August 25, 2009

Can You Trust Your TPA to Handle Negligence Claims??

Third party administrators are paid to handle routine medical and weekly benefit claims, but is that really enough? 

When selecting or recommending a TPA for Texas locations, you need more than just a benefits administrator. You need a company that knows the unique Texas legal landscape and can fight for you if you have a litigated claim. We are not bragging when we say Anchor Claims Management is without rival in this regard. It's a fact.

Experience and Attitude

We know from decades of experience with Texas nonsubscribing employers when it's time to contest a claim and when it's better not to. When we recommend legal action, we help our clients pursue it aggressively, and to good result.

In the past 18 months, Anchor Claims Management has helped employers prevail in seven difficult arbitration and trial cases with employees.

The central theme in all of these cases is this: solid claims administration and well-documented information is a given with Anchor. But without our knowledge of the Texas legal environment and our aggressive claims handling approach, the outcomes of theses cases could have been entirely different.

Entering Building. An employee working at a nursing home claimed she injured her knee while entering the building. She alleged negligence, saying the door mat was improperly placed, which caused her to trip and fall. The case went to arbitration, where the arbitrator ruled in favor of the employer.

Ladder. An employee removed a ladder from a truck when he injured his shoulder. He alleged negligence based on the employer not having adequate procedures in place regarding removing items from the company truck. The arbitrator ruled for the employer.

Wet Floor. An employee slipped and fell on a wet floor, injuring a shoulder, which required surgery. The employee claimed negligence, saying the insured failed to warn of a hazard. This case went to jury trial in Harris County, Texas, where defense counsel showed proper notices had been posted. The jury found no negligence and ruled for the insured.

Cut Injury. A Jasper, Texas, employee sued his employer for negligence after he cut his thumb while preparing food. The employee alleged negligence based on failure to warn and properly train employees. In this two-day trial the jury returned in favor of the employer, finding no negligence.

Platform Injury. In this case, an employee who was working as a carpenter for a mobile home manufacturer injured her knee when she stepped off a platform. She sued the employer, alleging negligence due to improper training, failure to warn of a hazard and failure to provide proper equipment. The court remanded the case to arbitration, where the arbitrator ruled in favor of the employer.

For more information contact Byron McBride at bmcbride@combindedgroup.com or call Byron at 469-892-9841.

http://www.anchor-claims.com/