Leaders Speak

Many years ago, a colleague taught me the concept of Moral Hazard (MH) and its application to injury claims. The definition of MH in essence is a situation where a person is protected from risk in some manner and as a result behaves differently in certain situations. More broadly, I find it useful to think about MH in the context of how a particular system’s presence may impact… [Continue Reading]

Accessing a workers’ compensation network has become an integral part of virtually every risk management program. While adjusters, nurses and others usually attempt to channel to network providers when permitted by law, many times the goal seems to be focused on obtaining a retrospective discount for services rather than prospectively selecting the provider who is… [Continue Reading]

The average cost of both medical and lost time claims continues to escalate driving both payors and employers to focus in more detail on the relative return for specific administrative expenses along with the underlying factors contributing to higher overall costs. As this focus has intensified, it has become imperative for workers’ compensation organizations to have… [Continue Reading]

The Mandatory Insurer Reporting (MIR) process is complex and affects multiple data sources and processes within the claims management process. The risk and cost of achieving compliance with MIR requirements has elevated this issue to the very top decision making levels of payer organizations. With penalties of…[Continue Reading]

Maximizing network penetration is one of the ways a PBM program can manage workers’ compensation pharmacy costs. The higher a PBM’s network penetration rate, the greater the opportunity to gain insight into utilization patterns and to control costs. The problem with relying too heavily on this type of performance indicator is that there is no standard… [Continue Reading]

First, a disclaimer before risking making a total fool of myself. My only in-house claims management experience was the five years I spent with a large reinsurance company as an orthopedic consultant helping them manage long-term disability claims….something I really enjoyed. As we all know, workers’ compensation (WC) is a different organism. [Continue Reading]

My first rotation as an intern at the University of California, San Diego was the emergency room (ER) – a three-month immersion no less! I was now an M.D., and had to figure things out in a hurry. In retrospect, it was a great jumping off point…As I view the landscape in retrospect, too many times the IMEs or peers I have performed were done long after the claim has “jumped the track.” [Continue Reading]

In a previous article, I questioned that lawyers stopped practicing law when it came to MSP compliance issues. In an industry whose entire premise is risk management, I also have frequently questioned where are all the risk managers and actuaries. But then it dawned on me that they probably don’t fully understand…[Continue Reading]

I am interested to know how many readers thought this article would be about what MSAs are or their mysterious appearance in 2001. The mystery I chose to write about is the one that has had me stumped since the publication of the infamous Patel Memo, and that is when did workers’ compensation lawyers stop practicing law? For all the angst endured during…[Continue reading]

Medical diagnostic imaging encompasses many expensive testing procedures, including MRI and CT scans, representing one of most integral components in medicine and certainly one of the fastest growing healthcare expenses in the United States Workers’ Compensation sector. [Continue Reading]