Prior Carriers

2664241

Are there are any guidelines when there are several carriers over the years and who picks up the claims?

Janet

The company I work for has changed TPA's twice in the last 5 years. Without fail, about a year into the new TPA, old claims will surface that are not the responsibility of the new TPA, but due to time limitations, the old TPA is no longer responsible. What I've done is this: I review each "old" claim individually (I use a worksheet to be sure I'm consistent) and determine if the claim has merit. (That is, why didn't the claim get paid? Was it submitted and the old TPA just didn't pay it? Did the provider "drop the ball"? Did the EE "drop the ball"?, etc.) If it appears the claim should've been paid by the old TPA, I request that our new TPA pay the claim "out of plan". So far, I haven't had any unreasonably large claims. Often, the fault lies with the provider or EE (they didn't file timely, didn't follow through, etc.), so the claim has no merit.
Hope this helps.

bsa

If you are questioning work comp insurance carriers, most have "reserves" that are held for a certain period of time for future medical expenses. Now, this may be unique to my state, so I would advise checking your state w/c laws. Ask your current carrier, they should be able to tell you if your state's w/c laws require reserves. My broker has always been very informative and has educated me numerous times regarding the in's and out's of w/c insurance. I am very, very lucky to have a relatively safe workforce with only minor injuries involved, so reserves have never been a major concern, but I understand from my broker that reserves can affect your annual premiums because they carryover from year to year.