Fundamentals of Efficient Claims Service
- Prompt payment of legitimate claims.
- Early and aggressive investigation to yield detection of questionable elements.
- Thorough and cooperative effort to bring injured workers back to work as soon as possible.
- Medical cost management.
FCC’s Return-to-Work Program
- Enables First Cardinal of Texas to control exposure to your company and these costs by participating in return-to-work programs for full and light duty capacities.
- We work with you and other team members, your adjuster, vocational and rehabititional specialists, physicians, defense counsel, and risk management associates to accomplish this goal.
- Return-to-work programs are designed to minimize the loss dollars spent by returning the employee back to work as soon as possible.
- A coordinated team approach can maintain a successful return-to-work program.
Claims Review Meetings
- First Cardinal of Texas will provide claims and risk management liaisons to review cases, or special circumstances which occur due to loss.
- Cases are handled over the phone. When a more in- depth meeting is needed, appointments will be scheduled.
- All bills are audited to comply with the Texas fee schedule and reviewed for proper coding relative to the compensable injury.
- A component of our total cost containment program has checks in place to alert us of potential issues with treatment frequency and providers who are chronic abusers. This helps control the cost of the medical care.
Cost Containment cont.
- A radiological service network is utilized which provides certain diagnostic testing at reduced rates. Savings are normally captured in such tests as MRI’s, CAT scans and bone scans.
- First Cardinal of Texas will appoint defense counsel to represent your interests at all necessary TDI-DWC proceedings. Our staff provides professional over- sight of the litigation process and defense counsel activity.
First Cardinal of Texas Duties
- Initiate contact within 24 hours of loss to gather information and investigate compensability, lost time, or any other questionable elements of the claim.
- When appropriate will assign a dedicated nurse to initiate triage and contact the attending physician, claimant, and you.
- On site investigations performed as required. Immediate contact with employee by the adjuster for statement, review benefits, and request documentation such as a medical authorization.
- Continuous contact with employee to review their progress and facilitate return-to-work efforts. Regular contact with physician to review treatment plans and return-to-work dates.
- Coordinate required services, such as independent medical exams, special investigators, and defense counsel.
- Reduce attorney representation by educating the injured employees and making us available to answer their questions.
- Pay what we owe and defend against non-meritorious claims.
- Aggressively pursue all types of financial recovery with our dedicated claims recovery unit.