Maxon

Home
Plan Management
Online Enrollment
Claim Status
Insurance Company Outsourcing
Insurance Products
About
FAQ
contact

Plans Managed
 Funding Mechanisms
Muliemployer
Single Employer - Commercial
Single Employer (Public Sector)
Student Accident and Sickness
Workers' Compensation
Statutory Disability

Workers’ Compensation

man on phoneMaxon’s Workers’ Compensation division manages all administrative functions under one roof. Loss of time and medical claims are handled in the same office along with medical case management. As is the case with all of Maxon’s administration systems, our Workers’ Compensation administration system was developed in-house, and is maintained by our own programming staff. This gives us the flexibility to provide any special report desired by our clients. It also provides our staff the ability to easily coordinate aspects of a particular claim.

Maxon’s Claims Management Philosophy and Best Practices

Maxon’s philosophy regarding the handling of Workers’ Compensation claims is as follows:

• To have all personnel involved in a case work hands on as a team. This means that loss of time examination works hand in hand with medical examination and medical case management. All personnel are involved from the opening of a case.

• To work with the client to ensure quick reporting (24 hours) of claims.

A Hartford Financial Services Group study reported in 2004, found that claims filed a month or more after an injury cost an average of 48 percent more to settle than those reported the first week. The primary explanation for these results was that “a delay in reporting a claim often means a delay in starting appropriate treatment. This adds to the recovery time and the cost of medical care and wage replacement and can even make the difference in whether the worker will ever return to the job.”

• To respond quickly with the Three Point Contact upon first report of claim.

The Three Point Contact process is used in determining the nature and extent of injury and disability. Through the contact with the injured employee, the employee’s supervisor and the treating physician, the claim process of returning the injured employee to work, as soon as practical, begins. The Three Point Contact is required on all loss of time claims and will be done within 48 hours after the injury occurs. Timing is important in order to insure compliance with the section 15 time limits for processing of initial claims.

• To use best practices in settling claims.

Maxon’s practice in settling and denying claims includes:
  • Clinical validation of medical diagnoses.
  • Reviewing the medical necessity of treatments using the claimant’s medical history and clinical evidence.
  • Use of industry standard treatment guidelines, such as Milliman USA “Care Management Guidelines”, as the starting point for medical necessity determinations.
  • Use of industry standard durational guidelines, such as the Reed Group “The Medical Disability Advisor” Disability Duration Guidelines as the starting point for loss of time determinations.
  • Use of American College of Occupational and Environmental Medicine Utilization Management Database.
  • Use of nurse/case managers that supports the claims administrators’ screening criteria.
  • Comprehensive collection and management of information on a claimant’s clinical condition, physical limitations, and work status to help determine the medical necessity of certain types of treatments and services.

Work-Related Injury/Illness Questionnaire

Other common forms can be obtained directly from the
New York State Workers’ Compensation Board
http://www.wcb.state.ny.us/content/main/Forms.jsp

back to top