Safety Group Services

30 Years of Experience  |  A Leader in Unparalleled Service

The following is a brief outline of the services provided by Associated Safetygroup Management (ASM). This is in conjunction with, and in most circumstances, in addition to those of the carrier.

For convenience of identification, we have listed the services in three categories:

A.   Claims Administration
B.    Underwriting/Statistical
C.    Loss Control - Reduction and Control of Accidents

A. CLAIMS ADMINISTRATION

1. Process all reported claims in accordance with requirements of the law and provide instruction with regard to procedures for filing Workers’ Compensation claims.
2. Accomplish such initial investigation as may be required and investigation of all questionable claims.
3. Confer with the claimants attending physician, employers’ physician and the employer personnel to develop facts and obtain all necessary data for resolution of the claim.
4. Recommend physical examination of the claimant by a medical specialist as required from our panel of consulting physicians, as well as the State Insurance Fund.
5. Verify and approve medical bills according to the New York State Medical Fee Schedules or usual and customary charges for clients that have first aid pay programs.
6. Verify the indemnity benefit due the claimant under the provision of the law and follow up with the State Insurance Fund for the required payment.
7. Provide legal representation at formal hearings as required under the provision of the law before an Administrative Law Judge.
8. Provide the client with a written report of the hearings when requested.
9. Upon request, provide the client with a cost report showing claims reported.
10. Prepare and file necessary reports with the appropriate New York State Agencies as required.
11. All claims are reviewed and investigated thoroughly from inception to final adjudication.
12. Where any unusual situations arise, they will be discussed and reviewed in detail with the client.  All possible negotiated settlements are reviewed and discussed with recommendations made to the carrier.
13. Claims personnel are available at all times to review and discuss various claims situations with the employer or other interested parties.
14. All claims will be reviewed by our staff regarding reserves before submission to the New York Compensation Insurance Rating Board to ensure proper reserving.  This assumes the best posture as respects Experience Modification and available dollars for dividend purposes.
15. Our staff will monitor bills and prescription charges for accuracy, causal relationship, and compliance with fee schedules when necessary.  Files are continually reviewed to see if there is a need for specialty examinations.  The use of rehabilitation facilities and coordination with attending physician and employer to provide adjusted work assignments where possible.
16. Associated Safetygroup Management will follow up on every possibility of subrogation or contribution in reference to Third Party Negligence Actions Section 15-8 of the New York Workers’ Compensation Law (Second Injury Fund); Section 32 settlements, Lump Sum Settlements and Section 25A of the New York Workers’ Compensation Law (Re-Opened Case Fund); and will address all such issued in order to preserve the rights of the clients and proceed under any applicable statute of limitations.
17. If Third Party Negligence claims do result in litigation we will monitor the trial and be certain our Notice of Lien is filed and honored, if and when the case is settled.  We will obtain further verifications and other information as requested by client’s counsel, and will always act as a liaison between counsel and clients and other interested parties.
18. If a serious claim occurs, circumstances often call for the need for rehabilitation services.  The purpose of rehabilitation is to have a nurse visit the disabled claimant, check on their progress, and ascertain through coordination with physicians treating them whether or not they are able to return to light work, or for that matter, regular work.  As you know, the tendency is that many physicians over treat, wherein claimants remain disabled.  The main purpose of rehabilitation is to overcome extended or prolonged disability, and also produce a psychological effect upon claimants that someone is interested in their return to work, and their progress.  If rehabilitation is necessary, the nurse assigned can coordinate all activities through the physician involved in the treatment and the various rehabilitation facilities available.  ASM will follow-up with the carrier to assure that the proper actions are taken on a timely basis regarding rehabilitation.

As a service to our clients we keep abreast of your current policy, renewals, audits, and experience modifications to make certain they are processed in a timely manner.  We will review all areas of your policy including classification codes and assist in any discrepancy that may exist in this area.

We are authorized by the State Insurance Fund to issue certificates of insurance from our office.  We will furnish a completed certificate within 48 hours of your request.

RENEWALS – When a renewal is received, we send a notice reminding you to review the bill.  Should you advise us of any changes, such as an increase or decrease in payroll, payments plans, entities or locations, we notify the State Insurance Fund immediately to have the policy adjusted accordingly.

AUDITS – We review all audit bills to make certain that the manual rate discounts, experience modification, and the benefit level increase percentages are correct.  Should the audit include additional charges, such as subcontractors, we advise you of these charges and assist you in having the necessary adjustments applied.

EXPERIENCE RATING – We conduct a complete review of each member’s experience rating modification published by the New York Compensation Insurance Rating Board.  Once the rate is received, we review the status of the claims, check the payrolls and rating values used as well as the mathematical accuracy of the formula to determine the validity of the modification.  A detailed analysis is sent to each member outlining which losses were included in their rating and an explanation of why the modification changed from the previous year.  Our review consists of identifying the claims reserves set.  If a claim has been closed at a lower cost, six months prior to the rating, which involved a Third Party Recovery or the Second Injury Fund, or if a claim is settled and closed as non-compensable, we advise the carrier to request the appropriate reduction in reserves and pursue a full revision on the member’s behalf.

As requested, our department will do an analysis to determine the possible savings of absorbing the cost of the small first aid claims.  Our findings will determine if you would have saved had a first aid program been implemented.  This program can result in a savings if the reduction in premium exceeds your out of pocket expenses.

1. Review operational procedures to evaluate existing loss control programming.
2. Management consultation to determine appropriate programs designed to your individual requirement.
3. Monitor the Insurance Carrier’s loss control activities and services.
4. Provide periodic safety and health bulletins geared to your industry.
5. Availability of driver safety programs.