product. Inadvertent …
Article

Ask The Pharmacist: Medication-Assisted Treatment (MAT) for Opioid Use

… Why would someone be prescribed an opioid to treat opioid addiction? Medication-assisted treatment  (MAT) is a safe and … they do carry the risk of addiction themselves. However, when used properly as part of an overall treatment program, the risk is minimized. Additionally, people with opioid use … idea is that the person will be more empowered to begin making lifestyle changes that lead to an addiction-free future. Naltrexone is an opioid antagonist and is used differently to treat …
Article

Behind a Reliable IME: The Critical Need for Quality Assurance

… only builds trust with clients but also assures them of adherence to regulatory requirements. An integral part of this approach involves creating a client-specific protocol. This is achieved … director to perform random quality audits to ensure high-quality standards Eval u ating an IME: The “Seven Cs” When assessing an IME report, the "Seven Cs" should be used: Correct: Verify basic information and avoid …
Case Study

Independence Day

… adjusters trust to ensure injured workers receive the best care in a timely manner. Below is an example of how Ms. Hurley helped an injured worker with life-threatening injuries reach his highest functional potential.   … A workplace explosion blasted the employee down an elevator shaft and slammed him to the bottom, causing fractures to his skull, face, hip and … Though the worker’s injuries were so catastrophic that return-to-work career paths were not an option, Ms. Hurley developed an excellent working relationship with him and his family to …
Case Study

2022 Telephonic Heart of Case Management Award Winner

… A 45-year-old manager of an auto repair company was assisting an employee when a vehicle he was standing near fell off a lift and onto his foot, creating an open fracture of his large right toe with bone puncturing skin. The injured employee was …
News Release

More States Pass Opioid Prescribing Limit Laws—Congress Also Weighs In

… passed HB 86 , limiting the initial opioid prescription for an opioid naive patient to a seven-day supply. An opioid naive patient is described as a patient who has not been prescribed any opioid for the … cancer or palliative care are excluded from the limit. Also excluded are patients receiving an opioid to treat opioid abuse or dependence. The bill was signed by the Governor on March 21, … for opioid naive patients in acute pain situations to a seven-day supply. Wyoming defines an opioid naive patient as an individual who has not received an opioid in the past 45 days. This …
Article

From FNOL to Settlement: Improving Third Party Claims with Data Driven Decisions

… of the way to improve outcomes for the insurer and the claimant. The ideal arrangement is for an adjuster to work out of an expert workspace that complements the claims management system by providing smarter guidance … Within their workspace, an adjuster should have access to an evolving picture of the claim as it develops comprised of key data from FNOL, vehicle damage … to the accident potentially helping insurance companies improve outcomes. By having access and an integrated analysis of damage data, adjusters can get a better picture of the overall claim. …
Article

Specialty Solutions Spotlight: Translation, Transcription and Interpretation Services in Workers’ Comp

… language. Given this, it’s not surprising that communication in multiple languages can play an important role in injured employee recovery. Getting hurt on the job can be a very stressful … medical provider communicate efficiently regarding care. When using translation services like an interpreter, all parties involved need to be in sync. It is important to set the tone at the beginning of the process. Follow these tips when preparing to work with an interpreter in workers’ comp: …
Blog

Look for a Broken Spirit, Not Just a Broken Bone

… someone gets hurt on the job, the workers’ compensation system is often adept at zeroing in on an injury and delivering timely care. But that well-intentioned focus on a patient’s physical … ones, which might be harder to spot. Today, a comprehensive approach that identifies and meets an injured worker’s needs is more important than ever because the coronavirus pandemic is … adjusters and case managers consider the whole person and scan for behaviors that could signal an injured worker is having trouble managing the attendant stress of an injury. As with the need …
Author

Shahin Hatamian

… compensation solutions. With over 20 years of high-tech industry experience, Shahin has an extensive and proven knowledge of product development, marketing, organizational leadership, business strategy, partnerships and global business. Shahin holds an MSEE and an MBA. …
Blog

Strong networks in conjunction with a solid care model provide pathways to address injured worker mental-health challenges

… Products, Coventry. Kate has over 20 years’ experience in the healthcare industry with an emphasis in network development and leadership as well as being a contributing author to … than obesity and smoking. There is ample evidence that mental-health assistance can play an important role in a worker’s recovery. Where things get less clear is determining what behavioral-health interventions an injured worker needs to achieve success returning to work. One fundamental question centers on …
Article

What is the Coventry Outcomes-Based Network Program?

… return to work and financial outcomes when compared to their peers. When implementing an outcomes-based network program, an employer’s strategic focus shifts from unit-cost reductions to life-of-claim disposition. Partnering with Coventry means working with an organization that is committed to identifying those providers who have been associated with …
Blog

No doctor, no problem

… to have to give treatment. Following that same trend, pharmacists are also moving towards an expanded scope or practice by promoting additional formal education, licensure standards, … of CCCs, like extended hours of operation, convenient locations, ability to walk-in without an appointment, and shorter wait times than most clinical facilities. Customers can also do … all injuries or illnesses can be treated at a CCC, it’s still a great alternative to going to an emergency room when the situation isn’t emergent. Plus, since the majority of CCCs are staffed …
Article

Six Questions with Olivier Baudoux on Automation in Claims and Collision Repair

… the consumer experience so everything we do is centered around this mission. After an accident, it can take anywhere from a few days to potentially weeks or months to get … journey, from the time a person first notifies the insurance company that they’ve been in an accident to the post-repair diagnostic scan before the repaired vehicle is returned to its … and collision repair facilities have to sort through so much information to accurately build an estimate, there’s just a big opportunity to improve the process. …
Article

5 Must-Know Home Modification Tips

… Managing an injured employee’s transition back to daily life involves more than just overseeing their … An occupational therapist usually conducts an early evaluation to identify the injured employee’s key needs. Considerations might include … housing market or properties that aren’t suitable for necessary modifications. Partnering with an experienced home modification coordinator can help mitigate challenges, ensuring that the …
Article

Medicare Secondary Payer Updates

… choices possible by providing them and their representatives with the opportunity to select an option for meeting future medical obligations that fits their individual circumstances, while … obligations will keep you informed. In other Medicare news, on November 18, 2019 CMS issued an important reminder for Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs) … Act (MMSEA) NGHP RREs are not required to resubmit Section 111 Claim Input records with an MBI where they previously reported using the beneficiary’s HICN.  If the RRE wants to update …
Article

Medicare Secondary Payer Updates

… choices possible by providing them and their representatives with the opportunity to select an option for meeting future medical obligations that fits their individual circumstances, while … obligations will keep you informed. In other Medicare news, on November 18, 2019 CMS issued an important reminder for Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs) … Act (MMSEA) NGHP RREs are not required to resubmit Section 111 Claim Input records with an MBI where they previously reported using the beneficiary’s HICN.  If the RRE wants to update …
Author

Wayne Krause

… roles as technician, teacher, business owner and insurance claims expert. Considered an authority on most automotive topics including repair techniques and diagnostics, he is an active member of many industry boards and committees. Wayne is also the California state chair for I-CAR and an instructor in the Southern California region. …
Article

Focusing on a Physical Work Injury Could Mean Missing a Mental Health Challenge

… When an injury occurs employees place trust in their employer to provide reliable claim professionals, … the mental health challenges that often go hand-in-hand with a physical injury. Identifying an injured employee’s comprehensive needs is more important than ever. Compounding stress can … active listening and behavioral coaching can facilitate improvement  Talk therapy can serve as an appropriate treatment for mental health obstacles …
Article

Bridging the Gap for New Adjusters with Innovative Tools

… This innovative tool features an outline of the human body shaded in blue, helping adjusters to visualize and comprehend medical claims more effectively. By breaking down complex medical information into an easily understandable format, the Blue Man becomes an invaluable resource for newcomers. Here’s how it works: … When an adjuster reviews a claim, the Blue Man highlights the injured area of the body in blue. This …
News Release

Enlyte Announces Winners of 2023 Heart of Case Management Awards

… across the country. The national program recognizes four case managers of Genex Services, an Enlyte company, who have made the greatest impact on the injured employees they served, and … than ever,” said Tim Howard, SVP, field case management “Not only do these professionals play an essential role in helping injured employees get back to work, but they also provide services … Among this year's winners is a case manager who used her critical thinking skills to allow an Amish builder to return to function following a spinal cord injury. Another uncovered a …
Article

From Airbnb to Uber: How Peer to Peer Insurance is Transforming the Insurance Industry

… If you’ve ever taken Uber or stayed in an Airbnb, then you’ve participated in the peer-to-peer economy. Interestingly, Uber, which was … steps in to meet the need with its share of retained premiums and reinsurance. But if there’s an excess of premiums in the pool, the funds are returned to individual contributors, used to … in the insurance industry. Friendsurance , founded in Germany in 2010, while not technically an insurance company—it operates as an independent broker—was the first company to put the model …
Article

Specialty Solutions Spotlight: The Significance of Tesla in MRI

… What does tesla signify in the context of an MRI scan? Magnetic resonance imaging (MRI) is effective for visualizing injuries involving … vessel issues, joint or tendon injuries and brain injuries from trauma.  MRI works by running an electric current through coiled wires, generating a brief magnetic field within the body. A … the International System of Units (SI), was named after scientist Nikola Tesla. The quality of an MRI machine relies heavily on its magnet strength. Greater magnetic strength leads to improved …
Article

Six Key Concepts in Pharmacy Benefit Management

… From the onset of a claim, an injured worker most likely will need medication – whether that is pain medication, antibiotics … a PBM provides adjusters insight into what medications the individual receives. If there is an issue with the medication being filled, such as an off-formulary fill, then the PBM blocks the medication from being filled until the adjuster is … claim. When a PBM is able to utilize technology such as predictive analytics , it can provide an adjuster with insights into potentially problematic claims before they become an issue. In …