Claim Services

Dedicated Claim Experts

MEMIC’s ultimate goal is to keep workers safe, but when an injury does occur, it is our mission to help get the employee back to work and back to life as it was before the accident. As workers’ compensation specialists, we know the potential impacts an injury can have on employers, injured workers and their families. Our claim team works hard to help get the best possible outcomes for all those involved.

Our dedicated claim handling approach means employers work with the same claim specialist for all their claims. And with caseloads of 115 per claim specialist, far below the industry average, we spend more time on all aspects of the claim and provide the injured workers with personal service throughout
their claim.

Specialized experts at your service

• Claim Specialists with jurisdictional expertise
• Certified Nurse Case Managers
• Special Investigators
• Legal Advocates

Service you expect…and more

• Initial contact with the employer and employee within 24 hours and with the medical provider within 48 hours for lost time claims.
• Easy injury reporting including MEMIC handling of state filings.
• On time claim payments—we strive to issue all payments within the state prescribed period.
• Claim reviews—a detailed analysis of each open claim, including information related to the medical, disability, legal and financial aspects, as well as an action plan for claim resolution.
• Reviews can also be conducted by telephone or video conference.
• Claim reserves—we adequately set claim reserves to protect the financial stability of our policyholders. By rule, we discuss reserve adjustments of more than $25,000 with the policyholder as well as notify the agent/broker. Policyholders also have the flexibility of setting their own reserve notification threshold.

Medical Assistance with a Focus on Return-to-Work

When a serious injury occurs, MEMIC is dedicated to helping injured workers get the medical care needed for a successful recovery while managing costs.

Certified nurse case managers

Experienced nursing professionals are assigned to all cases involving complex medical issues or prolonged lost time from work (typically 14 or more days) as well as at the onset of all catastrophic claims. And because MEMIC realizes the impact injuries can have beyond the injured worker, our nurse case managers assist the family members through the claim recovery process.

Prescription drug program

Injured workers avoid out-of-pocket costs for medication by using the convenient MEMIC prescription drug card, and we save on the billed cost by garnering below average wholesale prices. We also monitor for potential prescription drug abuse so we can intervene in a timely manner.

Medical bill and utilization review

All medical bills are analyzed with a focus on fee schedules, usual and customary pricing, and preferred provider agreements. We review the medical appropriateness of treatments using national standards and protocols recognized by providers to ensure quality guidelines are met.

Managed care and preferred providers

We have established state-approved managed care programs and preferred provider organization networks in all jurisdictions.