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Claims Administration

At the Comp Alliance, we know that the manner in which claims are handled has a tremendous impact on the overall costs. Our claims department is staffed with experienced workers' compensation examiners who are responsive to our members' needs.

OUR CLAIMS ADMINISTRATION SERVICES AND FEATURES INCLUDE:

• Full claims administration of NYS Workers’ Compensation Claims and NYS Volunteer Firefighter and Volunteer Ambulance Workers’ Benefit Laws
• Direct member access to designated claims representatives, ensuring continuity of all claims communications
• A fully paperless environment
• Direct member access to designated claims manger/supervisor ensuring, proper oversight and handling of all claim
• Processing of all initial claims within 48 hours
• Calls returned within 24 hours
• Professional assistance and guidance with the administration of 207A/C claims
• Returning employees to work in the timeliest manner possible
• Assist members with returning employees to work on a light duty or modified duty basis
• Timely updates for members tracking severe claims
• Member feedback solicited on the handling of severe claims
• Claims training workshops for member personnel responsible for claims communications
• Quarterly loss run provided to members that includes detailed information on member’s claims
• All Medicare/CMS Section 111 reporting is completed on behalf of the client
• Pharmacy Benefit Management and Diagnostic Networks to injured employees
• Full compliance with all NYS Workers’ Compensation Board electronic reporting requirements
• Updates on changes to the laws or regulations related to workers’ compensation that may impact members claims

For information on how to minimize claim costs or claim handling and reporting, review the documents below.

default Minimize Claim Costs Sheet (334 KB)

default Claim Reporting (799 KB)

default Claim Handling Protocols C 2F Guide (1.21 MB)

Risk Management & Loss Control Services

A key component of reducing workers' compensation costs is avoiding accidents in the first place.  Our team of in-house, risk management professionals works closely with members to create a safer work environment.  Our risk managers are available to attend scheduled board and safety committee meetings to discuss available risk management services, review individual members’ losses and present loss control recommendations. 

The Comp Alliance has developed a comprehensive risk management plan to help its members get the most from our loss control services.  We offer regional trainings for state or federal mandate training, individualized training on issues that are driving losses, workplace inspections and assistance with the establishment and operation of safety committees. 

Comp Alliance PDF Risk Management Service Information Sheets 

• pdf Risk Management Services Sheet (1.09 MB)
• pdf Comp Alliance Academy Sheet (2.18 MB)
• pdf Safety Source Sheet (3.43 MB)
• pdf Risk Management Training Topics Available Sheet (1.17 MB)

OUR RISK MANAGEMENT & LOSS CONTROL SERVICES INCLUDE:

• Online Exclusive Safety Training Center - Comp Alliance Academy
• Periodic inspections of each member's facilities and operations
• Identification of improvement areas, workplace hazards, and hazard mitigation measures   
• Analysis of members’ loss runs and injury trends
• Assistance in the development and implementation of corrective actions for identified hazards
• “Repeater” consultations for employees involved in frequent workplace incidents to correct and minimize the number of repeat accidents or injuries
• Review of members’ safety programs and policies
• Assistance with formulating and/or updating safety policies and training programs for topics including: bloodborne pathogens, hazardous communication (right to know), workplace violence, "Lock-Out/Tag-Out," as well as other technical topics for which compliance is mandated by State and Federal laws.
• Assist members in the establishment of safety committees and provide ongoing support at safety committee meetings
• Quarterly articles on safety-related topics
• Safety training DVDs on mandatory training topics
• Regional Safety Training Seminars on safety topics that municipal staff are required to receive on annual basis, such as:
  • Hazard Communication (Right-to-Know)
  • Workplace Violence
  • Lockout / Tag-Out
  • Bloodborne Pathogens
  • Harassment in the Workplace
  • HAZWOPER (Hazardous Waste Operations and Emergency Response)
• On-site classroom training for members on: 
  • Use of Personal Protective Equipment (PPE)
  • Confined Space Entry
  • Trenching
  • Fall Protection
  • Driver Safety
  • Back Safety
  • Chainsaw Safety
  • Accident Review and Investigation
  • Safety Committee Development and Operations

Underwriting & Member Services

Underwriting members in a group program goes well beyond a simple calculation of funding. At the Comp Alliance we analyze all existing members and new accounts seeking a commitment to the philosophy of the program and dedication to the standards set in our risk management program. Our member services team increases the overall satisfaction of our members by providing responsive, professional and personalized service.

OUR UNDERWRITING AND MEMBER SERVICES:

• Establishing the annual funding level of the program based on actuarially derived liabilities
• Equitable rate development for all members utilizing, loss information, risk management assessments, experience modification
• Reviewing rate adequacy to provide stability for the entire group
• Timely and comprehensive response to client inquiries on billing, loss runs, etc.
• Helping members reduce rates where possible through integration of claims results and loss control practices
• Assisting members with compliance with regulatory requirements