DMB Risk Solutions, LLC

A large insurance broker created a workers compensation claims advocacy department for their own clients who do not have the internal resources to monitor employee injuries.  This unit supervised the insurance carrier/ third party administrator’s efforts and ensured that medical appointments were being kept, the medical bill review service was being utilized and all claims were moving to closure.  Other services this group provided included  generating customized management reports and maintaining OSHA logs for the client.

Initially the unit began using paper files and their Lotus Notes task manager to document their efforts.  However, it soon became cumbersome as the department grew past 6 employees.   Client specific management reports were generated by pulling the claims data from TPA’s/ carriers on-line claims system.  However, every month, each report was manually duplicated for each separate client.  In addition, OSHA logs were maintained in a separate system, requiring the unit to maintain duplicate incident records

Initially, the department went to several large RMIS vendors to find a software solution.  However, due to the number of customized reports and features needed to address the present process and the number of incoming data sources (up to 15 to 20 to capture all clients and all insurance carriers/ TPA’s), the 5 year cost of the application including license and incoming data consolidation fees was over $200K.  Due to the start up nature of this unit, they were unable to justify the expense.

We developed a customized client-server database application for a fraction of the licensing cost of the large RMIS vendors.  Utilizing the data already available from the carriers/ TPA’s on-line claims system, we also created a data consolidation utility that extracted the required data from these systems and generated a compatible data set for the new application.  This utility saves an estimated $30K-$40K annually in additional data consolidation fees.   Our solution was designed specifically around the units existing process and generated all the necessary management reports including OSHA logs.  This resulted in a significant reduction in work hours documenting their process and generating reports.