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Employers diverge on handling workers compensation claims

Posted On: Oct. 29, 2014 12:00 AM CST

ANAHEIM, Calif. — Self-administration of workers compensation claims can be a favorable option for health care organizations to track how their workers are being treated.

At the same time, third-party administrators can aid health systems that manage comp claims in multiple states, workers comp claims managers said Wednesday during a panel discussion at the American Society for Healthcare Risk Management's annual conference.

Patrick Venditti, executive director of BJC Corporate Health Services in St. Louis, the risk management division of St. Louis-based BJC HealthCare, said the nonprofit health care provider used a TPA to manage workers comp claims before 2005. But it moved to administering its own workers comp claims because it allowed the parent of 12 hospitals and other medical facilities to effectively treat injured workers and reduce its costs, while the TPA previously focused primarily on costs, he said.

“Being in a health care setting,” Mr. Venditti said, “we are aligned with our physicians, we get to know a lot of physicians within the system.” The health care provider is self-insured, and has 28,000 employees and about 5,000 volunteers eligible for workers comp, he said. “So we partnered with them and the goals that we have are aligned to get the best care we can for those patients.”

Dan Nicholson, director of integrated disability management at Sutter Health in Sacramento, California, agreed that self-administration has been favorable for his company, which is self-insured and has about 50,000 employees.

“When you're self administered in a health care setting, your goal is patient care,” Mr. Nicholson said. “That's … drilled down to the people in our claims staff because we're all there to facilitate care at the bedside. And to do that effectively, we need to make sure our injured clinicians get good, effective medical treatment and they get back to work as soon as practical.”

Suzann M. Bylund, senior director of associate risk management programs at Ascension Risk Services in St. Louis, the risk management division of Ascension Health, said the health care provider's workers comp claims are administered by Sedgwick Claims Management Services Inc. Sedgwick has adjusters who work exclusively on Ascension claims at the health system's offices, and Ms. Bylund said they are treated as part of the Ascension staff.

Working with a large TPA has helped Ascension manage the nuances and legal changes in workers comp systems across the country, Ms. Bylund said. The health system, which is self insured, has 155,000 employees in 23 states and Washington.

“We've found it to work very well just because of the sheer size of the program,” she said.

Mr. Nicholson said organizations that use TPAs to manage workers comp claims should follow Ascension's example by integrating TPA claims handlers with internal staff.

“Make sure that you treat your claims staff like they were one of your own employees,” he said. “Treat them well, recognize them when they do good work... and don't manage them with a hammer because it doesn't work.”

Mark Walls, vice president of communications and strategic analysis for St. Louis-based workers comp insurer Safety National Casualty Corp., moderated the panel

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