We saw lots of reports in www.workcompcentral.com and editorials on this issue. The Belleville News-Democrat did a very solid job of telling us all their concerns and we agree with them.
However, we want to be sure our readers remember one critically important point. Getting a private adjusting company isn’t going to do anything for claims management for WC claims for IL state workers if we don’t also give them tools to work with.
You can’t truly “blame” the wildly overloaded CMS adjusters and claims managers who have been stupidly overburdened with several thousand complex claims per adjuster. No one on the planet could effectively handle that case-load. However, if you are going to outsource these claims to a private company, please remember
· The new private adjusting company is going to need to have something like a hundred adjusters to match commercial standards in the claims industry. That is going to cost money.
· The new private adjusting company is going to have to get a PPP into place as soon as the rules allow it. That will cost money.
· The new private adjusting company is going to have to coordinate with the Attorney General’s office and the random group of outside approved attorneys to get better defense protocols going. As we have advised in the past, we are happy to train the Assistant Attorney’s General who handle WC defense for free, if the OAG wants it. We would also love to see the State run a new RFP for outside defense attorneys.
· The new private adjusting company is going to need
o Accident investigation rules that State HR managers will actually enforce and
o Nurse case managers in major claims and
o Utilization review and
o IME’s with great experts and
o Surveillance operatives and
o Light duty return to work programs and
o Safety reviews to avoid injuries where there are lots of WC claims.
That is all going to cost money. But we assure our readers it is money that has to be spent. Please note if we spend the money needed to do all these things will save our State and its taxpayers millions and millions of dollars—in the last four years, our Auditor General confirms over 1/3 of a billion in taxpayer dollars has been needlessly given to State workers and their lawyers and favorite doctors, some of it for claims that have been so badly handled, they appear to be fraudulent. If we have to pay WC claims, the State should also learn from what they are doing and avoid accidents and injuries.
As soon as the State of IL gets this into place, we hope someone will contact Mayor Rahm Emanuel in Chicago and point out his municipal WC claims system is also comically managed, hemorrhaging millions of taxpayer dollars and needs similar reforms. We are happy to help them also.
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