WORKERS COMPENSATION AND GENERAL LIABILITY CLAIMS ADMINISTRATION
Millennium Risk Managers specializes in the administration of workers compensation claims and general liability claims administration for large self insured employers and large state association general liability and workers compensation group pools.
Millennium Risk Managers has a long history of taking pride in the fact that we are Alabama owned company that specializes in administering only Alabama workers compensation claims and general liability claims for only large corporations doing business in Alabama.
Some think that the above philosophy is self limiting; however, the companies that do business with Millennium Risk Managers take heart in the fact that the business that they conduct within the State of Alabama and the corresponding risk associated with their geographic business are extremely well protected within this state by Millennium Risk Managers solely due to the fact that we know our state risk environment.
When a company does business in this state and they allow for their financial risk to be handled by a larger administrating company, what they generally get is paper pushing. Our company knows which judges to watch out for, which doctors to watch out for, which case management companies to watch out for, which private investigating companies to watch out for and which employees to watch out for, etc.
Our programs for claims administration are not paper cut from a large geographic profile; rather, they are county and state regionalized to optimize the correct lawyers, doctors and hospitals’ talents to the benefit of the financial bottom line of our clients’ financial records while at the same time making sure that our companies’ employees are given the best care possible within the United States of America.
Alabama is one of a handful of states that allows the employer to choose the authorized treating physician for the company’s injured employees.
The following gives summaries of our philosophy and programs to give quality of care and quality of caring for our employees together with programs that will minimize the day to day medical cost and the ultimate litigation cost derived from a workers compensation claim by employers operating within the State of Alabama.
Millennium Risk Managers conducts internal claims audits on a monthly basis by the Senior Claims Administrators of each department to verify that all claims administration benchmarks are maintained for each client. This internal audit process is designed to identify any flaws within the claims administration system including the medical bill adjudication system prior to any outside audit. Each file is designed and maintained for the purpose of easy outside audit accessibility.
The Senior Claims Supervisors conduct a 15 area internal claim audit on internal files monthly to ensure that all of the “Best Practices” are being maintained on a consistent basis.
All adjusters must attend a minimum of eight (8) hours of outside training per year. All adjusters are licensed with the State of Alabama Department of Industrial Relations.
The in-house attorneys must attend a minimum of twelve (12) hours per year of continuing legal education and generally, on average, have 24 hours of continuing legal education.
All management staff must attend at least two (2) management training seminars per year.
Millennium Risk Managers believes in a team concept that encompasses the entire claims administration process. This team concept envisions the account having as much input into all aspects of the decision making process as determined by the account. For example, Group Fund Administrators are given the opportunity to participate in the interviewing and hiring process of the adjusters that are dedicated for that particular group pool and they also participate in salary ranges for senior claims staff positions that are dedicated to that particular group pool.
CLAIMS INVESTIGATIVE PROCESS
Each lost time file is reviewed by the Millennium Risk Managers’ General Counsel prior to the assignment of the case to the designated adjuster. This initial legal review is conducted to provide initial instructions to the adjuster and it provides an initial legal review based upon the fact situation as to the compensability of the claim or compensability questions of the claim as it relates to the Alabama workers compensation Statute and current Supreme Court decisions which have been handed down interpreting the specific sections of the Alabama workers compensation Statute. This is critical in Alabama to have each file reviewed by an attorney that is specialized in only workers compensation law and this review provides a “safety zone” for the potential denied claim as it relates to outrageous conduct lawsuits in the State of Alabama.
After the initial legal review and the identification of a potential fact situation which justifies a full denial of benefits or a particular denial of benefits, Millennium Risk Managers’ policy is to retain (on behalf of the client) a private investigator to take an onsite statement of all witnesses and the claimant at the very outset of the claim. This is critical that the statement process be conducted by an outside source (for an unbiased statement taking process to eliminate the credibility issue in the event of trial) and at the very beginning so that the claimant cannot, at a later point, come up with a new fact or a new body part that he or she claims was involved in the work comp incident. Employees who are experienced at malingering understand that as the authorized treating physician is about to place the employee at maximum medical improvement they will (1) identify to the doctor a new part of the body that is now involved and (2) request a panel of four physicians in an attempt to remain off work. It is the initial statement process that is utilized by Millennium Risk Managers to combat the migration of the injury with a new doctor.
Once the medical records are obtained and the statements are obtained, Millennium Risk Managers is in a position to make a recommendation to the client as to whether the claim should be accepted or denied in full or partially and the client will make the final decision based upon the recommendation of Millennium Risk Managers.
The client designates Millennium Risk Managers’ authority level; however, it is our recommendation that no authority level be given to any third party administration company and that the account be involved in every decision in settlement, mediation and litigation decisions.
A narrative report is provided for each claim that has a total incurred of $50,000 or more (this report can be initiated at any total incurred level determined by the client; however, it is recommended that the narrative report to be initiated at a $75,000 total incurred point). This report is produced every three months and is vital to loss control, actuaries and pool administrators.
OUTSIDE AUDITORS AND CONSULTANTS
Millennium Risk Managers is a strong advocate in the outside claims audit process. Each file is maintained and designed for the outside audit process and Millennium Risk Managers strongly urges the account Administrator to hire an outside claims audit firm to conduct a claims audit at a minimum of one time a year and preferably two times a year.
OVERALL POOL RESERVE REVIEW AUDIT
During the month preceding the beginning of a new fund year, MRM’s legal staff and the account’s top administration staff meet over a two to three day period and review every open and reopen claim pending for all years.
During this review, all of the adjuster notes are reviewed by claim together with the outstanding reserves for each reserve type bucket and compare those outstanding reserves to the past twenty four month payments out of each reserve bucket to ensure that we have proper reserve trending and proper reserves established on each file prior to the financials being reported to the actuaries at the beginning of the fund year.
This process is critical to make sure that the reserves maintain a historical level funding as well as to identify trends in cost mechanisms as well as to ensure that the adjusters are properly implementing cost containment programs that have been developed and implemented for the overall pool’s financial integrity.
DIVIDEND CALCULATION AND DIVIDEND RESERVE AUDIT
If the group pool pays dividends, whether it is by check or front end billing discounts, MRM’s software calculates the dividends and MRM’s claim system has the capability of printing off the dividends checks or placing the dividends on the billings as front end billing discounts.
Prior to the calculation of the dividends and the designation of the members who will receive the dividends, MRM undertakes a reserve audit for all open and reopen claims to make sure that the proper loss ratios, by member, are established for the years that the dividends are to be paid from for any given dividend declaration periods.
INTERNAL MODIFICATION FACTOR CALCULATION
Millennium Risk Managers has the software capabilities of computing each fund member’s Modification Factor internally. MRM’s software as well as the timing of data calculations follows NCCI rules and regulations. Correspondingly, we take the data as of the six months preceding the year of calculation and we utilize the loss data for the three years as of that six month snapshot time period as per NCCI’s regulations.
If the account has NCCI calculate the Modification Factors, this same process of reserve reviews are undertaken prior to the electronic submission of data to NCCI.
PREMIUM BILLING AND UNDERWRITING
Millennium Risk Managers’ underwriting team meets with fund administrators and loss control departments approximately two to three months before fund year renewal. We review experience mods, loss history, payment history, safety programs, etc. for each individual fund member to determine discretionary discounts to be applied to each individual fund member.
This process produces a preliminary billing for each member that is based upon accurate loss control information and loss data information. This produces a preliminary billing that assists the fund administrator in making sure that there has been a proper billing for each member to make sure that the members who have implemented strong loss control and good communication on claims that have resulted in excellent loss history by member are maintained in the billing process.
Millennium Risk Managers has a very sophisticated billing system and Millennium Risk Managers inputs all payroll audit information (whether it be secured by self audits or onsite payroll audits) and inputs all payroll data by member by class code together with the appropriate discounts and mod factors that have been derived from extensive preliminary audits and reviews and produces the proper billings which are mailed out by MRM.
MRM records and maintains on its sophisticated billing receipts software all payments that have been received as well as maintains all delinquent members’ status tighter with 30 day cancellation notices as well as official cancellation notices to the fund member, the fund administrator and to the State.
FUND ADMINISTRATOR AND MRM POLICY ADMINISTRATION STAFF MONTHLY MEETINGS
MRM’s Policy Administration staff (which is fully bonded) has extensive training, twenty years experience in payroll coding, billing and excess carrier billing, reporting, collections and electronic reporting to NCCI. If the account reports to NCCI, MRM’s Policy Administration staff has extensive training in proper electronic reporting to NCCI which is critical as it relates to the participation in reporting to NCCI’s database requirements.
Every month, MRM will meet with the account administrator to go over payroll audit results and statutes as well as final audit billings, collections and delinquencies and go over all current year billings and premium collections.
It is at this meeting each month that the fund administrator reviews, by each member account, the premium delinquency and time of delinquency and authorizes 30 day cancellation notices and actual cancellation notices which are then implemented by MRM’s Policy Administration staff.
In addition to the above services provided by MRM’s Policy Administration staff, we also provide the following:
- Quotes for incoming members
- Provides information to the actuaries for rate studies
- Monitors volume discounts
- Posting of accounts receivable
- Depositing of funds
- Calculation of dividends
CLAIMS REVIEW PROCESS
Millennium Risk Managers is a strong, strong advocate that Millennium Risk Managers’ staff attorney and adjuster meet with the account’s largest participating members’ representative, litigation counsel representative and human resource representatives once a month to review and give claims direction on each and every pending claim against the larger pool members.
EXCESS CARRIER REPORTING
Millennium Risk Managers’ client administrative staff does all of the reporting requirements to the account’s reinsurance carrier at no additional charge or add on fee.
INSURANCE COMPANY APPROVAL
Millennium Risk Managers specializes in providing TPA services only for employers and trade associations operating in the State of Alabama and no one else.
Millennium Risk Managers has a solid working relationship with all major reinsurance carriers and is an approved third party administrator for virtually all reinsurance carriers.
Millennium Risk Managers insists on providing training to its clients so that proper reporting of claims procedures are maintained and implemented and most importantly to give training to management and supervisors as to specific claims programs that need to be implemented and understood so that the exposure level is minimized before the claim ever occurs.
Additionally, our system will help develop an action-item list and strategies, to streamline procedures and to identify areas that are hot button issues for the claims management process.
The above process helps to identify supervisory level participation in the claims reporting process as well as the claims investigation process and assists in making the supervisor of a particular department responsible for safety issues, reporting issues, and first-line safety investigation issues. It makes the supervisor responsible for that department’s cost figures.
CURRENT PENDING RUNOFF FILES AND CLAIMS DATA PRICING
Millennium Risk Managers has extensive experience in taking over existing claims that are handled by a non-related third party administrator. The account or self insured company’s leadership must decide whether to allow the previous claims administrator to maintain the existing claim files or to allow those claim files to be taken over by a new claims administrator. There are positive and negatives for either decision.
Millennium Risk Managers’ General Counsel provides oversight and initial pursuit of all subrogation interest; however, in the event litigation must be initiated or in the event any type of court appearance must be filed to protect the subrogation rights of the account and the self insured company, Millennium Risk Managers’ General Counsel will advise the account Administrator and/or the self insured company’s representative of that necessity to employ outside counsel and the account Administrator will make the final decision as to whether or not the account’s litigation attorney can be retained for the sole purpose of initiating legal proceedings to protect the subrogation interest of a particular case.
This service is included in the proposed service fee.
EXCESS CLAIM REIMBURSEMENT SUBMISSIONS
Millennium Risk Managers’ staff also pursues all reimbursements from the account’s reinsurance carrier and maintains all financial records for all excess claims and reimbursements for the financial department of the account.
MEDICAL COST CONTAINMENT SERVICES
At Millennium Risk Managers we have taken the necessary steps to offer our clients the opportunity to provide their employees with the highest level of medical care for their injuries while at the same time ensuring that this care is provided at the lowest possible cost.
Millennium Risk Managers is a founding member of AlaMed, the largest workers compensation preferred provider organization in the State of Alabama. Our accounts enjoy the reduced medical costs obtained through the AlaMed PPO at no additional charge to our accounts. This feature saves huge dollars on the catastrophic claims and is an added value/feature of our services to our accounts.
This access to the AlaMed PPO and the bill adjudication process to reduce the billed charges to the AlaMed Fee Schedule is included in the proposed claims administration fee and is at no additional charge to the account.
MEDICAL COST CONTAINMENT
Millennium Risk Managers is a founding member of AlaMed, the largest preferred provider organization for workers compensation medical services in the State of Alabama.
AlaMed has preferred provider contract status with all of the major hospitals, surgical centers, outpatient diagnostic centers, orthopedists, neurosurgeons, gatekeepers, durable medical companies, case management companies, pharmaceutical companies and surveillance companies operating in the State of Alabama.
AlaMed’s reimbursement rates to these medical vendors and specialty service vendors are far below the Alabama state reimbursement medical fee schedule.
Unlike all the other TPA’s that have a medical cost containment contract with medical vendors, Millennium Risk Managers provides these discounted medical charges to our accounts at no charge or fee associated with the cost savings on medical bills.
The accounts that choose Millennium Risk Managers to handle their company’s claims administration can literally pay for the TPA services based upon the medical savings that are given to our accounts at no charge.
Millennium Risk Managers’ bill adjudication department is onsite at our company and therefore, the adjusters have immediate access to any questions or pre-certs concerning medical payments and our company’s long standing relationship with these major medical institutions ensure our accounts quality medical treatment.
PHARMACEUTICAL COST CONTAINMENT PROGRAM
Millennium Risk Managers Pharmaceutical Program requires the account Administrator to retain two outside vendors. The outside vendors recommended for this program implementation is Dr. Tim Covington (Former President of Samford University School of Pharmacy) and a pharmaceutical formulary supplier with pharmaceutical card programs.
SITE SPECIFIC PPO LIST
Millennium Risk Managers implements a management medical protocol which identifies all vendors which will be utilized by our program including surgeons, gatekeepers, outpatient diagnostic centers, specific pharmacies, etc. These policies are encompassed in the following.
NO EMAIL RESTRICTIONS
There are absolutely no restrictions on communicating with the adjusters for the account Administrator and we encourage multiple daily communications, not only with the adjuster; but also, the accounting department, the legal staff, and the I.T. staff for trouble shooting and legal issues.
The claims data system is extremely flexible and has the capability of multiple unlimited supplemental fields for the capturing of specific loss data that is not already captured by the system.
DETAILED LOSS RUNS
All of these reports are standard reports that are provided monthly to the account at no additional charge.
Millennium Risk Managers can provide check registers as requested at no additional charge. There will be one check register submitted to the account administrator each month.
Millennium Risk Managers will set up the check printing system in MRM’s claim system so that checks can be printed for payment with a logo established by the account Administrator so that the checks will appear and be referenced to The account’s workers compensation program. There is a one-time charge for the setting up of this check template.
The account Administrator is responsible for opening up and owning the claims fund checking account because Millennium Risk Managers does not want to own any asset or appear to own any funding mechanism associated with the account’s financial exposure obligations.
All of the checks for the account administrator’s Alabama workers compensation obligations will be printed here at Millennium Risk Managers on check stock created by Millennium Risk Managers payment system that corresponds to the account’s claims fund checking account which will be owned and maintained by the account’s finance department.
SETTING OR INCREASING RESERVES – $25,000
It is the core responsibility of Millennium Risk Managers to provide an accurate total incurred exposure to the finance department of the account and it is extremely dangerous for the account Administrator to retain the absolute right to establish the reserves because the excess carrier does not like internal reserve setting by the account and the actuaries must establish the incurred but not reported reserves for the finance department will double this reserve in the event that “step-reserving” is identified from an historical perspective.
One of the best attributes that Millennium Risk Managers brings to the table is an extremely accurate ultimate total loss reserve and we do not believe in step-reserving.
Millennium Risk Managers’ standard procedure is to have a claims team reserve audit one time a year during the month that the account’s financial fiscal year ends. At this meeting, we go over all pertinent facts as known at that time and we either increase or decrease the outstanding reserves so that the finance department can have an accurate ultimate reserve figure to place on the account’s end of the year financial statements as a “contingent liability footnote to the financial records”.
Also, all reserves are examined by the claims team monthly at the proposed monthly claims meeting so that there is, as accurate as possible, monthly reserve figure maintained at all times that are based upon current known facts.
Also, as Millennium Risk Managers’ best practice, the adjuster must fill out a reserve increase sheet and present the same to the senior claims supervisor for review prior to any discussions beginning on the increase in the reserve amount.
NOTE: BOTTOM LINE, THIS AREA OF THE CLAIMS ADMINISTRATION IS EITHER STABLE OR FRAGMENTED AND IT MUST BE ESTABLISHED AND MAINTAINED AS A STABLE FIGURE FOR THE OUTSIDE FINANCIAL AUDITOR. THE ACTUARY, THE FINANCE DEPARTMENT AND THE REINSURANCE CARRIER AND THIS SHOULD BE A CLAIMS TEAM ENDEAVOR, I.E. NOT ONE INDIVIDUAL’S DECISION.
TRANSITIONAL LIGHT DUTY PROGRAM
This program is extremely important in that it is in writing.
If this program is not in writing, the account has set itself up to be sued for Wrongful Termination and for violating the Americans with Disabilities Act.
This program caps the duration or time period of light duty programs.
If this program is not in place and in writing and an employee has an injury (but not at MMI) and the doctor temporarily returns him back to work light duty an the employer accommodates him by giving the employee a very low, low, low impact job duty that is not truly within a job description and the employee stays at this job for a length of time and then the doctor places the employee at MMI with the same restrictions but now they are classified as permanent, and the employer at that point informs the employee that they cannot permanently accommodate the employee with this low, low, low impact job, the employee will sue for (1) Wrongful Termination and (2) violating ADA. It is important to note that it is very hard to take the position of substantial hardship at the ADA trial when the employer has been voluntarily making the accommodations all along.
This document minimizes liabilities that attach as much as possible in the State of Alabama and in Federal Court.
EXAGGERATED CLAIMS MANAGEMENT
Our number one goal is to take care of our clients’ employees that are truly injured while on the job. Unfortunately, significant abuses sometimes occur. Our clients deserve the best possible assistance in dealing with problem or exaggerated claims. We at Millennium Risk Managers are firm believers in the selective use of surveillance on such claims. We have literally saved our clients millions of dollars in abuse cases by successfully utilizing surveillance.
COMPUTER SUPPORT AND RISK MANAGEMENT INFORMATION SYSTEM
Millennium Risk Managers will provide monthly loss data as follows:
- Monthly Check Registers detailing all payments made during any given month, whether medical or indemnity, identifying claimant and payee.
- Cumulative Employer’s Report indicating the amounts that have been expended to date, outstanding reserves, total incurred losses to date by individual locations.
- Individual Employer’s Report detailing each location’s claims by employee. This report specifies claim type, claim status, injury date, part of body injured, cause of injury, type of injury as well as payments made during the month, payments to date, reserve balances and total incurred in regards to compensation, medical rehab, and other expenses.
Millennium Risk Managers can also provide specialized reports based upon the requirements of the account. Examples are as follows:
- Claims Analysis by Body Part – this specialized report indicates the total dollars incurred for all injuries by specific body parts.
- Claims Analysis by Nature of Injury – this specialized report indicates the total dollars incurred by types of injury.
- Claims Analysis by Cause – this specialized report indicates the total dollars incurred by immediate cause and basic cause.
Our computer automatically re-prices all medical bills to the State Fee Schedule at no additional cost to our clients. At any time, we can provide our clients with reports detailing each medical bill and the actual dollar savings that have been provided by our Millennium Risk Managers re-pricing system.
Due to the accounts presently represented by MRM, we do extensive work in the Legislature in the form of (1) drafting workers compensation legislation, (2) reviewing workers compensation legislation and (3) testifying before House and Senate subcommittees in regards to compensation legislation affecting the employers operating within the State of Alabama.
As a result, MRM has the ability to know, (before the general employee population), all statutory movements passing through the Legislature. This has proven extremely valuable to our accounts. Likewise, we are able to solicit the assistance of other association and employer lobbyists to further advance legislation favorable to MRM’s accounts
Download a Claim Form
MRM Clients can report work injury claims 24 hours a day, 7 days a week by down-loading theFirst Report of Injury Form filling it out, saving a copy of the completed form and e-mailing the form to FROI@mrm-llc.com, or fax to (205) 263-0503. All claims should be reported immediately upon notification to the employer. The party submitting a FROI form should identify succinct and complete contact information in their e-mail or Fax cover sheet.
You will need the following information to complete the form:
- Injured worker’s: Name; Address; Telephone Number; Social Security Number; Date of Hire and Date of Birth
- Date of Injury and Description of Injury
- Name and Address of Medical Provider
- Wage Information
- Ten-Digit Alabama Employer Unemployment Compensation Number
Submit a Claim Online
– this section is in development, please check back soon