How To Get The Most From Your Workers' Comp Third Party Administrator

The old saying “the squeaky wheel gets the grease” is appropriate when describing the best way to get cost-saving results from your workers' compensation TPA.  That's not to say that TPAs simply do nothing for your company unless you make some noise.  However, high volume is the way TPAs make money, so your claims representative may handle a couple thousand companies other than yours.  There are several ways to make your company a priority with your assigned claims representative.

First, make friends with your claims representative.  He or she does not have an easy job juggling cost control for hundreds or thousands of clients every day.  Depending on the size of your company and volume of your claims, give your TPA representative a call every week or every other week just to touch base and discuss strategies for active claims.  When you speak with your claims representative on a regular basis, there should not be any surprises when the BWC sends your premium notices. 

Next, set some larger goals to be met quarterly or semi-annual for both your company and your TPA to reach together.  For example, your company can strive to report injuries to your TPA within 24 hours to ensure early cost control intervention while your TPA can promise to review all your lost time claims for handicap reimbursement or settlement evaluation.  Ask your TPA what you could be doing to make their job easier.  Something as simple as returning phone calls or e-mails in a timely manner can make all the difference to the management of your claims.  Your TPA must file most appeals within 14 days, but they can't file appeals without your approval.  If you don't return a simple phone call to your TPA, you might have just bought your company a costly claim.

Finally, know your TPA's limits.  There are just simply some things that a TPA is not supposed to handle.  If your company has a particularly contentious or complicated claim, your TPA hearing representative might not be your best choice to handle a hearing before the Industrial Commission.  Be cautious of TPAs that market the fact that they have attorneys who handle their hearings.  The TPA's hearing representative may well be a licensed attorney, but because that attorney is an employee or contractor for a TPA, they are not allowed to practice law before the Industrial Commission.  Additionally if an injured worker files a Violation of Specific Safety Requirement or appeals an issue into the court of common pleas, you will need legal counsel right away.

Frequent, respectful, and open communication with your TPA is the best way to ensure that your workers' compensation claims are being managed appropriately.  Never assume that your TPA is or is not taking specific action on your behalf.  Your relationship is a partnership; your company does not simply turn over the responsibility to the TPA for managing claims. 

The Frost Brown Todd LLC Labor and Employment attorneys can help your company handle workers' compensation matters for which your TPA might not be best equipped.

Posted by: Noel C. Shepard

Categories: Workers Compensation