SHORT ON BALANCE
The recent article by Peter Rousmaniere (Risk & Insurance®, July 1, 2007, Page 14) about TPAs deserves some comment.
While I agree with most of Rousmaniere's statements, I disagree with the way some of them are presented, and what seems to be an overall negative tone of his article.
Having over 30 years worth of TPA claims management experience, providing quality services to dozens of employers, I believe it is true that some TPAs do unfairly engage in questionable practices involving subcontractors, but not all do that, and it would have been appropriate for Rousmaniere to have also pointed out some of the positive aspects of TPAs using the services of subcontractors.
Rousmaniere uses the phrases "lighten the claims load on an adjuster," and "use the case manager as an expensive clerk." A case manager, who is typically a highly qualified, licensed nurse, can and should be much more than an expensive clerk. The information collected and digested by a case manager appropriately assigned to a case is probably much more detailed and relevant than information obtained by an adjuster who does not have the same degree of medical experience and training.
Furthermore, assigning an appropriate case to a licensed, experienced, independent investigator is likely to result in more and better information than that obtained by the average inside claims adjuster who has to handle many more aspects of claims than just the investigative part.
After reading this article, one might conclude that all claims-handling work should be performed by the adjuster and no delegation to a vendor or subcontractor is appropriate, which, I believe, is a very real but misguided perception on the part of some employers.
Rousmaniere, unfortunately, does not use the phrase "proper management," which is a key ingredient in any successful business venture.
Workers' Compensation Claims Manager
Custom Employee Benefits Insurance
Long Beach, Calif.
In order for coffee to release its oils, the temperature has to exceed 180 to 190 degrees F when brewing. (See: The Law column by Philip Kircher, Risk & Insurance®, July 1, 2007, Page 19).
As a medic, we are trained to know that burns can start to occur at 110 to 120 degrees F. For true risk management, coffee vendors should cook at the higher temperature and then refrigerate down to the lower range.
Who would buy it at that temperature I am not so sure, but with the nanny state I am surprised at nothing.
Even if McDonald's had dropped by 50 degrees as you suggest, it still would not be 100 percent safe and likely the court would have ruled against them.
I note that the court failed to set standards as to what it would have found safe, which is typical.
Shall we try for 98.6?
Nicolaysen Agency Inc.
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September 15, 2007
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