Expertise

Workers’ Compensation

The fundamental goals of Workers’ Compensation are the healthy recovery of the injured worker, and the timely and accurate delivery of benefits, as prescribed by State law.

Our Suite of Services

Work injuries can have a significant impact on an organization, both in terms of claim costs and lost productivity. AdminSure provides a suite of services that is designed to minimize this impact:

AOE/COE Investigation
Fraud Deterrence
Case Management
Medical Management
Benefit Determination
Coordination of Benefits
Administration of Benefits
Return-to-Work Programs
Disability Management
Litigation Management
Expense Audit/Approval
Subrogation Recovery

The fundamental goals of Workers’ Compensation are the healthy recovery of the injured worker, and the timely and accurate delivery of benefits, as prescribed by State law.

Early in the process, our main focus is to make sure that appropriate medical care is provided. Our team of claims professionals and medical management specialists carefully coordinate their efforts to ensure that the injured worker receives timely, effective treatment.

Once their medical needs have been met, our focus turns to getting the injured worker back on their feet. We work with them, their medical providers and their employers to facilitate a timely return to work. As lost time from work is costly and disruptive.

Along the way, we communicate continuously with all parties. For instance, we take the time to speak with injured workers, to explain benefits to them and to answer any questions they may have. At the same time, we keep employers in the loop so they are always up to date.

Last, but not least, we fight abuse of the system. This not only includes exaggerated or fraudulent claims, but also overcharging by medical care providers and other vendors.

Public Entity Programs

Public entity programs require special know-how. AdminSure is familiar with the unique requirements of municipalities, counties, school districts and other governmental agencies.

For example, sworn safety officers are entitled to Labor Code Section 4850 Benefits. They may also they may also be entitled to benefits for injuries and illnesses that are not ordinarily compensable. in addition, retirement benefits may be triggered by a work injury. AdminSure understands these complicated issues and knows how they affect a Workers’ Compensation Program.

General & Auto Liability

Since 1982, we have successfully handled General and Auto Liability claims for our clients.

We are Claims Experts

Since 1982, we have successfully handled General and Auto Liability claims for our clients.

Upon receipt of a claim, we immediately contact the claimant or their attorney to let them know we will be handling the matter. In addition, we develop a plan of action that focuses on case resolution.

At the same time, we begin an investigation into the facts, acting as a buffer between the parties while gathering the information we need to determine how the claim should be resolved. If the facts indicate there is adverse liability, we document and verify damages.

Based on our findings, we make recommendations as to whether or not claims should be rejected, settled or compromised. Our knowledge of liability issues and valuation methods means that we are able to resolve claims expeditiously without setting unwanted precedent.

Our goal is to achieve reasonable outcomes while closing claims as soon as possible. Meritorious claims are promptly settled. Questionable claims are rejected or compromised. Explanations are provided to reduce misunderstandings and unnecessary litigation.

In the event litigation cannot be avoided, we manage the process proactively to minimize costs and risk exposure, monitoring proceedings and consulting with defense counsel at all stages.

We are experts in the following areas:

Insurance Coverage
Claim Investigation
Excess Reporting
Claim Reserving
Liability Analysis
Claimant Contact
Damage Verification
Settlement Evaluation
Litigation Management
Expense Audit/Approval
Settlement Negotiation

Also, we provide for a wide variety of risks, including:

Auto Liability
Trucking Liability
Transit Liability
General Liability
Premises Liability
Product Liability
Construction Liability
School District Liability
Utility Services Liability
Law Enforcement Liability
Municipality Liability

Public Entity Programs

AdminSure has substantial experience with situations that are peculiar to public entities, such as police vehicle pursuits, false arrest, excessive force, civil rights, inverse condemnation, dangerous conditions of public property, road design, responsibilities to students, etcetera. We are also familiar with the claim presentation statutes and the various immunities afforded by the Government, Education and Utility Codes.

Self-Insurance Programs

From its very inception, AdminSure has designed, implemented and managed numerous Self-Insurance Programs. In the process, we have developed a clear understanding of what makes a Program successful.

Why Self-Insure

Self-Insurance is a formal risk management technique whereby an organization chooses to pay its own claims. For many organizations, it offers a superior alternative to traditional insurance:

It improves their cash flow since they pay claims as they are incurred instead of paying lump-sum premiums up front.
It gives them more control over how their claims are handled.
It can help them improve their public and employee relations, by putting their own interests ahead of an insurance company’s.
It gives them better feedback for proactive risk management and loss prevention, from which they reap all of the benefits.
And, it can save them a lot of money since they are not financing someone else’s losses.

Why Utilize a TPA

Although it is possible to self-administer a Self-Insurance Program, most organizations contract with a Third Party Administrator (TPA) such as AdminSure in order to realize a number of benefits:

They are able to focus on their main business instead of becoming bogged down with the details of a Self-Insurance Program.
They are insulated from adversarial situations which sometimes accompany the claim handling process.
They delegate to the TPA the administrative complexity, deadlines and penalties that arise from Federal and State Regulations.
They benefit from access to the TPA’s specialized claims, medical management and information systems.
And, they benefit from the TPA’s experience and know-how to achieve the best results possible.

What to Consider

The benefits of Self-Insurance to an organization can be substantial to their bottom line and in other ways. However, when implementing a Self-Insurance Program, there are a number of things to consider:

Regulatory Rules and Regulations.
Reserve audits and Self-Insurance bonds.
Annual reports and actuarial studies.
Claims management responsibilities.
Technical audits and penalties.

What to Do

Many organizations have entrusted their Self-Insurance Programs to AdminSure, whose comprehensive suite of services is designed to meet their specific needs. These services, which include claims administration, medical management and information systems, make Self-Insurance not only feasible, but desirable.

Also, most organizations minimize their risk and maximize the effectiveness of their Self-Insurance Programs by purchasing excess insurance to protect themselves against catastrophic losses. A proper Self-Insurance Retention (SIR) carefully balances premium with loss exposure, resulting in a Program that achieves the best results.

Expertise

Workers’ Compensation

Our Suite of Services

Public Entity Programs

General & Auto Liability

We are Claims Experts

Public Entity Programs

Self-Insurance Programs

Why Self-Insure

Why Utilize a TPA

What to Consider

What to Do

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