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37 Cards in this Set

  • Front
  • Back
5 reasons to choose PartnerSource?
- Experience
- Commitment
- Value
- Resources
- Track Record
-Designed and Implemented hundreds of programs over 14 years
- Represents most of the biggest nonsubscribing employers(over 50 w/ 500+ ee's and over 12 with 10,000)
- Devoloped every major injury benefit plan design innovation since 1989
- 90% of firms revenues relate to occ injury programs
- Member and Award Recipient, Texas Assoc. of Responsible Nonsubscribers
- Organized the Nonsubscriber Committee for the Texas Assoc. of Business
- Frequent speeches and articles, including the "Nonsubscriber Newsletter"(the leading industry publication since 1992)
- Fees below market for comparable resources
- Flat, Hourly, contingent, or other basis
- Discounted consulting rates for retainer clients
- Value added service packages for insurance clients
- The only fully integrated nonsubscriber consulting firm
- In-house employment and employee benefit lawyers
- Employee communication services
- Claims and defense litigation management services
- Medical management through our affilitate (OccMD Group)
- Nonsubscriber insurance experts - licensed P&C and employee benefit insurance agents(but freq. work with insurance brokers)
Track Record
- Over $300 million in occ program client savings
- Implemented most of the largest new nonsubscriber programs over the past decade, several of which cover hundreds of locations
- Negotiated one of a kind nonsubscriber insurance coverage terms with multiple carriers
- Developed or updated injury benefit plans cover over 500,000 employees
Occupational Disease/Cumulative Trauma (ie. Carpal Tunnel)
Medical Claims are defined by 4 things:
1. Definition of injury
2. Course and scope
3. OD/CT
4. Exclusions
TWCC-5 Form
Annual Notice to TWCC of Nonsubscriber status
TWCC-7 Form
Monthly Notice to TWCC of Lost-Time/OD Injuries
4 Employer (Nonsubscriber)TWCC Reporting and Disclosure Requirements
1. Annual Notice(Form TWCC-5) to TWCC of Nonsubscriber Status
2. Monthly Notice to TWCC of Lost-Time/OD Injuries
3. Written notice to employees
4. Workplace Posters
5 Reasons to become a nonsubscriber(Source: Feasability Analysis)
1. Better Medical Care for Injured Employees
2. Immediate Notice of On-The-Job Injuries
3. Benefit and Liability "Risks" are Better Known and Insurable
4. A Road Well-Traveled(Approx. 40% of all TX employers nonsubscribe)
5. Lower Costs(savings of 50-85%)
Average medical/indemnity cost per claim under WC
Average nonsubscriber total cost(incurred medical + indemnity) is between:
$1,000 and $2,200
Nonsubscribers typically see a _______ reduction in Insurance premiums vs. Texas WC.
Average duration of disability under TX WC
5-6 months(21-25% higher than other state wc systems)
Texas averages ___% more services per claim and ___% more visits per claim than other state wc systems.
45% more services and 32% more visits
Primary reason companies do not become nonsubscribers
Negligence Liability(failure to provide a safe workplace)
Less than __% of nonsubscriber claims result in a negligence liability claim
.001%(reasons include, ERISA, Arbitration and Better/Faster Care)
Nonsubscribers achieve significantly lower costs because 5 things
1. Early Intervention for injury claims
2. Use of occupational injury specialists
3. Active medical case management
4. Increased emphasis on safety and modified duty
5. flexible plan designs
Industry Averages: Workers Comp medical costs were ___% higher than nonsubscriber medical costs.
237%(Retail department stores were 91% higher and restuarants were 283% higher)
Virtually anyone with a health care provider "license" is considered an "approved provider" under______
TX WC(Nonsubscribers are not bound by state mandates and can develop closed networks that only allow occupational injury specialists)
The two fundamental cost drivers of wc are:
1. lax injury reporting rules
2. no control over health care provider choice and medical management of the claim.
2 Ways that nonsubscription directly addresses the two main cost drivers of WC is by:
1. requiring immediate injury reporting(usually no later than 24 hours)
2. treatment with approved providers
Definition of Excess Coverage
Excess Coverage is for legal liability purposes only (being sued for negligence). That includes attorney fees, settlements, judgments or awards, arbitration fees, court costs, ect.
The carrier that will bill monthly and adjust the premium based on the payroll is:
Lexington(all others do a final year end audit of the payroll to true up premium)
Which insurance carrier bills customer direct?
5 Representative PartnerSource Nonsub Clients are:
1. Dillard's
2. Sysco Foods
3. Randall's_Tom Thumb
4. Sonic Drive-Ins
5. Pappas Restaurants
Number of days notice TWCC requires to opt of WC
Average cost of sprained ankle under ordinary medical plan
$400-$500(under workers comp - $4,000)
What is the statute of limitations for a negligence lawsuit?
104 weeks from the date of the injury.
The maximum weekly wage replacement under TX WC is $_____
Removing the weekly wage replacement cap under nonsubscriber is recommended because it accomplishes 2 things.
1. eliminates cutting back benefits for the companies most valuable, higher wage earning employees
2. acts as a favorable comparison to WC
Two ways to Exercise Control Responsibly of the Nonsubcriber Benefit Plan.
1. The injury benefit plan must be designed in a way that avoids the appearance that the employer’s financial interests were put ahead of the legitimate interests of injured employees
2. The injury benefit plan must provide a level of benefits that is adequate to fully address the vast majority (if not all) of the medical and financial needs of all injured Texas employees.
Nonsubcriber wage replacement is taxed as ordinary income(True or False)
True(WC is not taxed)
How long will Nonsubscriber wage replacement be taxed?
6 calendar months following the month of injury.
What is the average maximum liability that is set by our clients?
150 - 250k(which includes all medical, lost wages, and death & dismemberment)*Retail is at the low end