Phone: 918.664.8816 or 800.553.4659
Fax: 918.665.7310

PO Box 471647
Tulsa OK 74147-1647

Claims

The information we will need from you will include

  • Plant and shift information
  • Payroll by class codes
  • Checking account information
  • Excess reinsurance information
  • and information to service your existing claims.

The meeting will also focus on setting objectives with your personnel to solve any current problems and ensure timely reporting of claims, timely provision of information, and identifying key personnel that can extend authority.

A claims meeting will occur at a later date to refine procedures for claims processing. Items to be discussed at this meeting include availability of a contact person, medical services, defense attorneys, settlement authority and reserving practices.

We feel by starting with a management plan, we will develop a partnership that will enhance the success of your claims and safety programs.

Claims Procedures

Our belief is that benefits allowed by law require employers to provide good medical care and to provide those required benefits based on the fairness and reasonableness of the evidence at hand. We provide advice to help you determine proper compensation for injury or illness in accordance with the laws of the local jurisdiction. Additionally, we diligently follow proper procedures for reporting, investigation, recording and treatment of industrial injuries and diseases.

US&C's reserving philosophy is based on known facts plus experience. We will reserve based on the best available evidence rather than on the worst-case scenario. Our reserve and settlement analysis are based on facts with the goal in mind being settlement without a court trial unless it is absolutely necessary. Reserves are evaluated at least every 60 days for changes of condition.

Contact cards are sent to all claimants with no lost-time, informing them that their claim has been received, and include the name of the processor handling the claim and our toll-free telephone number should they have any questions. We contact all lost-time claimants by telephone within 24 hours of the time we receive the claim. Recorded statements in deposition form are taken on all lost-time claims. We constantly monitor lost-time claims in progress and verify bi-weekly that the claimant is still off work prior to paying indemnity benefits. A follow-up contact with the injured employee is made to determine progress with treatment and personal needs.

Settlement plans are based on medical evidence that has been or will be submitted to the court. We take into consideration the credibility of the employee, witnesses' statements, the opposing attorney's ability and reputation, past findings of the assigned judge, and any other information that can be presented to the court to establish a fair zone of value for the case. There may be cases that call for added incentives, allowed by law, to be included in the final settlement. Examples are future medical costs, vocational rehabilitation, job retraining or bonuses. These can be effective tools in finalizing a settlement when needed.

Benefits are required when an injury to an employee meets the criteria of the law. The injury must "be in the course of and arise from" the employment. When this criterion is not met, the employer has a duty to deny benefits for the good of all employees. Questionable cases are closely watched and extra effort is taken to ensure that the proper decision is made on whether to deny, compromise, or accept the injury as compensable. When there is evidence of fraud we have the duty to report the case to the State Attorney General.

If an employee hires an attorney, he/she has elected to make the situation adversarial. The court takes responsibility for protecting the worker and the situation becomes tilted in favor of the worker. We believe we must work hard to keep the system balanced and use an aggressive philosophy with methods and actions that best protect the rights of the employer and still pay the fair and reasonable benefits to which the employee is entitled.

Medical Cost Control

Medical costs are usually 50% or more of the total workers compensation costs. The system is further burdened by annual inflation of health costs, including fees for the medical providers. The Oklahoma Workers' Compensation Act has established a medical fee schedule that provides for capping these fees if properly used. Many of our competitors contract out bills for adjudication and then charge a cost-plus to the employer. US&C has its own in-house review system that, at no extra charge, ensures the proper fee is paid. We exceed the requirements of the Act by paying medical bills within 30 days. In addition, we maintain agreements with an HMO and a PPO that give additional discounts when a member provider is utilized. We also have contracts with several certified workplace medical programs to allow our clients to make a selection that best fits their needs.

Other available resources include medical case management providers for the more serious injuries and the use of auditors for large hospital expenses. We only recommend these services on an as needed basis. Our oversight of these providers comes at no extra charge.

Litigation Management

Once an employee retains an attorney, US&C maintains full responsibility for controlling the file. We coordinate employer and witness notification, medical evidence accumulation, and analysis of a settlement plan will be under the control of our claims department. With the employer's authority, we manage the file to ensure that the case is handled in an aggressive but even-handed manner. We review all depositions and interrogatories and mail copies to the employer for their review.

Additional Services Provided At No Charge

US&C will report to your reinsurance carrier as needed in accordance with their reporting procedures. When the claim experience reaches the point for reinsurance reimbursement, we will request payment from the reinsurance carrier at no charge.

If an employee qualifies for vocational rehabilitation, US&C will arrange for the evaluation and determine the cost of retraining or job placement at no charge.

Employers are provided copies of bills paid and copies of checks issued for payment as well as explanations of benefits paid at no charge.

Subrogation and recovery of funds will be supervised by US&C. Before action is taken in filing a lawsuit, we will advise you and request your authorization to use an attorney. Our service here is available at no charge.

US&C will prepare reports required by the Workers' Compensation Court and remit taxes on orders and settlements to the Tax Commission at no charge.

US&C will provide closure review of all lost-time claims and litigated files prior to placing them in closed file storage at no charge.

US&C will prepare quarterly multiple Injury Trust Fund reports annual Actual Paid Losses report, and annual Rebate Request reports at no charge.

Claims Processing

If you choose US&C as your TPA, we request a set up meeting as soon as possible. Working together, our account specialist and your key staff will identify your needs and the approach needed to service your account. At this foundation meeting, we will explain in detail the mechanics of our system.