By Johnny Meyer, Settlement Advisors Manager, Ametros
Legacy cases may be the bane of your existence. You might have a case in particular where you know the injured worker is frustrated with the workers’ compensation system — the scrutiny, the providers, the delays, the denials — and yet he shows no interest in settling. You know because the adjuster asks him every few months. And yet, his claim continues for years.
To settle these claims and get them off the books requires more than perfunctory communication; it involves putting yourself in the shoes of the injured worker — understanding his particular situation, his needs, and, especially his fears. Increasingly, workers’ compensation payers are using outside neutral third parties to do this, and they are helping to settle legacy claims in a manner that is a win-win for all parties involved.
Barriers to Settlement
There are myriad reasons injured workers won’t settle their claims, but the overarching one is fear of change and the responsibility of managing one’s own medical care. Some of the most difficult cases to settle are those where the injured worker needs the ongoing, future medical treatment.
Imagine your life suddenly turned upside down because of an injury. In addition to the pain you’re having, you are at the mercy of a complicated system you don’t understand. But after a while you become familiar with it enough to have some sense of security. You know your medical care will be taken care of, despite some denials of treatment and headaches that may come with the territory. You know you you’ll have some additional money coming in to help pay your living expenses and take care of your family. And you know that there is someone — the adjuster, case manager, or attorney — who communicates with you about your situation, even if it is infrequently, and only by email. At least there is someone with expertise helping you out. You know there is someone that can help you navigate the complicated healthcare and workers’ compensation maze.
Settling a claim means the injured worker is on his own; to find his own providers, buy his own medications, navigate Medicare issues if he is a beneficiary, and manage the settlement money to cover his medical treatments and ensure it won’t run out too soon. Many of these injured workers don’t want to settle because, as much as they may detest dealing with the workers’ compensation system, their anxiety over going it alone is stronger. Rightfully so, some of these injured workers have become creatures of habit, preferring the safety net of the workers’ compensation system as opposed to taking a perceived risk by settling the claim.
Fortunately, there are advocates available to guide these injured workers through the post settlement process, and at minimal cost to them. Professional administrators are outside and neutral organizations brought in specifically to work with the injured worker who has settled his claim.
Professional administrators act as facilitators during the settlement process, and are typically only paid if a case settles.
Administrators are care advocates post-settlement, working for the injured worker. That means they handle every aspect of medical care after settlement; from helping the injured worker maximize the settlement money through medical discounts and finding providers that are convenient and appealing to him, to handling the burden of Medicare reporting and protecting other government benefits that may affect the worker.
Having reached a settlement means the injured worker is free to see any medical provider he wants, and there is no utilization review or denials of treatment. Professional administrators with strong provider and pharmaceutical networks can offer discounted costs, saving money for the injured worker. The role of the professional administrator is to make sure the injured worker is using his settlement dollars appropriately, and to handle administrative burdens, which the injured worker would otherwise have to do. The goal is to help the injured worker move on with his life and be as productive as possible.
Steps to Settlement
Often times, adjusters, attorneys, and risk managers engage an administrator on claims they cannot move toward settlement. Once the professional administrator gets information about an injured worker, the first order of business is to reach out, educate and build a relationship with him. Many of these injured workers have had little if any direct contact with anyone involved with the claim for years. Aside from the occasional email or phone call, they typically see no one. Calling the injured worker and offering to go see him can be a tremendous ice breaker.
The professional administrator should understand the fears of the injured workers and develop a level of trust. The injured worker needs to understand that they can get a fresh start, out of the workers’ compensation bureaucracy, but with a high level of support. It’s often helpful if a representative from the administrator explains the post-settlement process to the injured worker and how seamless it will be; that Medicare reporting requirements will be met, that someone will help them manage the money, and that discounts for medical care are available.
Beyond that, the most successful professional administrators are those who can think outside the box. In getting to know the person they need to do some fact finding and see how they can help.
It’s about building rapport and truly being an advocate for the injured worker. That involves doing some legwork to understand and be able to meet the worker’s true needs and desires. It’s about building the relationship from the ground up and being sincere about it.
There are times when the professional administrator’s best efforts just won’t work. Sometimes, the issue holding up the resolution of a case is still ongoing or the injured party simply has unrealistic expectations. For instance, if the settlement offer is $200,000 and the injured worker is insisting on $2 million, there might not be a successful resolution. Usually, however, a qualified professional administrator can really help move a legacy claim to settlement. Since there is no cost upfront, on many cases, it’s worth a shot!
About Johnny Meyer
Johnny is the Settlement Advisors Manager with Ametros, working to provide all parties with an innovative solution to settlement. He places a high focus on business development while concentrating on care and compassion for injured parties.
He brings over a decade of experience working in business development, marketing, and customer service and obtained his B.A in Sports Management with a minor in Business Management from Salem State University. He’s passionate about volunteering with the Make-A-Wish Foundation & animal shelters, traveling, cooking, and sports.
Ametros is the industry leader in post-settlement medical administration. Founded in 2010, Ametros is changing the way individuals navigate healthcare by providing them with post-settlement medical management tools for their settlement funds. Ametros offers its members integrated medical administration tools and reporting, seamless and automated payment technology, and access to significant healthcare discounts for pharmaceuticals, provider visits, and medical equipment.
Ametros has become a trusted partner for thousands of members receiving funds from workers’ compensation and liability settlements. Ametros also provides solutions for all parties in the settlement process, including plaintiff attorneys, insurance carriers, employers, third party administrators, and structured settlement brokers. With its core products, CareGuard and Amethyst, Ametros enables its members to approach settlement and lifelong financial and medical management with confidence and security. Ametros’ services are frequently useful for settlement recipients needing help administering a Medicare Set-Aside, but can be used to help administer any allocation of self-pay medical funds.