ESIS Impact^SM
Workers Compensation
Liability
Integrated Disability Management

ESIS Impact^SM

ESIS Impact^SM is a balanced approach to claims management. ESIS Impact^SM combines people, process, and technology in an architecture that incorporates a dynamic intake process; designated claim teams; our select, outcome-based provider network; proprietary medical and pharmacy programs; contemporary return to work tools; risk control services; and analytics to pinpoint cost drivers and trigger action throughout the claim process. ESIS Impact^SM is further enhanced by ESIS’ recognized strengths, including the following:

• Proactive client services team – Your client executive is your strategic partner. This colleague ensures the effective execution and tactical delivery of your loss cost reduction initiatives. Your program is further advocated by a core team of representatives from corporate technical support, medical programs, risk control, and RMIS, all committed to driving consistency, quality, and execution.
• Sophisticated technology – Our online services provide access to vital information, helping you make better decisions:
  • Global RiskAdvantage® – customizable tool includes a dashboard, alerts, international capabilities, and report scheduling
  • Imaged files – fully paperless environment allows you to easily view all eligible claim file data online
  • ESIS e-risk MANAGER^SM – assists you in managing your risk and compliance worldwide
• Enhanced data analytics – ESIS’ analysis combines medical and claim information, enabling us to mark trends, track performance, and set new goals. We turn this data into useful information, providing in-depth reporting that identifies future initiatives to improve your overall program results.
• Financial strength, stability and experience – Financial stability since 1953 brings the benefit of scale and experience as well as continuous investment in best-in-class people and technology.
• Flexibility – Our clients retain significant financial stake and interest in their outcomes. As such, we embrace customized solutions that are executable, measurable, and deliver expected results.
• Integration – The power of our ability to drive better outcomes for our clients is in the integration of loss mitigation, claim and medical management, return to work tools, sophisticated technology, and integrated analytics.

ESIS Impact^SM Fact Sheet

Workers Compensation

Business owners, managers, and supervisors know all too well the consequences that come when workers’ compensation costs go awry. At ESIS, we are committed to helping our clients implement best practice procedures to combat this issue. From years of experience, we’ve learned that sharing common goals to reduce workers’ compensation costs provides visible benefits to our clients, and we have developed an innovative approach to help businesses harness escalating workers’ compensation costs.

There are many factors that contribute to rising workers’ compensation costs, including the growing number of U.S. workers over the age of 55, state-mandated benefit levels, the amount and type of medical treatment provided to injured employees, and how long the employee remains out of work. ESIS has established several innovative services programs to help employers achieve the best possible outcomes:

• Reporting and assignment – Intake services are available 24 hours per day, 7 days per week, with claims assigned to appropriate personnel within one business day.
• Supervision – Team supervisors do not handle caseloads themselves, but instead devote their time exclusively to developing the professional skills of the adjusters on their teams and reviewing files handled by their team members.
• Investigation – Basic to proper claim handling and good customer service, our investigation procedures assist in determining the compensability of the claim, how much it may ultimately cost, and how to manage it properly.
• Reserving – We establish and maintain claim reserves that, in aggregate, prove sufficient to discharge our clients’ obligations. Accurate reserving is as much art as science, and our staff’s experience is an indispensable tool in predicting the ultimate cost of claims.
• Recovery and fraud protection – Fraud costs you money; when and if it does occur, we are committed to helping you finding and stopping it. Our trained technicians identify claim patterns consistent with fraud, refer suspected fraudulent claims to our Special Investigation Unit (SIU), identify recovery potential, and coordinate offsets and apportionments whenever applicable.
• Disability management/return to work – The goal of disability management is to return employees to work as soon as possible, and the duration of disability depends on many factors. By establishing close communication with the injured worker, the supervisor, and the provider, our claims representatives are able to develop an appropriate strategy for early return to work and coordinate and confirm full return to work in the most expeditious manner.
• Medical management and medical cost containment – Medical management is crucial to controlling claim costs and claim outcomes. ESIS remains actively involved with the injured worker’s medical providers regarding diagnosis, questions of causal relationship, treatment, rehabilitation, and disability evaluation. Additionally, we use medical cost containment techniques, including provider fee discounting, as a regular part of our claims handling process. It’s a task we’re well-equipped to handle. We’ve been able to save employers more than $187 million annually using our established techniques. The result is not only lower cost care, but better care and faster return to work.
• Vocational and medical rehabilitation – The sooner rehabilitation begins, the more effective it is. We intervene early in the development of the claim, using nurses as medical case managers to coordinate care delivery. Our goal is to deliver care in the most appropriate setting in order to lower costs, improve medical outcomes, and expedite return to work.

Liability

ESIS performs claims management services for a broad spectrum of standard casualty insurance products, including general liability, automobile liability, products liability, professional liability, and medical malpractice. We also accommodate customers with claims management needs of a more specialized nature through one or more of the following:

• Internal center specializing in quick resolution of routine premises-operations claims
• Team of specialists handling automobile liability, general liability, and products liability bodily injury claims
• Special Investigation Unit (SIU) to deal with suspected insurance fraud
• Automobile, truck, and heavy equipment appraisal services facility specializing in physical damage management
• National catastrophe team
• Offices specializing in the handling of construction claims

ESIS utilizes several key services to enhance our casualty program, including the following:

• Factual investigation – The blueprint for any successfully managed claim is a realistic initial investigation plan of action, identifying guidelines for completion within a specified timeframe. At ESIS, we base the plan of action on the proper use of best practices and tailor our investigation to the specific requirements of your particular claim.
• Damage investigation – Once the factual investigation is completed, we carefully examine data on the injuries and property damage resulting from the reported event. In each case, our claims professional concludes the damage investigation once he/she gathers enough information to be able to proceed to evaluation and negotiation or denial.
• Evaluation – Evaluating every facet of the claim and establishing a dollar value for settlement is critical to knowing how and when to extend a reasonable first offer to the claimant.

Integrated Disability Management

Seeking lower costs and higher productivity, employers today use a variety of programs and practices to deliver health, disability, and absence benefits across traditional benefits lines. And whether you’re looking to implement or expand an Integrated Disability Management (IDM) program in your organization, ESIS can help you reach your goals.

ESIS sets the standard for workers’ compensation claim management, as we have for close to 50 years. For IDM and other health and productivity management programs, we team with the nation’s leading case management services provider to produce consistently positive outcomes for your business’ sick and injured employees.

Working with ESIS, our clients are able to design IDM solutions that feature any and all of today’s leading practices, including the three that form the cornerstone of most successful programs:

• A common return to work program for occupational and off-the-job injuries
• Integrated case management to treat injuries the same regardless of cause
• A common intake system for all disabilities and absence

Claims Associate Training Program
Litigation Management - Electronic Billing