Business and Employee Partner
We draw upon the best resources to control claims from the onset, emphasizing a healthy return to work.
Whether your Workers' Compensation coverage is insured or self-insured, Matrix administers and manages claims to facilitate an employee' s recovery and timely return to work. Workers' Compensation can be managed on a stand-alone basis or integrated with the management of disability claims.
We review every claim for validity and compensability
We work in partnership with you to make the appropriate compensability decision for acceptance or denial of each claim. This decision needs to be in accordance with the workers compensation laws of each jurisdiction and Matrix employees will act in good faith on behalf of the company and its client partners. . Time frames for acceptance or denial are governed by state law - and are closely tracked through system diaries and on-line reports. Matrix will notify the injured worker of the decision to delay the claim in accordance with client and insurer claim handling instructions and in compliance with state law.
We will fully investigate questionable claims, using a variety of public and private resources for obtaining background checks, medical history, prior claim records, etc. We will keep you apprised and involve you in our investigations – and will request your assistance in providing personnel records that are relevant to our investigation before making a decision on compensability
We keep recovery on track
Your claims team reviews each case at its initiation and regularly thereafter to ensure that your injured employee is progressing as expected. At each review, using screening criteria developed in cooperation with you, we consider whether case management would improve the employee' s recovery or facilitate return to work. (For information on case management services, please refer to Nurse Case Management.)
We participate in the development of individual rehabilitation programs. We also engage outside service providers—rehabilitation counselors, investigators and independent medical consultants—to facilitate recovery, identify fraud and minimize the potential for litigation.
We manage litigationWhen litigation does arise, we manage it proactively to minimize costs to you and facilitate better outcomes. We consult with and assist your legal counsel in file assessment, report preparation and trial preparation.
We monitor financial liability and manage expenses
The estimation of financial liabilities is critical to the successful management of Workers' Compensation claims. We establish and monitor reserves for the estimated cost of claims with great care, requiring management sign-offs at specified monetary levels and key junctures in the life of each claim.
We also disburse payments for outside service providers, subject to your approval, negotiating rates and monitoring charges for reasonableness.