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Self-Insured Claim Administration

Stop Claims Corp. is a licensed third-party firm based in Washington State.  We take a proactive approach to the claims management process.  Stop Claims is committed to fighting for the care your workers need, while simultaneously controlling unnecessary claim costs- it’s possible to achieve both!  In addition to claim cost containment, we have proven success in increasing employee engagement in the return-to-work process and improving workplace safety culture.

Our TPA’s specialize in administrating claims for organizations of all sizes and industry types.  We take on the most complex agricultural issues, public entities, collective bargaining agreements, union relationships, and more!  We understand that every organization is unique and has its respective needs.  Stop Claims’ vision is to be an extension of your organization- rather than to provide a one-size-fits-all workers comp solution.  We will tailor our services to work alongside your team; offering comprehensive packages as well as a la carte services to provide as much, or as little support as needed.  We handle the entire claim management process from start to finish for many of our clients.  Stop Claims can customize solutions to complement your in-house workers comp and risk management team; specialty solutions include legal representation, private investigative services, vocational rehabilitation services, safety consultations, and more.

We also specialize in transitioning growing organizations from L&I’s state fund to self-insured programs.  If your organization is growing, we are here to make the transition as painless as possible!  We implement world class workers comp programs the right way, the first time.  This includes ongoing claim administration, the design and implementation of early return to work programs, as well as safety and health management programs.

 

Self-Insured Claim Administration Services:

Claim Resolution

  • Claim Allowance Orders (SIF-2 Completion)
  • Interlocutory Requests
  • Claim Denial Requests/Orders
  • No Medical Report Denials
  • Injury Claim Adjudication
  • Occupational Disease Claim Adjudication
  • Hearing Loss Claim Adjudication
  • Infectious Disease Claim Adjudication
  • Mental Health Claim Adjudication
  • Cardiovascular Injury Claim Adjudication
  • Presumption of Coverage for First Responders
  • Presumption of Coverage for Health Emergency Labor Standards (HELSA)
  • Allowance/Denial of Newly Contended Medical Conditions
  • Segregation of Unrelated Medical Conditions

 

Medical Case Management

  • Authorization/Denial of Medical Treatment
  • Authorization/Denial of Dental Treatment
  • Nurse Case Management
  • Liaising: Attending Physician, Concurrent Providers
  • Management of Chiropractic & Palliative Care
  • SIMP Authorization/Denial
  • Independent Medical Examination (IME) Coordination
  • Enforcement of Medical Reporting Requirements
  • Medical Record Sweeps
  • Obesity Treatment Program Management
  • Coordination with Out of State Providers
  • Payment of Medical Bills
  • Functional Capacity Evaluation (FCE) Coordination
  • Mental Health Treatment Management
  • Surgery Coordination

 

Claim Resolution

  • Claim Closure Requests/Orders
  • Permanent Partial Disability Award Administration
  • Pension Award Administration
  • Claim Consolidation
  • Non-Cooperation & Suspension Orders
  • Release of Claim File Information
  • Claim Reopening Adjudication

Claim Resolution

  • Claim Closure Requests/Orders
  • Permanent Partial Disability Award Administration
  • Pension Award Administration
  • Claim Consolidation
  • Non-Cooperation & Suspension Orders
  • Release of Claim File Information
  • Claim Reopening Adjudication

 

Dispute Resolution

  • Department of Labor & Industries: Protests
  • Board of Industrial Insurance Appeals: Mediation, Appeal, and Petition for Review (PFR) Hearing Representation
  • Superior Court: Appeal Representation
  • Supreme Court: Appeal Representation
  • Recovery of Overpayments

 

Vocational Rehabilitation Counseling

  • Vocational Rehabilitation Eligibility Determination
  • Comprehensive Early Return to Work Programs
  • Certified Job Analysis
  • Ability to Work Assessments
  • Preferred Worker Program
  • Comprehensive Vocational Rehabilitation
  • Plan Development & Plan Implementation
  • Accountability Agreements
  • Closing Reports
  • Vocational Dispute Settlement
  • Job Modifications & Reimbursement
  • Self-Insurance Vocational Reporting Form (SIVRF)

 

Indemnity

  • Wage Calculations (SIF-5 Completion)
  • LEP Calculations
  • Administration of Indemnity Payments: Time-Loss, Loss of Earning Power, Etc.
  • Administration of Indemnity Settlements: Permanent Partial Disability, Pensions, Hearing Loss, Etc.
  • Kept on Salary Policy Development & Administration
  • Buy-Back Policy Development & Administration
  • Payment to Minor Workers
  • Cost of Living Adjustment Determinations & Payment Administration
  • Maximum & Minimum Time-Loss Compensation Rate Determinations
  • L&I Reporting: Statement of Benefits, Underpayments, Overpayments
  • Complex Indemnity Dispute Resolutions