Self insured company questions

[inpain247]

Hello, my claim was made in the state of . Have been on comp for several years with several herniated disc from a work injury. also i am collecting SSDI

My insurance company sent me a letter last year asking if i would like to settle so i finally agreed with my lawyer to go forward with it. well its now going on a year since this settlement process has begun and i found out through my lawyer that its my work place " City Government " that has not made a decision on this yet after several meetings and he also said they don’t have to settle if they don’t want to and if they do, they pay 100% of the settlement ? why do they pay the settlement?

So my question is : If my former place of work is a self insured work place , then why do I get checks through the insurance company and treatment through them also and get a hard time with meds and treatment with them and not the work place ? Also they (IC) are the ones that asked if I would like to settle, why not my work place ? I just don’t understand how this all works.

Thanks for any insight on this.

[capricorn]

My employer was also self insured....the employer pays a certain amount of money per year to cover their WC costs.....the IC is their spokesperson....In case of a bad injury there may not be enough money in the employers fund or they run out and most of the time their is a lower settlement than from an employer who is not self insured...It's the IC job and their attorney to make this right for the employer....I hope this helped somewhat.

[1171]

A self-insured entity is responsible for all work comp payments. they usually contract out for adjusters but generally the payments come directly out of employer funded accounts.
they do it because that's the agreement they have with the state's work comp board. they do not have an insurance policy or an insurance carrier. they have to post a bond and have a separate set of insurance regulations.
just because it's their bank accounts doesn't mean they have to make the day to day administrative and adjustment decisions. they can hire somebody who keeps up with all the regulations just like hiring an atty or any other service.

[inpain247]

1171 Wrote:A self-insured entity is responsible for all work comp payments. they usually contract out for adjusters but generally the payments come directly out of employer funded accounts.
they do it because that's the agreement they have with the state's work comp board. they do not have an insurance policy or an insurance carrier. they have to post a bond and have a separate set of insurance regulations.
just because it's their bank accounts doesn't mean they have to make the day to day administrative and adjustment decisions. they can hire somebody who keeps up with all the regulations just like hiring an atty or any other service.

Ok, I understand to a degree but there are some things I don’t understand. You say they don’t have an insurance policy but yet I deal with an insurance company on everything I do or need to have done. Even at my herrings I deal with the lawyers from the Insurance company and I also have a prescription card from the IC. My checks come right from the IC with the IC's name on them . The IC even has sent PI's after me for quite some time now, So your saying that my place of work pays for everything?

Sorry, I just don’t comprehend all of this yet, I’m trying to understand so be patient with me.

[1171]

how do you know you are dealing with a carrier and not a self-insurance administrator?
similiar sounding names don't mean anything; it's how it's legally identified on the insurance certificate.
It is illegal to have a policy and be self-insured simultaneously for the same entity and same injuries.
If they have both, file a complaint with your state insurance department.

many carriers have a separate entity that handles contract administration.
verify your assumptions. your dept of insurance should have a listing of all authorized self-insurance administrators on file.
having a similar name is not the same as being the same legal entity.
If your employer is self-insured then they pay all costs- $ for $ plus a fee to the contracted adjustment company.

your employer also has to have a self-insurance certificate on file with your state insurance commissioner, naming who they have contracted with for claims administration.

either they are self-insured or they are not; they can't be both.

you have not put your state in your profile so I cannot help you with your state's self-insurance regulations.

[inpain247]

1171 Wrote:how do you know you are dealing with a carrier and not a self-insurance administrator?
similiar sounding names don't mean anything; it's how it's legally identified on the insurance certificate.
It is illegal to have a policy and be self-insured simultaneously for the same entity and same injuries.
If they have both, file a complaint with your state insurance department.

many carriers have a separate entity that handles contract administration.
verify your assumptions. your dept of insurance should have a listing of all authorized self-insurance administrators on file.
having a similar name is not the same as being the same legal entity.
If your employer is self-insured then they pay all costs- $ for $ plus a fee to the contracted adjustment company.

your employer also has to have a self-insurance certificate on file with your state insurance commissioner, naming who they have contracted with for claims administration.

either they are self-insured or they are not; they can't be both.

you have not put your state in your profile so I cannot help you with your state's self-insurance regulations.

State is New York

[1171]

For New york state you can verify status of self-insured here
http://www.wcb.state.ny.us/content/main/...loyers.jsp

a political entity that self-insures is required to report their licensed Third Party Administrator (TPA)

if your city governement employer is self-insured they should be listed here
http://www.wcb.state.ny.us/content/main/...deNums.pdf

you can search insurance carriers licensed to sell in NY state here
http://awebproxyprd.ins.state.ny.us/onep...no.jsp?c=m