Company Streamlines Claims Process for Workers? Comp, Group-Health Insurance

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Company streamlines claims process for workers’ comp, group-health insurance

One-stop shopping for health-insurance claims? It seemed like a good idea to a couple of Arkansas businessmen who have formed a joint venture to combine claims administration for group-health and workers’ compensation insurance.

Matt Lile of Little Rock and Mark Davis of Fort Smith are the two entrepreneurs, and their new venture is Risk Management Solutions Inc. Davis is president of Risk Management, an affiliate of Advanced Insurance Administration of which Lile is president.

“This all comes out of the 24-hour coverage concept, where the eventual idea is to get workers’ comp and group health all in one policy,” says Davis. “It all comes from one source, so you make one phone call instead of two or three to get the benefits you need. … You still buy two policies [group health insurance and workers’ compensation] but it all comes from one source, that being through the same broker or agent [but] you don’t have to go to two different sources.

“More importantly, you don’t have to go to two sources for claims administration. Both are done under one roof.”

Lile says the combination sounds logical, yet the insurance industry, in the past, has been doubtful that such a combination would work.

“The reason people have not done it is that the general thought pattern was you had to have one insurance policy to make it work,” Lile says. Indeed, one policy covering both workers’ comp and group-health benefits might make the combination better, he continues.

“But we think the real savings is in combining the administrative services,” Lile says. That includes paying the claims and medical case management, including the sometimes-sticky task of determining whether an ailment or injury is covered by workers’ comp or by group-health insurance.

Additionally, Lile says, First All America, a $6.6 billion insurance carrier with an A+ rating, has agreed to service both workers’ comp and major medical claims.

One employer, after meeting with officials from Risk Management Solutions, estimated annual savings initially of at least $35,000. That company has about 650 employees and will realize the savings in payroll expenses, Lile says.

Davis says the two men crossed paths frequently in recent years and share similar philosophies in delivering client coverage and services. “As we approached new clients together, it became a natural occurrence that we would marry under a joint venture,” he says.

The idea, Davis thinks, is a natural, although he believes it’s unique.

“It’s one of the first I’m aware of where somebody’s put both [worker’s comp and group health insurance claims administration] in the same place.”