Workers Compensation Claims
OneBeacon handles Workers Compensation claims in California directly through our Los Angeles office. Workers Compensation Claims in the states of CO, CT, GA, MA, MN, NJ, NY, PA and VA directly through our Denver office. For claims in the remaining states, OneBeacon has retained third-party administrator Gallagher Bassett. Gallagher Bassett is the largest property/casualty third-party administrator in the country as of 2010 and was named “Best Property/Casualty Third-Party Claims Administrator” by the readers of Business Insurance in the years 2008, 2009 and 2010. Deborah Schoen-Cruz 781.332.9710, oversees the claims handled by Gallagher-Bassett. Cindy Van Eyll 952.852.0828, manages workers compensation claims.
Our knowledge and expertise – combined with a powerful coverage solution – can help prevent injuries to your employees by promoting safe operations and help protect your business by effectively addressing injuries when they occur. To manage workers compensation costs once injuries occur, we recommend:
- Prompt, caring responses to injuries.
- Channeling injured employees to appropriate medical providers.
- Immediately reporting the claim to OneBeacon.
- Providing transitional duty options for a prompt return to work.
- Containing medical costs.
Adopt a formal program for both point-of-injury response and post-injury follow-up and contact. This includes displaying a positive and concerned response to an injury and maintaining regular contact with the employee until he or she is back on the job.
Channeling to Medical Providers
Promote and publicize your Medical Provider Panel before workplace injuries occur. Ensure your Supervisors and Managers are familiar with the designated medical providers and train them to recommend the Occupational Medicine provider for initial care in non-emergency situations.
On-the-job accidents can occur despite an employer’s best efforts to avoid them. In the event of an injury, it is critical to report the claim immediately. Early reporting means earlier care and more controlled costs. For guidance with reporting a claim, use our Workers Compensation Reporting Checklist.
Return to Work
OneBeacon manages workers compensation claims to promote your employee’s recovery and quickest possible return to work. OneBeacon also works directly with employers to return employees to transitional work whenever possible. Getting injured employees back to work is our primary focus.
Medical Cost Containment/Pharmacy First Fill program
- Management of the medical expense portion of a claim is critical. Medical claim costs can escalate quickly, so OneBeacon works with key partners to deploy a full array of cost containment programs. These programs begin immediately after an injury occurs and will continue as long as treatment is medically necessary. Our cost containment programs include:
- Preferred provider organizations:
We utilize the Coventry PPO in all states except KY, LA, NJ, NY and TX.
- To look up providers, please visit: www.coventrywcs.com.
- Select “Client Login & Tools” in the top right center of the homepage. Type the Client ID of BEA and select the arrow to the right of the field. Select channeling tools which will display The First Health Network. To select providers by name, select the Name Search Option. The region search allows you to search for providers by geographic regions such as city, county, zip code, etc.
- The requirements for CA employers effective 7/01/14 can be found in the publication: OneBeacon-Coventry CA MPN information.
- The MPN provides MPN Medical Access Assistants within the United States who are available Monday – Saturday, 7:00 a.m. to 8:00 p.m. Pacific Time to provide employee assistance with access to medical care under the MPN.
For NJ and NY, we utilize the Procura Network.
- To look up providers, go to www.procura-inc.com
- Select “Find a Doctor, Hospital or Facility” from the Quick Links on the right-hand side of the homepage.
- Select “Workers Compensation” as the Search Type.
Regulatory restrictions prevent us from broad PPO utilization in KY, LA, and TX.
- For CA, CO, CT, GA, MA, MN, NJ, NY, PA and VA, our Pharmacy Benefit Manager is TMESYS. To locate participating pharmacies, please visit www.tmesys.com
- For all other States the Pharmacy Benefit Manager is FirstScript. To locate participating pharmacies, please visit: www.firstscript.com/pharmacy
- Telephonic nurse case management: Our telephonic nurse case management program is designed to make sure the claimant’s medical treatment is proceeding suitably for his or her injuries, resulting in enhanced medical care, cost-effective medical treatment, and the earliest possible return to work. Our collaborating professional nurses work closely with insureds, claimants, their physicians and our work comp claims professionals to establish and implement return-to-work programs for claimants who have suffered serious injuries.
- Catastrophic injury management: OneBeacon partners with a vendor specializing in the management of catastrophic injuries to see that the most challenging injuries receive coordinated medical treatment and quality, cost-effective medical care.
- Hospital bill review: Through our hospital bill review program, we review hospital bills for accuracy, necessity of services, questionable charges and duplicate billing.
- Provider bill review: To help manage the ever-increasing cost of medical care, we employ several cost control methods, including the use of a sophisticated medical bill review program. We partner with a leading bill review vendor, which allows us to leverage their state-of-the-art bill review system to help prevent duplicate payments, avoid payment for unrelated charges and reduce medical payments to appropriate amounts.
- Utilization review: OneBeacon utilizes a program providing expert review and consultation with doctors and nurses regarding the appropriateness, timeliness, and cost-effectiveness of proposed medical treatment for in-patient and out-patient services.