We offer 24-hour on-line access to claims information and a staff of over 50 qualified individuals to help you manage and understand claims processes and data.
Risico Claims Management, Inc. has developed effective claims management processes to ensure that any and all claim exposures are promptly identified.
- Insurance Coverage
- Compensability AOE/COE issues
- Third Party Subrogation Recovery
- Litigation Potential
- Return-to-Work opportunities
- Medical Control
- Claims Reserving
- Development of Apportionment
Our highly trained, experienced staff have backgrounds in almost every type of Workers’ Compensation environment, which include:
- Large Corporations
- Small Businesses
- Employers with Multiple Locations
- Self-insured Public Entities
- Self-insured Private Employers
Risico can customize its services to suit the claims reporting and handling requirements of any specific client. Our courteous, professional staff is available to help you manage the cost of your Workers’ Compensation claims by providing transitional or modified return-to-work solutions to assist in keeping lost time to a minimum.
Risico strives for excellence in its adherence to well-defined standards of effective claims handling, in tenacious pursuit of two objectives: (1) Responsible and timely administration of benefits in compliance with the law, and (2) Excellence in claims handling, including intelligent claims investigation that identifies questionable claims, and prudent cost containment practices that allow greater medical control and reduction in claims cost.
Risico also utilizes a panel of experienced outside vendors to provide ancillary services that also can contribute to superior claims result. This panel includes:
- Workers’ Compensation Defense Attorneys
- Investigators – AOE/COE, surveillance
- Lien Representatives
Risico also manages medical costs by the use of a Medical Provider Network, furnishing employees with access to appropriate, quality medical providers; while additionally helping to contain medical costs by keeping all medical treatment within the network.
- Physicians in every medical specialty
- Hospitals and Clinics
- Pharmacy Benefit Program
- Surgical Facilities
- Durable Medical Equipment providers
- Medical Transportation Vendors
As an extension of these services, Risico Claims Management and Risico Total Managed Care offer early intervention services and Nurse Case Managers to provide telephonic, field on-site case management, utilization review, a Return-to-Work Coordinator and Medical Bill Review services to guarantee compliance with California’s Official Medical Fee Schedule.