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Consultants find that WSI is handling claims fairly

BISMARCK -- Workforce Safety and Insurance "is not a bad organization," and there is no indication the agency is unfairly denying injured workers' claims, consultants who studied the agency's claims handling found.

"Not at all," said Anthony Walker, senior vice president of Marsh USA Inc. "I did not see this and my staff did not see this."

WSI is the state's workers' compensation agency. Marsh USA, of New York, was hired in January at the behest of Gov. John Hoeven to examine accusations among critics, including some WSI employees, that WSI was inappropriately denying claims. The Marsh representatives gave their report to the WSI board and a legislative committee Wednesday.

"Overall, WSI is performing well," Walker said.

Nonetheless, Walker said, on claims handling, "I would give it a 'C' " because he said some claims that were denied and claims that were approved lacked documentation, so it was difficult for Marsh's staff to fully determine if some of them were decided the wrong way.

"If the documentation isn't there, we can't tell if it was inappropriately denied," Walker said.

He said they saw some claims that could have been decided either way and were denied when WSI focused narrowly on an interpretation of state law. He thinks they should have been accepted.

Walker said there should be more action plans written and followed on injured workers' cases "to bring about an appropriate resolution."

He said Marsh's people also found that some inexperienced claims handlers were not supervised as much as they should be. More consideration should be given to assigning cases to adjusters based on their experience. That would give the newer adjusters more time to get acquainted with the laws while working with simpler cases involving simple medical claims, Walker said.

Marsh representatives examined nearly 500 random claim files.

The study found a dedicated staff that shows commitment to their work, Marsh's representatives said. Marsh praised a team approach being taken to some of the injured workers' cases and said that be extended to other claims cases.

The Marsh representatives also found WSI's fraud unit concentrates too much time and effort on pursuing possible fraud by the injured workers. Workers' compensation fraud perpetrated by medical providers and employers "can be much more expensive" than fraud by workers, Walker said. "There are some missed opportunities there."

Marsh gave WSI low marks for not pursuing third parties who should be socked with the costs of some claims, a process known as subrogation.

For instance, Marsh would find a case in which a worker was hurt by a piece of farm machinery, or in which a ladder broke. WSI did not investigate whether the farm equipment may have been at fault or the ladder defective.

Rep. Rick Berg, R-Fargo, chairman of the Legislature's interim Industry, Business and Labor Committee, which heard the report Wednesday, told Walker, "The subrogation was a shocking thing to me."

But Rep. Bob Skarphol, R-Tioga, said that several years ago, it was decided that pursuing subrogation was too expensive for the amount of money it was recovering.

WSI will provide Marsh with an action plan on how it will address the weaknesses, Walker said.

Legislators and the WSI board will hear another consultants report, on the agency's human resources issues, today.

Janell Cole works for Forum Communications Co., which owns The Dickinson Press.