Correct Medical Diagnosis Keeps Employer from Feeling the Pain of a Mod Increase
See how a water and sewer pump company avoided a costly workers' comp claim through expert assessment. Our quick action and independent nurse evaluation correctly identified a medical complication, saving the employer over $21,000 in potential costs and preventing an 8-point Experience Mod increase. Learn how proper claim investigation drives significant savings.
Business
Water and sewer pump company and employs 27, locally. There are additional employees in two other states as well.
Situation
An employee had undergone gall bladder surgery in late January. He was released back to work full duty (without restrictions) three weeks later. On his second day back to work, this employee was moving some cross ties and herniated his healing surgical incision, necessitating further medical and surgical interventions.
Assessment
Began investigating this claim and determined further assessment was necessary. An independent Registered Nurse with experience in occupational injuries was engaged and began an investigation. After reviewing the circumstances of this injury and speaking with the employer to get specifics about the employee’s recent abdominal surgery, the nurse concluded that the herniation was a result of complications from the surgery.
Solution
The independent nurse alerted the carrier to this determination and the claim was denied under Workers’ Comp. The carrier agreed that this herniation was a complication of and was directly related to the recent abdominal surgery. The claim was instead submitted to the employee’s health insurance plan for coverage.
Result
This claim was closed in less than three weeks, saving the employer the cost of medical care and potential future wages. Disability guidelines report that a typical uncomplicated incisional hernia costs an average of $21,102 ($10,001 in indemnity and $11,101 in medical expenses). Had this claim been accepted under Workers’ Compensation, it would have increased the employer’s Experience Mod eight points, or a total of approximately $15,000 over three years (based upon the rate & payrolls remaining constant over the three year period).
Don't Just Take Our Word for It! Real Businesses, Real Results
David, I just can't thank you enough to finding and returning to us the $27,438 in overcharges from our last two years of audits. I only wish we had been allowed to go back to the prior years to recover money. More importantly, you provided us with a process so that we can avoid being overcharged in the future by the insurance companies.
I just cannot thank you enough for helping us to take control of our work comp. In addition to making my life easier by helping to manage our claims, your team helped us create a very strong safety culture. Our injuries are down significantly, but more importantly, you helped reduce our work comp premium by over $80,000 a year.
David, you and your East Coast Risk Management team blew us away. First, your team recovered over $42,000 in overcharges that my agent allowed to happen. Second, over the next 7 months you overhauled our safety programs and hiring process. Your injury management team minimized a potentially uncontrollable and ugly claim which would have cost us tens of thousands of dollars in additional premium and rehiring costs. Third, your negotiations with our insurance company resulted in an additional $49,387 (44%) reduction in my workers compensation renewal premium. We figure you have added over $100,000 to our bottom line in just 1 year. Thanks!!!!
Throughout David’s career he has always been on the forefront of thinking. His understanding of insurance and specifically workers' compensation allow him to see things and establish practices that others eventually follow. David takes an entrepreneurial approach to problem solving resulting in both savings and added protection for his customers.
I first became acquainted with David’s knowledge of Workers’ Compensation when I attended a seminar in 2007. I took the opportunity to meet with David to discuss better ways we could handle not only our Work Comp claims, but how we needed to drastically overhaul our HR processes. The Benefits have been multitude. I have great confidence in ultimately can make a company more profitable.
9 months ago I hired Duncan and their East Coast Risk Management to implement their Risk Solutions Program. As a result, I just saved $57,494 on my insurance renewal - That's 42%. Duncan met with me and my employees, toured my facility and put together an aggressive Risk Solutions Business Plan. They started implementing immediately and are in our plant several times each and every month.
David Leng is very knowledgeable about Workers’ Compensation and a pleasure to work with. His knowledge allowed our company to reduce its Workers’ Compensation premiums by almost 55%.
Working with Duncan we were able to enhance the safety culture in our organization and reduced our Workers’ Compensation costs by over $300,000 a year.
Duncan found that my experience modifier was WRONG!!!! Not one of over a dozen plus agents that I spoke to previously saw that! They were able to get my experience modifier corrected, and force my insurance companies to return over $86,000 to me! They leveraged what safety changes they implemented and obtain an insurance policy at our renewal that was over $100,000 lower. In a span of 4 months, they put almost $200,000 back in my pocket!
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