February 28, 2017 • News

Professional Administration as an Extension of Employee or Client Benefits

A shift is underway in workers’ compensation. Both risk managers and plaintiff attorneys are now offering administration services on every medical settlement as a matter of best practice. At Ametros, we are already working with many risk managers at self-insured employers and carriers that are making it policy to offer Ametros' CareGuard and/or Amethyst services to ensure employees are taken care of after they settle their workers’ compensation claim. Multi-line insurance carriers are following suit and offering these services as a way to enhance their client's experience - keeping the customer happy after settling a claim means they are more likely to retain other insurance policies with the carrier and spread positive recommendations. At the same time, many plaintiff attorneys are suggesting that their clients use administration services so they can continue to get personalized attention, access to deep savings on future medical care, and compliance help after settlement.

Ultimately, for all parties it's about responsible professionals making an effort to ensure that employees or customers have the most positive experience as possible with the resolution of their medical claim. The old method of simply paying an injured person cash and walking away is no longer good enough. Injured individuals are confronted with many issues after settlement when trying to get treatment for their injury. The expectation that an administrator like Ametros will be on hand to help them and offer customized services is becoming second nature, helping to make settlements more likely while ultimately doing the right thing for the injured individual.

Similar to designating flex spending account (FSA) and health savings account (HSA) administrators or 401k and IRA administrators, a medical administrator for the injured person is crucial to making sure the money is managed properly and the employee is in good hands after settlement. Our customers have realized that while there are many tools to help them in other aspects of their life, services to help injured individuals manage their medical care is one area that needs more attention.

We interviewed two of our CareGuard members, Cindy and Omar*, to show the powerful impact that offering CareGuard had on their settlement experience:

Cindy James had worked 22 years for a hospital as a nurse before a workplace injury shortened her career. "I worked really hard and it was stressful, but I liked my job. We were helping people." Three years ago, at age 64, Cindy suffered two herniated discs in her back that she couldn't recover from to get back to work. "My life since the injury has revolved around physical therapy and trying to stay healthy," she shares. In 2016, after surgery, Cindy's condition was stable and when her adjuster asked her if she wanted to settle her case, she was nervous about what that meant. "It seemed like a lot of responsibility and I wanted to keep treating at my hospital like I had been," Cindy continues.

Cindy's adjuster, Rick, followed his company's policy to offer Ametros' CareGuard service to help Cindy manage her healthcare after she settles. Rick asked Jayson, one of Ametros' Settlement Specialists, to reach out and discuss the service with Cindy. "We've spoken with hundreds of injured employees," comments Jayson. "But I remember Cindy well. We talked for over an hour about what her medical treatments and financial needs would be after settlement. I really got to know her and her husband, and when we settled the case she sent me a very nice note."

Ametros' CareGuard service was a great fit for Cindy because it took the responsibility of dealing with all the medical bills off of her shoulders. As a former nurse, Cindy knew she did not want to handle her ongoing bills, while verifying and negotiating pricing. In addition, Jayson shared with her Ametros' exclusive partnership with her hospital chain that allowed employees to continue receiving medical treatment there, or to go anywhere they would like. This was an important consideration for Cindy. "My husband and I are happy we settled the case with CareGuard. They have made everything run smoothly," Cindy adds.

Ametros’ CareGuard service also helped Omar settle well. At age 47, Omar was the unfortunate victim of a machine malfunction at work. When a support bar buckled, he suffered a back injury, the loss of his right arm and lost vision in his right eye. He had a claim both with the product manufacturer and through his employer’s workers’ compensation. The liability carrier had a practice of offering CareGuard on any claim with medical over $100,000. The adjuster asked Tina, a Client Engagement Manager at Ametros, to contact Omar’s attorney to explain how CareGuard would help, and that the carrier would pay for the cost of the service.

Omar's attorney, James, quickly understood the value of CareGuard. It would help his client, Omar, save a sizable amount of his settlement over time and it meant that a professional group would be helping Omar with his Medicare Set Aside reporting. James shared with Tina that he was concerned that Omar did not fully understand how to do the reporting, and he was worried that Omar might jeopardize his Medicare benefits.

James set up a meeting with Omar and had Tina call them and walk them both through the process. A few months later, Omar settled his case and had CareGuard manage his medical funds with a dedicated MSA account as well as an account for all non-Medicare covered expenses. He has now been a CareGuard member for over a year. "I am very happy that the CareGuard team got me my prosthetic and found me a new pain doctor closer to home," Omar shares. "I use them to set up all of my appointments and they are very helpful. I couldn't do it alone."

Cindy and Omar are just two examples of the thousands of injured individuals whose settlement funds we manage at Ametros. Making their lives better after settlement is our mission. Plaintiff attorneys, self-insured employers and carriers are all increasingly finding that ensuring the injured individual is taken care of after settlement helps them all do their job better and have peace of mind that for the years - and often decades - after settlement the injured person will have support.

Would your organization or firm like to learn more about strategies to offer Ametros' services on your medical settlements?  Or, do you have a case where our services can help? Contact us at 877.275.7415 or email us at referral@ametros.com.

*The stories and interviews described are based on true events. The names of the third parties have been changed.

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