Categories
Health and Benefits

Employee Advocacy Case Study – Carrier Confusion

Employee Advocacy

Employer-sponsored health insurance and group benefits can be confusing. It is important to have trusted advisors available to assist plan participants in understanding their coverage and navigating the claims process. RMC’s employee advocacy team is a live resource available to assist plan participants with any questions or issues they may experience while using their coverage.

Below is a recent example of RMC’s employee advocacy team stepping in to quickly resolve an issue that a plan participant experienced while filing a claim.

The Accident

An employee fell at home and suffered a serious bone fracture. The employee received immediate medical attention, and their employer-sponsored health insurance covered the initial setting of the bone and all necessary rehabilitation. Due to the severity of the break, the employee was directed by their doctor not to return to work for approximately 90 days to avoid aggravating the injury. Luckily, the employee’s employer also provided Short-Term Disability and Accident Insurance to replace some of the income lost during the rehabilitation period.

Trouble Filing the Claim

Unfortunately, filing the Short-Term Disability and Accident claim was not as straight forward as the employee had hoped. First, the employee attempted to contact the insurance company to start the paperwork for the Short-Term Disability and Accident Insurance claim. After two weeks without success the employee contacted their Human Resources Manager for assistance. Over the next week the HR Manager was also unsuccessful in initiating the claim. Finally, the HR Manager contacted RMC to ask for assistance.

The Resolution

Within ten minutes RMC’s employee advocacy team determined that the employee and HR Manager had been contacting the wrong insurance company. Instead of the contacting their current carrier, they were attempting to file a claim with a carrier they used several years ago. RMC contacted the current carrier and received confirmation of benefits and the forms required to file a claim right away.

RMC’s employee advocacy team assisted the employee in completing the forms and submitting the claim. The team was also able to streamline the claims submittal process, eliminating several unnecessary and redundant steps that resulted from poor communication between the carrier and employee. On the day following the claim submittal, the carrier informed RMC’s team that the Accident funds would be sent to the employee the next day and the Short-Term Disability funds would follow within a week.

The employee was extremely thankful to have this claim resolved. Now that the burden of financial uncertainty had been removed, their attention could be focused on what matters most: recovery. RMC’s “human touch” approach made all the difference!

Categories
Captive Insurance

Why Form a Captive Insurance Company?

RMC Group is a leader in risk management.  One strategy, which we offer, is the management of captive insurance companies. We have helped many businesses form a captive insurance company and have helped them achieve significant benefits.  A captive insurance company is an excellent risk management tool.  In addition, it can be a profitable business and can offer significant benefits to the owner(s) and insured(s). Below are some of the benefits a business might realize by including a captive insurance company in its risk management strategy.

Coverage Control – A captive insurance company enables a business to better manage insurance risk.  By forming a captive, the business establishes underwriting guidelines, determines premiums, writes the insurance contracts and controls the settlement of claims.  In addition, the business is able to tailor coverage to the insurance risks that are specific to the business.  The business is not limited to coverages that a commercial insurer is willing to offer.

Uninsurable Risks – A captive insurance company can provide coverage for insurance risks that are unavailable or prohibitively expensive in the commercial market.

Cost Reduction – A captive insurance company can reduce insurance expenses by eliminating such commercial insurance company costs as commissions, overhead expenses and profits.

Underwriting Profits – A captive insurance company can be a source of profit.  Premiums paid to the captive in excess of the claims paid by the captive are retained by the captive as net profit, instead of going to an unrelated commercial insurance company.

Rate Control – A captive insurance company provides greater control over a business’s insurance costs.  Premiums paid to a captive are based on the claims experience of the associated business.  In contrast, premiums paid to a commercial insurance company are based on the aggregated claims experience of unrelated businesses, some of which may have poor claims experience.  In other words, when a business pays insurance premiums to a commercial insurance company, it is often subsidizing the insurance costs of unrelated businesses.

Reinsurance Access – A captive insurance company can provide access to the reinsurance market, which may result in better coverage at a lower cost, when compared to the commercial insurance market.

Investment Income – By forming a captive insurance company, a business can control the investment of unearned premiums and reserves, instead of paying these amounts to an unrelated commercial insurance company.

Claims Control – By forming a captive insurance company, a business gains control over the claims adjudication and payment process, which can result in a more efficient and expeditious process.

For more information on how to get a captive started or other risk management strategies, contact RMC Group at 239.298.8210 or [email protected].

Categories
Business Insurance Captive Insurance

8 Reasons Why You Should Form a Captive

Many business owners have formed a captive insurance company and realized significant benefits.  However, the decision whether to form a captive is often clouded by misconceptions and a failure to recognize the advantages of owning your own insurance company. A captive insurance company is an excellent risk management tool.  In addition, it can be a profitable business and can offer significant benefits to the owner(s) and insured(s). Here are 8 reasons to form a captive insurance company:

1. Coverage Control: A captive insurance company enables a business owner to better manage insurance risk.  By establishing a captive, a business owner is able to tailor coverage to the insurance risks that are specific to the business.  In addition, the business is not limited to coverages that a commercial insurer is willing to offer.

2. Uninsurable Risks: A captive insurance company can provide coverage for insurance risks that are unavailable or prohibitively expensive in the commercial market.

3. Cost Reduction: A captive insurance company can reduce insurance expenses by eliminating commercial insurance company costs, such as commissions, overhead expenses, and profits.

4. Underwriting Profits: A captive insurance company can be a source of profit.  Premiums paid to the captive in excess of the claims paid by the captive are retained by the captive as net profit.

5. Rate Control: A captive insurance company provides greater control over a business’s insurance costs.  Premiums paid to a captive are based on the claims experience of the associated business.

6. Reinsurance Access: A captive insurance company can provide access to the reinsurance market, which may result in better coverage at a lower cost, when compared to the commercial insurance market.

7. Investment Income: By forming a captive insurance company, a business owner can control the investment of unearned premiums and reserves, instead of paying these amounts to an unrelated commercial insurance company.

8. Claims Control: By forming a captive insurance company, a business owner gains control over the claims adjudication and payment process, which can result in a more efficient and expeditious process.

If you think that a captive might be right for your clients, contact us today!

Categories
Business Insurance Personal Insurance

Water Loss? Be Careful Who You Call, Don’t Give Up Your Rights!

A hot insurance topic in the news today is costing people a lot of grief and money. If not handled properly, you could give up your rights during a property loss and be dragged into a lawsuit with your contractor for repairs you thought were covered under your policy.

It’s a known fact that water losses are the most frequent and costly types of claims for property insurance companies in Florida. For every premium dollar collected, about 1/3 is paid out in water claims.

If you have the unfortunate experience of discovering water damage, your most immediate concern is usually to prevent further damage, and ultimately the spread of mold. With moisture and humidity in the air, mold is a big concern that should be addressed immediately. Your first step is to call a plumber or disaster cleanup company and begin the remediation cleanup process.

When the cleanup crew arrives, you might be asked to sign a contract to begin work that also promises to streamline the process of working with your insurance carrier. What you might not realize is that the contract that you sign could contain a provision called an Assignment of Benefits or AOB, which essentially assigns your right to recover from your insurance company to the contractor you just hired.

AOB’s were originally created to protect the general public, but the technique is being used by dishonest people to take advantage of both customers and insurance companies.

Here’s what happens. After you sign your rights away, the contractor performs work and then approaches your insurance company for payment directly. The AOB gives your contractor the right to recover from your insurance company and cuts you out of the equation entirely.

Many times, the project costs are inflated making it difficult for insurance carriers to contest the claim entirely, and a settlement is reached quickly before things get out of hand. The contractor may even invoice the insurance company for additional work performed that isn’t recoverable under your policy, and could turn to you for the balance owed. If you decide not to pay, you might find yourself in court.

In the 9 years between 2005 and 2014, AOB claims increased 1,000%. In 2014 alone there were 92,521 AOB claims, up from 9,424 in 2005. Congress has two bills on the table right now that are designed to deal with this issue. For the time being, it’s important to be informed and know how to deal with these claims ahead of time to protect yourself.

The best way to safeguard against these unscrupulous characters is to make contact with your insurance agent as soon as you discover a loss. Even better, contact your agent today and find out who is on your insurance carrier’s list of preferred vendors. Typically, carriers have agreements in place with contractors and remediation companies ahead of time to prevent these issues from occurring. In the end, you will save yourself time and a potential lawsuit, or additional unnecessary out of pocket expenses.

Would you like a personal risk management review? Contact RMC Group at 888.599.5553 and let us help you!