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Workers' Compensation Pool The North Carolina Association of County Commissioners (NCACC) began the Workers’ Compensation Pool in 1981. Local governments were often unable to buy certain types of coverages at a time when insurance rates were escalating rapidly and the traditional insurance market could not provide the coverages that were needed to meet the county’s specific needs. The Pool’s objective, created by counties to meet their specific needs, was to help counties jointly manage this risk and prevent future insurance market changes from creating havoc on county budgets. The Pool not only provides coverages for county members but also helps its members gain control of their losses. With the oversight of the Association staff, service partner Sedgwick Claims Management Services, Inc. (SCMS) administers the Pool’s claims so members can receive prompt and responsive claims administration. The Association staff and SCMS manage the day-to-day operations. Since inception, the Pool has extended its membership from 65 to 138 members. About the pool
The Pool is governed by a Board of Trustees, comprised of county and county management staff, who are responsible for the strategic direction of the Pool. As a non-profit joint agency focused on long-term needs of its members, short-term financial return is not the Pool’s motivation. Trustees must represent a participating member county, and are appointed to three-year terms by the President of the North Carolina Association of County Commissioners. Direction and authority is granted at quarterly meetings of the Board of Trustees, based on feedback from individual members as well as staff. Membership, coverages and services Membership is open to all county governments who are members of the NCACC, and to certain other county-related agencies. It provides benefits solely for pool member employees who suffer physical injury or death as a result of occupational accidents or disease. Benefits, including lost wages, medical and related expenses, are set in accordance with North Carolina General Statutes. These statutes provide for payment of both weekly compensation and medical expenses. Members’ contributions are based on each participant’s payroll and rates as established by the Board of Trustees. Adjustments are made based on a participant’s claims experience. Rates may also be reduced through upfront discounts and other considerations as determined by the Board of Trustees. Members that choose to carry higher deductibles or who elect to participate in multiple pools that are offered to member counties realize additional savings. A variety of deductible options are available. The Pool offers a number of specific coverages and services to our participating members. Such as:
Updates on new programs and NCIC rules On-line claims reporting is now available. You must be a pool member to utilize this service. Simply click here, select which type of claim you wish to report, complete the form and hit the submit button. Once completed, a copy will be faxed back to your office for your records. We have a variety of pro-active and cost effective programs to control your claims.
Rather than spend tedious time filing out and mailing or faxing first reports or loss notices, the claims reporting person can simply pick up the phone from any location and report the claim. Using a telephonic reporting system allows the claim process to begin much faster. Just call 1-877-NCACCRM (1-877-622-2276) and one call does it all. NO MORE PAPERWORK, we will complete the first report of injury or loss notices for you. This is for all (WC, auto, property, GL) types of claims. This service is available 24 hours a day, seven days a week, at no cost to members of the Pools. A copy of the report is faxed back to your office for your records. The after-hours emergency number to speak with the claims supervisor on call regarding a serious claims is 1-866-261-5788. Members may still report claims though traditional methods, but we encourage you to give this service a try. One study that compared telephonic reporting of claims vs. traditional paper methods, showed that clients using toll free reporting had claims that were open for 32% fewer days and Workers’ compensation lost time cases cost 29% less. The survey also showed that claims reported within 10 days had 75% less litigation and attorney involvement. We encourage you to promptly report all claims and to use this method. Telephonic nurse case managers The North Carolina Association of County Commissioners’ Risk Management Pools’ Managed Care Program works in conjunction with Sedgwick Claims Management Services (SCMS). When a WC accident occurs that results in lost time, and once the accident is reported to SCMS, the case is automatically referred to a Telephonic Nurse Case Manager. Normally, within 24 hours a Telephonic Nurse Case Manager will contact the employer. The nurse will want to verify with the employer that, (1) the employee is indeed out of work, (2) the employee’s current job duties, and (3) to discuss the availability of light duty work, if necessary, that the employee may be able to perform. During the initial contact, the employer should be prepared to provide the nurse with the employee’s current job description. The nurse will work closely with the injured employee and the treating physician to ensure that the employee is receiving the appropriate medical treatment to return to gainful employment as soon as possible. On-site medical and vocational case managers For more complicated and/or serious injuries, the case will be automatically assigned to an on-site nurse case manager once the case has been reported to SCMS. The on-site nurse will work with the employer, the treating physician, and one-on-one with the injured employee. If for any reason the injured employee is unable to return to their current job and responsibilities, a Vocational Specialist will be referred to the case. The Vocational Specialist will work with the injured employee to identify and locate what jobs are available within their limitations.
Once you have submitted Form 19, “Employer’s Report of Injury to Employee,” to SCMS a claims representative will correspond directly with the physician and hospitals involved and obtain the required reports and bills. In some instances, providers will send the bills directly to you, the employer. If this occurs, please forward the reports and/or bills to SCMS as soon as possible for processing. SCMS should pay all bills directly to the provider of medical services and/or supplies. All bills received by SCMS are reviewed by SCMS to verify that they are in accordance with the fee schedule. Because the selection of the appropriate medical care provider is so important, we offer panels of doctors and medical facilities to our Pool Members. These panels list the doctors in their specific area that are within the PPO network. Not only are these doctors more specialized in treating workers’ compensation injuries, to give your workers the best possible treatment, but many of them offer substantial discounts to the fee scheduled price, which help control your Workers’ Compensation costs. If you would like a panel for your location, please visit our Workers’ Compensation links and you can print one out. Diagnostic and durable medical networks The most effective way to keep costs down is to control the medical portion of a claim. To help in this, the NCACC Workers’ Compensation Pool has partnered with numerous companies to provide services from MRI’s to Tens units to Hospital beds and everything in-between, all at substantial cost savings. It is the policy of the NCACC Workers’ Compensation Pool to provide its Members prompt, high-quality, cost-effective legal representation. The RMP seeks to utilize attorneys who are experts in their fields in order to provide its Members the best possible defense. Additionally, the RMP seeks to minimize and control these legal costs by eliminating unnecessary and unreasonable costs. Comprehensive guidelines have been put in place to ensure the highest standards of legal representation at the most cost efficient means. Some links that you may find helpful: Want a listing of PPO doctors in your area or to add a doctor to the PPO Network? Click here. (You will need to use STRATA for your username, and SW01 for your password.) What’s new at the NC Industrial Commission? Click here Want news on WC law developments? Click here Want the NC Department of Insurance? Click here Want to know about a medical term or condition? Click here Want to locate a local pharmacy in the Express Scripts network? Click here Need an online medical dictionary? Click here |