THIRD-PARTY CLAIMS MANAGEMENT

ANCILLARY/SUPPORT

This program acknowledges the 80/20 rule; the adage that 80% of total costs come from 20% of the claims.

As such, for qualifying employers, a set of claim criteria can be established to identify potentially expensive complex to be referred into WCTL’s Full Management program. Medical, Legal and case management resources are utilized wherever needed to affect a positive claim outcome. The program helps impose maximum accountability on the medical and insurance community and greatly increases the success of legal appeals and cost relief.

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HYBRID

CLAIMS MANAGEMENT WITH SELECTED OR TARGETED MEDICAL MANAGEMENT

Cost per claim:

$750

Return on Investment:

3.5x

Return on Investment:

5x

$950

Cost per claim:

FULL MEDICAL

A Case Manager is assigned to manage the Employer’s claims utilizing a sophisticated database that collects and consolidates your safety and claims data to satisfy internal and external reporting requirements.

The Case manager acts as the conduit between the Employer and the corresponding provincial WCB to ensure claims are reported within the respective timelines then follows up with the WCB to advocate proper management and resolution of each claim.

An interactive online portal allows the Employer to submit claim information and access claims management status (and reports) quickly and efficiently.

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CLAIMS MANAGEMENT SERVICES ONLY

PRIMARY

Return on Investment:

$500

Cost per claim:

2.75x

PUBLIC SECTOR/ REGULATED INDUSTRIES

This service is designed to augment in-house, self-managed disability management programs by providing WCTL’s medical and legal resources combined with proprietary technology to manage complex claims, legal appeals and Cost Relief.

An employer can fully adopt WCTL’s software to manage its claims or simply use it as a seamless interface to communicate with WCTL’s claims management team and to integrate relevant data for analytical and reporting purposes.

WCTL uses claim analytics to identify claims with the highest cost potential so that a set of criteria can be established that will determine which claims would be referred into this WCTL program.

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NURSE

TRIAGE

WCTL’s National Nurse Triage program is the only one of its kind in Canada and adheres to best practice Nurse Triage protocols. Proactive Nurse triage helps reduce the number of medical aid, restricted work and time loss claims while ensuring injured employees are directed to medical care when required. Telephonic Nurse Triage at the point of injury minimizes the probability that seemingly straight forward incidents spiral into complex and costly claims. The program provides employers with a level of accountability that vastly improves the integrity of HSE statistics.

Nurse Triage is most effective when bundled with WCTL’s Disability Claims Management Services. However, the Nurse Triage program can also be offered on a “Standalone” basis for a minimum monthly subscription fee.

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This program offers all the Primary Services combined with WCTL’s full complement of Medical and Legal resources creating a considerable advantage when dealing with Disability Insurers and the medical community. The success rate of legal appeals and cost relief are second to none.

The expertise of Case Managers, Nurses, Occupational Physicians and Specialists is deployed within the framework of WCTL’s established claims management system. The program adheres to defined protocols that have been proven for more than 20 years to reduce claim durations while improving the care and recovery of injured employees.

An extra layer of proprietary technology tracks every action on a claim and generates a financial business case that calculates claims management costs vs savings achieved to ensure complete accountability.

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FULL MEDICAL

Return on Investment:

$950

Cost per claim:

5x

CLAIMS MANAGEMENT WITH FULL MEDICAL MANAGEMENT

Primary

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Primary Anchor

Full

Medical

Full Anchor

Hybrid

Hybrd Anchor

Public

Sector/

Regulated

Industries

Public Anchor

Nurse

Triage

Triage Anchor