Our Insurance Claims Handling Eats Your Insurance Claims Handling for Breakfast

Our Insurance Claims Handling Eats Your Insurance Claims Handling for Breakfast

In most areas of the United States, there are statutes in place protecting insureds from inadequate claims handling, but that doesn’t mean every insurance carrier is providing the type of insurance claims handling that insureds deserve. More often than not, workers’ compensation claims are not being handled quickly or in the best interest of the insured.

When companies are insured through a program like Hearten, they have access to the best claims handling in the insurance industry. What makes Hearten's insurance carrier, Eastern Alliance, different?

They close insurance claims sooner.
The Eastern Alliance way to approach workers’ compensation claims is to help injured workers Return to Wellness and achieve the best possible outcome for both the insured business and their valued employee. To date, Eastern Alliance has closed 97.6% of 2017 and prior years’ Lost Time Claims. Every closed Lost Time Claim equals an injured worker who has returned to wellness and gone back to work. As of December 31, 2018, only 675 of Eastern Alliance’s 28,204 claims from the past 20 years were still open. That’s only 2.4%!

They manage prescription drug costs.
According to the 2018 NCCI Prescription Drug Update, prescription drug costs represent a significant portion of workers’ compensation medical costs. Data indicates that 14% of workers’ compensation medical payments are for prescription drugs. In comparison, only 4% of Eastern Alliance workers’ compensation payments are for prescriptions. The insurance industry as a whole sees an average $1,421 prescription drug cost per injured worker. A 5-year average for Eastern Alliance’s prescription drug cost is a mere $457 per injured worker.

They combat medical cost inflation.
Inflation is the most volatile factor in medical cost trend projections. The insurance industry sees a 2.2% average inflation rate, whereas Eastern Alliance has only seen a 1% inflation trend in the last 10 years.

They vigilantly review medical charges.
Eastern Alliance’s in-house staff of nurses and other experts look for any inappropriate charges. Because of their stringent analysis, they have saved:

  • $77,000,000 from Medical Bill Review
  • $627,000 from Negotiated Trauma Bills or Down Coding
  • $3,800,000 through the One Call Care Management Physical Therapy Network
  • $568,000 because of Pharmacy Benefit Managers who reduce prescription drug costs and improve convenience and safety.

They are experts in handling catastrophic cases.
Through their partnership with Paradigm Outcomes, 74% of Eastern Alliance’s serious and catastrophic claims with Outcome Plan Contracts completed from 2014-2018 are closed as of February 2019. This resulted in $24,300,000 in lifetime medical cost savings on serious and complex claims. From these catastrophic cases:

  • 85% of injured workers have utilized the Return to Wellness program
  • 46% of injured workers are now competitively employed
  • 18% of injured workers have returned to full-duty work
  • 64% of injured workers have not sought attorney involvement

They prepare for and proactively manage complex pain.
After an injury, everything might seem fine at first. However, it’s not unusual for pain to suddenly build up for an injured worker. If not managed appropriately, an injured worker and their claim can quickly spiral out of control. That’s why early identification of complex pain risk factors, along with prompt referral, results in better outcomes for injured workers. Through Eastern Alliance, there has been a savings of more than $38,900,000 after fees. Leading to higher success rates for Return to Wellness, 90% of injured workers were referred within two years of the date of injury- before it got out of hand.

Prompt referral lead to better outcomes with reduced morphine equivalency dosages, getting workers off opioids entirely and helping them return to work and wellness. Long-term use of opioids is not effective for managing pain, and success rate is 16% better when a referral is made within one year of an injury.

Their claims are shorter.
In Pennsylvania, the average duration of an injured worker’s disability is 22 weeks. Because of Eastern Alliance’s proactive and excellent claims handling, the average duration of a disability for them is only 17 weeks.

Your business and its employees deserve better claims handling.
Saving money and improving the lives of your injured workers are not mutually exclusive. Joining Hearten's workers’ compensation captive program means access to the best insurance claims handling in the insurance industry.