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Who are the Players?
There are many parties involved in the injury management process:
Employer
Your company is the employer. An employer can also be referred to as the "insured."
Insurance Broker
Your insurance broker understands the risks of your company and obtains insurance to cover those risks in the event of a loss.A broker reconciles problems between an insurance company and an employer. Some insurance brokers provide risk management services. These include:
- Loss Control
- Integrated Benefits
- RMIS (Risk Management Information Services) or Data
- Consulting and Workers' Compensation Cost Containment Consulting Services.
Insurance Company
Absorbs some of the financial risk of loss. Often referred to as the "carrier," the "underwriter" or the "insurer." All three terms mean the same thing.
Insurance is often referred to as "cover," "coverage," and "paper."
- In several states, workers'
compensation is provided by the
state itself through state
funds, including:
- North Dakota
- Ohio
- Washington
- Wyoming
- In Texas, workers' compensation is elective.
- There are several ways of obtaining insurance including self-insurance, insurance companies and captives. Discuss the best arrangement for your situation with an insurance broker or agent.
- In most states, employers are permitted to self-insure provided they can meet applicable criteria
- Many large employers have high
deductible programs:
- Although the employer pays the majority of each loss, this type of insurance arrangement is different from self-insurance because an insurance company "holds the paper"
- There is more control over how their claims are handled if a company self-insures
Third-Party Administrator (TPA) or Claims Handling Company
There are two types of claims handlers: Third -Party Administrators (TPAs) and insurance companies.
An insurance company has adjusters that handle claims. Independent companies also have adjusters to handle claims.
- A TPA is an independent company that adjusts claims
- TPA's focus on administering workers' compensation benefits in accordance with state laws
- "Unbundling" occurs when an insurance company allows the employer to use a TPA
Next Topic: Where Do I Get Help?
"Workers Compensation Management Program: Reduce Costs 20% to 50%"Lower your workers compensation expense by using the guidebook from Advisen and the Workers Comp Resource Center. Perfect for promotional distribution by brokers and agents! Learn More
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