We have developed what we feel are the optimum philosophies, procedures and work flow to support those philosophies.
We feel that all of these elements combined allow us to assist our clients in obtaining optimal results on
their Workers’ Compensation programs.
Proactive Claims Administration
Innovative Claim Solutions’ mission is to reduce our client’s overall cost of workers’ compensation liability by providing
quality claims management integrated with value-oriented medical management programs. Our goal is to integrate excellent
customer service that takes care of legitimately injured workers while involving the employer in the process throughout the
life of the claim. We utilize our vast experience and knowledge of workers’ compensation to focus and execute our primary
responsibility, which is managing our client’s program and providing service to their employees, while assembling the
‘best in class’ team of medical management partners.
During the past twelve years, ICS has demonstrated its ability to provide a superior claim product as well as solve
client workers’ compensation problems through the development of unique and creative customized programs targeted
specifically to public entities. We strive to provide our clients with an integrated claims management program that
keeps pace with the increasingly complex nature of California worker’s compensation claims administration.
Managed Care Services
ICS will partner with one of many managed care full service medical cost containment organizations specializing in workers' compensation.
Services include managed care, medical, hospital, pharmacy PPO access, bill review and software leasing programs.
All programs are offered as unbundled services:
- Medical Bill Review
- Utilization Review Management
- Medical Case Management
The managed care companies that partner with the Client and ICS will be uniquely qualified to provide the best medical managed care programs that promote quality medical care with the greatest cost savings, early return to work, and/or a permanent and stationary status of the injured worker.
The managed care companies that ICS and the Client select will have a proven track record that illustrates the ability to generate significant savings for the client, while always promoting the highest attainable level of physical and psycho/social wellness of each and every injured worker served.
- Early intervention, coordinating services and education of the injured claimant;
- Ongoing monitoring of treatment which helps to correct or prevent medical complication or secondary injury;
- Savings of claims dollars through continued monitoring and selective placement of claimants at the appropriate level of care;
- Reduction of relapses, needless hospital stays, and unnecessary emergency visits to the hospital;
- Ongoing communication and team management which help to generate movement from one level of care to the next with as little confusion and disruption as possible for the claimant;
- Generation of database for claims analysis;
- Providing accountability for and tracking of medical services required.
The above described philosophy is also the first step towards litigation management, by avoiding litigation to start with.
For those occasions where litigation is unavoidable, we have developed extensive procedures for litigation management.
The purpose of the ICS litigation management program is to reduce the client’s overall cost of risk, taking into consideration both
loss and cost factors in litigated claims.
ICS accomplishes this by taking a proactive approach to litigation. We encourage and foster early resolution.
We closely monitor the activities of defense counsel and hearing representatives to assure early disposition.
It is contrary to ICS’ operating procedures for the examiner to relegate claims handling tasks to a defense attorney or
hearing representative. Rather, the claims examiner will continue to actively manage all such litigated claims.
When a defense attorney is optioned, ICS holds defense counsel to strict standards of reporting frequency, report content,
cost containment, billing protocol and overall handling. Attorneys will not be authorized to perform or be reimbursed for tasks
that are the responsibility of ICS.
ICS is a huge proponent of early return to work, modified duty and early intervention disability management programs. We will
work with the Client to customize our approach to any programs they already have in place, or we will work with the Client to
create a program that is specific to their needs. ICS has worked with many different client programs and designated consultants.
We also suggest the creation of a customized Medical Referral Form designed to optimize results and communication with treating physicians.
The goal of such a form would be to force the treating physician to outline detailed work restrictions on every patient at every visit, or
explicitly explain why that is not feasible. We find this to be a valuable tool in supporting return to work programs.
Once specific work restrictions have been outlined, or confirmation obtained that the employee has been removed from work, we work to
ensure those details have been shared with the designated person for each client immediately so that accommodations can be evaluated at
the earliest possible time. We focus on what we call the ‘window of opportunity’ which is the first 72 hours following an injury.
If we can return employees to work, even in a modified duty capacity, within this window we can help our clients avoid the high costs of
temporary disability associated with indemnity claims
We feel we have a unique approach to interaction with injured workers at ICS. We refer to it as our ‘Employee Advocacy’ philosophy.
As part of this philosophy we focus on recognizing that your injured employees are our customers, and we interact with them accordingly.
We hope to have an opportunity to explain this approach in more detail. The bottom line is we want your employees to view our examiners
as part of the solution, not part of a problem.