Opinion/Personal View
WORKERS’ COMP CASE PREPARATION HELPS
EMPLOYER
By Michael S. Goldstein
(Mr. Goldstein is principal of Michael S. Goldstein Co. LPA.
His primary practice is workers’ compensation claim defense
on behalf of employers.)
Your Nov. 30 article, "Tackling steep
workers’ comp costs," leads Ohio businesses in the
right direction, but much of its advice does not apply to
Ohio companies.
Private insurance coverage for workers’
compensation is not permitted in Ohio. We are all either paying
premiums to the state insurance fund or are self-insured.
Thus, while the tenor of the article is correct
- that employers have to be proactive in managing claims -
some of the article’s advice cannot be followed here.
For example, Ohio employers cannot "carefully choose
insurance brokers, then lean heavily on those firms."
What Ohio employers can do is carefully
choose how their claims are administered and defended, then
make sure those chosen to do the job do so critically and
energetically.
Employers in Ohio have three choices: Evaluate
and defend claims using in-house resources; utilize the services
of a third-party administrator, or TPA, which may be connected
with an insurance company, or retain a workers’ compensation
defense attorney to work in conjunction with in-house staff
and with the TPA, if there is one.
A prime rule is to have someone in-house
who knows the company’s claims and knows the state system,
who will stay organized and who will push the company’s
representatives to take a proactive stance. This means certifying
proper claims and going to the wall on those that are not.
To manage a company’s workers’
compensation program without using a TPA requires not only
a knowledgeable staff, but a relatively large one as well.
One person (especially one person with collateral duties)
cannot do the job if the company has any great number of employees.
An attorney must be retained if any issue
goes so far as court, but an attorney is also necessary at
the administrative level - hearings before the Industrial
Commission - if a legal issue is to be argued or if witnesses
must be cross-examined. It is also a good idea to retain workers’
compensation counsel whenever a claim becomes particularly
complex, either factually or medically.
All those chosen by the employer to administer
and defend its claims must be taught the company philosophy;
Every aspect of a claim must be evaluated critically, and,
if a decision is made that it should be defended, it will
be defended vigorously.
The savings will follow, because properly
prepared and defended claims in Ohio can be, and most often
are, won by the employer. |
