At the end of each month, DMC conducts a thorough review of their client's Detailed Health Care and PRIME reports to ensure that there are no additional or unnecessary costs being charged to employers. After reviewing one client's reports, there were several errors noted, including two separate claims for industrial disease, which should not have been included in the calculation of PRIME Experience. DMC clarified the error for WHSCC which resulted in a reduction of over $50,000 in PRIME Experience Charges. It was also noted that claim costs for a third worker were charged to the wrong firm number. Those costs were also removed.
Total refund to DMC's client: $55,000.00
After a thorough review of all the claim files from a new client, it was found that a worker who had been on claim for two years was referred for LMR (Labour Marker Re-Entry) as he was not able to perform pre-injury job duties. DMC asked the employer why alternate duties were not available. The employer confirmed an accommodation was available, but they were never asked by Workers' Compensation to provide an alternate position to this worker. DMC asked the Workers' Compensation Case Manager to provide verification that a request for an alternate position had been sent to the employer and also to provide the employer's response. No such documentation existed, so DMC requested cost relief for the employer. The request was denied and an appeal was initiated requesting a refund for all claims costs spanning the two years of the claim (including LMR). Prior to the hearing, Workers' Compensation agreed to pay cost relief to the client.
Total (current) refund to DMC's client: $32,463.54
A new client approached DMC to participate in a Rate code appeal on their behalf. The client claimed that they had been incorrectly classified when the company was registered with Workers' Compensation. They had been unable to convince Workers’ Compensation that the incorrect rate had been applied, resulting in significant additional charges to the client. DMC submitted a request to Workers' Compensation to re-classify the client's assessment rate, but was denied. DMC then filed an external appeal and was successful in winning the argument. The company was reclassified retroactively!
Total refund to DMC's client: $175,000.00
Diagnostic testing and a Functional Capacity Evaluation (FCE) supported a worker's ability to participate in an Early and Safe Return to Work (ESRTW) program; however, the workers' family doctor disagreed and recommended the worker not return to work - a decision that was supported by the Workers' Compensation Case Manager. DMC appealed that decision, arguing that the Functional Capacity Evaluation was an objective analysis of the worker's functional abilities, and won the appeal! The result was the worker returned to work and nine months ($38,000.00) of wage loss benefits were removed from the employer's record.
Total refund to DMC's client: $38,000.00
When DMC began working with a new client in the spring of 2011, their claims duration was astounding, averaging 1308 days per claim. DMC intervention and claims management has reduced the average claims duration by 95% to 68 days. This is still high, but it is clearly moving in the right direction!
Total savings to DMC's client: an estimated $138,880.00 per claim, and a new claims management culture adopted within the organization.